van Rooij S J H, Kennis M, Sjouwerman R, van den Heuvel M P, Kahn R S, Geuze E
Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht,The Netherlands.
Psychol Med. 2015 Oct;45(13):2737-46. doi: 10.1017/S0033291715000707. Epub 2015 May 4.
Smaller hippocampal volume has often been observed in patients with post-traumatic stress disorder (PTSD). However, there is no consensus whether this is a result of stress/trauma exposure, or constitutes a vulnerability factor for the development of PTSD. Second, it is unclear whether hippocampal volume normalizes with successful treatment of PTSD, or whether a smaller hippocampus is a risk factor for the persistence of PTSD.
Magnetic resonance imaging (MRI) scans and clinical interviews were collected from 47 war veterans with PTSD, 25 healthy war veterans (combat controls) and 25 healthy non-military controls. All veterans were scanned a second time with a 6- to 8-month interval, during which PTSD patients received trauma-focused therapy. Based on post-treatment PTSD symptoms, patients were divided into a PTSD group who was in remission (n = 22) and a group in whom PTSD symptoms persisted (n = 22). MRI data were analysed with Freesurfer.
Smaller left hippocampal volume was observed in PTSD patients compared with both control groups. Hippocampal volume of the combat controls did not differ from healthy controls. Second, pre- and post-treatment analyses of the PTSD patients and combat controls revealed reduced (left) hippocampal volume only in the persistent patients at both time points. Importantly, hippocampal volume did not change with treatment.
Our findings suggest that a smaller (left) hippocampus is not the result of stress/trauma exposure. Furthermore, hippocampal volume does not increase with successful treatment. Instead, we demonstrate for the first time that a smaller (left) hippocampus constitutes a risk factor for the persistence of PTSD.
创伤后应激障碍（PTSD）患者常出现较小的海马体体积。然而，对于这是应激/创伤暴露的结果，还是构成PTSD发生的易感性因素，尚无定论。其次，尚不清楚PTSD成功治疗后海马体体积是否会恢复正常，或者较小的海马体是否是PTSD持续存在的危险因素。
收集了47名患有PTSD的退伍军人、25名健康退伍军人（战斗对照组）和25名健康非军人对照组的磁共振成像（MRI）扫描和临床访谈资料。所有退伍军人在间隔6至8个月时进行了第二次扫描，在此期间，PTSD患者接受了以创伤为重点的治疗。根据治疗后的PTSD症状，将患者分为缓解的PTSD组（n = 22）和PTSD症状持续存在的组（n = 22）。使用Freesurfer分析MRI数据。
与两个对照组相比，PTSD患者的左侧海马体体积较小。战斗对照组的海马体体积与健康对照组无差异。其次，对PTSD患者和战斗对照组的治疗前和治疗后分析显示，仅在两个时间点的持续存在患者中（左侧）海马体体积减小。重要的是，海马体体积并未随治疗而改变。
我们的研究结果表明，较小的（左侧）海马体不是应激/创伤暴露的结果。此外，成功治疗后海马体体积不会增加。相反，我们首次证明较小的（左侧）海马体是PTSD持续存在的危险因素。
