Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden.
Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden; Department of Psychology, University of Tromsø, Tromsø, Norway.
Biol Psychiatry. 2015 Apr 1;77(7):624-32. doi: 10.1016/j.biopsych.2014.09.005. Epub 2014 Sep 22.
Anorexia nervosa (AN) is a serious eating disorder characterized by self-starvation, extreme weight loss, and alterations in brain structure. Structural magnetic resonance imaging studies have documented brain volume reductions in acute AN, but it is unclear whether they are 1) regionally specific, or 2) reversible following weight restoration. Here, we measured cortical thickness (CT) for the first time in AN.
Structural magnetic resonance imaging data were acquired from adolescent and young adult female patients with acute AN (n = 40), recovered patients following long-term weight restoration (n = 34), and an equal number of age-matched healthy control subjects. Group differences in CT were tested with well-validated procedures implemented in FreeSurfer. The mediating role of clinical variables including body mass index and drive for thinness were explored. For completeness, we also used FreeSurfer's subcortical segmentation stream to test group differences in volumes of select gray matter regions of interest.
Vertex-wise analyses revealed significant thinning of over 85% of the cortical surface in patients with acute AN and CT normalization in recovered patients following long-term weight restoration, although normal age-related trajectories were absent in the disorder. This pattern of results was largely mirrored in subcortical volumes. We also observed a strong negative correlation between CT and drive for thinness in extrastriate regions involved in body perception.
Structural brain anomalies in AN as expressed in CT and subcortical volume are primarily the consequence of malnutrition and unlikely to reflect premorbid trait markers or permanent scars, but longitudinal data are needed.
神经性厌食症（AN）是一种严重的饮食失调症，其特征为自我饥饿、极度消瘦以及大脑结构的改变。结构磁共振成像研究已经记录了急性 AN 中的脑容量减少，但尚不清楚这些减少是 1）具有区域性特异性，还是 2）在体重恢复后可逆转。在这里，我们首次在 AN 中测量了皮质厚度（CT）。
从患有急性 AN 的青少年和年轻成年女性患者（n=40）、长期体重恢复后的康复患者（n=34）和数量相等的年龄匹配的健康对照者中获取结构磁共振成像数据。使用 FreeSurfer 中实施的经过充分验证的程序测试 CT 组间差异。探索了包括体重指数和减肥欲望在内的临床变量的中介作用。为了完整性，我们还使用了 FreeSurfer 的皮质下分割流来测试选定的灰质感兴趣区域的体积组间差异。
体素分析显示，急性 AN 患者的皮质表面有超过 85%的区域变薄，长期体重恢复后的康复患者的 CT 恢复正常，尽管该障碍缺乏正常的与年龄相关的轨迹。这一结果模式在皮质下体积中也得到了很大程度的反映。我们还观察到，在涉及身体感知的视额外区域中，CT 与减肥欲望之间存在强烈的负相关。
AN 中的结构脑异常表现在 CT 和皮质下体积上，主要是营养不良的结果，不太可能反映出先天的特征标记或永久性疤痕，但需要纵向数据。
