Seitz J, Herpertz-Dahlmann B, Konrad K
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH University Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
J Neural Transm (Vienna). 2016 Aug;123(8):949-59. doi: 10.1007/s00702-016-1567-9. Epub 2016 May 17.
Gray matter (GM) and white matter (WM) volume loss occur in the brains of patients with acute anorexia nervosa (AN) and improve again upon weight restoration. Adolescence is an important time period for AN to begin. However, little is known about the differences between brain changes in adolescents vs adults. We used a meta-analysis and a qualitative review of all MRI studies regarding acute structural brain volume changes and their recovery in adolescents and adults with AN. 29 studies with 473 acute, 121 short-term weight-recovered and 255 long-term recovered patients with AN were included in the meta-analysis. In acute AN, GM and WM were reduced compared to healthy controls. Acute adolescent patients showed a significantly greater GM reduction than adults (-8.4 vs -3.1 %), the difference in WM (-4.0 vs -2.1 %) did not reach significance. Short-term weight-recovered patients showed a remaining GM deficit of 3.6 % and a non-significant WM reduction of 0.9 % with no age differences. Following 1.5-8 years of remission, GM and WM were no longer significantly reduced in adults (GM -0.4 %, WM -0.7 %); long-term studies for adolescents were scarce. The qualitative review showed that GM volume loss was correlated with cognitive deficits and three studies found GM regions, cerebellar deficits and WM to be predictive of outcome. GM and WM are strongly reduced in acute AN and even more pronounced in adolescence. Long-term recovery appears to be complete for adults while no conclusions can be drawn for adolescents, thus caution remains.
在急性神经性厌食症（AN）患者的大脑中会出现灰质（GM）和白质（WM）体积减少的情况，且体重恢复后会再次改善。青春期是AN开始发病的一个重要时期。然而，对于青少年与成年人脑变化之间的差异却知之甚少。我们对所有关于青少年和成年AN患者急性脑结构体积变化及其恢复情况的MRI研究进行了荟萃分析和定性综述。荟萃分析纳入了29项研究，涉及473例急性、121例短期体重恢复和255例长期体重恢复的AN患者。在急性AN患者中，与健康对照相比，GM和WM减少。急性青少年患者的GM减少幅度显著大于成年人（-8.4%对-3.1%），WM的差异（-4.0%对-2.1%）未达到显著水平。短期体重恢复的患者GM仍有3.6%的 deficit，WM减少0.9%但无统计学意义，且无年龄差异。在缓解1.5 - 8年后，成年人的GM和WM不再显著减少（GM -0.4%，WM -0.7%）；针对青少年的长期研究较少。定性综述表明，GM体积减少与认知缺陷相关，三项研究发现GM区域、小脑缺陷和WM可预测预后。在急性AN中，GM和WM大幅减少，在青少年中更为明显。成年人的长期恢复似乎是完全的，而对于青少年则无法得出结论，因此仍需谨慎。 （注：原文中“a remaining GM deficit of 3.6 %”这里的“deficit”不太明确准确意思，暂按“ deficit”翻译为“ deficit” ）
