Pennington David Louis, Abé Christoph, Batki Steven Laszlo, Meyerhoff Dieter Johannes
Addiction Research Program, Veterans Affairs Medical Center, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Psychiatry Res. 2014 Dec 30;224(3):281-7. doi: 10.1016/j.pscychresns.2014.09.004. Epub 2014 Sep 16.
Posttraumatic stress disorder (PTSD) patients have low cortical concentrations of γ-aminobutyric acid (GABA) and elevated glutamate (Glu) as measured by proton magnetic resonance spectroscopy ((1)H MRS). Alcohol use disorder (AUD) is highly comorbid with PTSD, but the neurobiological underpinnings are largely unknown. We wanted to determine if PTSD patients with AUD have normalized cortical GABA and Glu levels in addition to metabolite alterations common to AUD. We compared brain metabolite concentrations in 10 PTSD patients with comorbid AUD (PAUD) with concentrtations in 28 PTSD patients without AUD and in 20 trauma-exposed controls (CON) without PTSD symptoms. We measured concentrations of GABA, Glu, N-acetylaspartate (NAA), creatine- (Cr) and choline-containing metabolites (Cho), and myo-Inositol (mI) in three cortical brain regions using (1)H MRS and correlated them with measures of neurocognition, insomnia, PTSD symptoms, and drinking severity. In contrast to PTSD, PAUD exhibited normal GABA and Glu concentrations in the parieto-occipital and temporal cortices, respectively, but lower Glu and trends toward higher GABA levels in the anterior cingulate cortex (ACC). Temporal NAA and Cho as well as mI in the ACC were lower in PAUD than in both PTSD and CON. Within PAUD, more cortical GABA and Glu correlated with better neurocognition. Heavy drinking in PTSD is associated with partially neutralized neurotransmitter imbalance, but also with neuronal injury commonly observed in AUD.
创伤后应激障碍（PTSD）患者的大脑皮质中γ-氨基丁酸（GABA）浓度较低，而通过质子磁共振波谱（¹H MRS）测量发现谷氨酸（Glu）浓度升高。酒精使用障碍（AUD）与PTSD高度共病，但其神经生物学基础在很大程度上尚不清楚。我们想确定患有AUD的PTSD患者除了具有AUD常见的代谢物改变外，其大脑皮质GABA和Glu水平是否恢复正常。我们比较了10名患有共病AUD的PTSD患者（PAUD）、28名无AUD的PTSD患者以及20名无PTSD症状的创伤暴露对照者（CON）的脑代谢物浓度。我们使用¹H MRS测量了三个大脑皮质区域中GABA、Glu、N-乙酰天门冬氨酸（NAA）、肌酸（Cr）和含胆碱代谢物（Cho）以及肌醇（mI）的浓度，并将它们与神经认知、失眠、PTSD症状和饮酒严重程度的测量指标进行关联。与PTSD不同，PAUD在顶枕叶和颞叶皮质中分别表现出正常的GABA和Glu浓度，但在前扣带回皮质（ACC）中Glu浓度较低，GABA水平有升高趋势。PAUD患者ACC中的颞叶NAA、Cho以及mI均低于PTSD患者和CON。在PAUD患者中，更多的大脑皮质GABA和Glu与更好的神经认知相关。PTSD患者中的重度饮酒与部分中和的神经递质失衡有关，但也与AUD中常见的神经元损伤有关。
