Ramage Amy E, Litz Brett T, Resick Patricia A, Woolsey Mary D, Dondanville Katherine A, Young-McCaughan Stacey, Borah Adam M, Borah Elisa V, Peterson Alan L, Fox Peter T
Department of Psychiatry and the Research Imaging Institute, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA,
Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Washington, DC, USA, Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
Soc Cogn Affect Neurosci. 2016 Feb;11(2):234-42. doi: 10.1093/scan/nsv102. Epub 2015 Sep 15.
Post-traumatic stress disorder (PTSD) is presumably the result of life threats and conditioned fear. However, the neurobiology of fear fails to explain the impact of traumas that do not entail threats. Neuronal function, assessed as glucose metabolism with (18)fluoro-deoxyglucose positron emission tomography, was contrasted in active duty, treatment-seeking US Army Soldiers with PTSD endorsing either danger- (n = 19) or non-danger-based (n = 26) traumas, and was compared with soldiers without PTSD (Combat Controls, n = 26) and Civilian Controls (n = 24). Prior meta-analyses of regions associated with fear or trauma script imagery in PTSD were used to compare glucose metabolism across groups. Danger-based traumas were associated with higher metabolism in the right amygdala than the control groups, while non-danger-based traumas associated with heightened precuneus metabolism relative to the danger group. In the danger group, PTSD severity was associated with higher metabolism in precuneus and dorsal anterior cingulate and lower metabolism in left amygdala (R(2 )= 0.61). In the non-danger group, PTSD symptom severity was associated with higher precuneus metabolism and lower right amygdala metabolism (R(2 )= 0.64). These findings suggest a biological basis to consider subtyping PTSD according to the nature of the traumatic context.
创伤后应激障碍（PTSD）可能是生命威胁和条件性恐惧的结果。然而，恐惧的神经生物学无法解释那些不涉及威胁的创伤所产生的影响。通过（18）氟脱氧葡萄糖正电子发射断层扫描评估的神经元功能，在现役、寻求治疗的美国陆军士兵中进行了对比，这些士兵患有PTSD，认可基于危险的创伤（n = 19）或非基于危险的创伤（n = 26），并与无PTSD的士兵（战斗对照组，n = 26）和平民对照组（n = 24）进行了比较。先前对PTSD中与恐惧或创伤脚本意象相关区域的荟萃分析被用于比较各组间的葡萄糖代谢情况。与对照组相比，基于危险的创伤与右侧杏仁核更高的代谢相关，而非基于危险的创伤与相对于危险组楔前叶代谢增强相关。在危险组中，PTSD严重程度与楔前叶和背侧前扣带回更高的代谢以及左侧杏仁核更低的代谢相关（R（2）= 0.61）。在非危险组中，PTSD症状严重程度与楔前叶更高的代谢和右侧杏仁核更低的代谢相关（R（2）= 0.64）。这些发现提示了根据创伤背景的性质对PTSD进行亚型分类的生物学基础。
