儿童和成人强迫症患者不同的皮质下体积改变：一项全球荟萃分析和大型分析
Distinct Subcortical Volume Alterations in Pediatric and Adult OCD: A Worldwide Meta- and Mega-Analysis.
作者信息
Boedhoe Premika S W, Schmaal Lianne, Abe Yoshinari, Ameis Stephanie H, Arnold Paul D, Batistuzzo Marcelo C, Benedetti Francesco, Beucke Jan C, Bollettini Irene, Bose Anushree, Brem Silvia, Calvo Anna, Cheng Yuqi, Cho Kang Ik K, Dallaspezia Sara, Denys Damiaan, Fitzgerald Kate D, Fouche Jean-Paul, Giménez Mònica, Gruner Patricia, Hanna Gregory L, Hibar Derrek P, Hoexter Marcelo Q, Hu Hao, Huyser Chaim, Ikari Keisuke, Jahanshad Neda, Kathmann Norbert, Kaufmann Christian, Koch Kathrin, Kwon Jun Soo, Lazaro Luisa, Liu Yanni, Lochner Christine, Marsh Rachel, Martínez-Zalacaín Ignacio, Mataix-Cols David, Menchón José M, Minuzzi Luciano, Nakamae Takashi, Nakao Tomohiro, Narayanaswamy Janardhanan C, Piras Fabrizio, Piras Federica, Pittenger Christopher, Reddy Y C Janardhan, Sato Joao R, Simpson H Blair, Soreni Noam, Soriano-Mas Carles, Spalletta Gianfranco, Stevens Michael C, Szeszko Philip R, Tolin David F, Venkatasubramanian Ganesan, Walitza Susanne, Wang Zhen, van Wingen Guido A, Xu Jian, Xu Xiufeng, Yun Je-Yeon, Zhao Qing, Thompson Paul M, Stein Dan J, van den Heuvel Odile A
机构信息
From the Department of Psychiatry and the Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam; Neuroscience Campus Amsterdam, Free University/VU University Medical Center, Amsterdam; the Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; the Centre for Addiction and Mental Health and Hospital for Sick Children, Toronto; the Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada; the Department of Psychiatry, Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil; Clinical Research Group Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan; the Department of Psychology, Humboldt-Universität zu Berlin, Berlin; the Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich; Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; the Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China; the Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea; the Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam; the Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, University of Cape Town, Cape Town, South Africa; the Department of Psychiatry, University of Stellenbosch, Cape Town; the Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomèdica en Red de Salud Mental (CIBERSAM), Barcelona; the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.; the Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey; De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam; the Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam; the Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; the Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich; TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München, Munich; the Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea; the Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; the Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa; Columbia University Medical Center, New York; the Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute and Columbia University, New York; the Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska Institutet, Stockholm; the Department of Clinical Sciences, University of Barcelona, Barcelona, Spain; the Mood Disorders Clinic and the Anxiety Treatment and Research Center, St. Joseph's HealthCare, Hamilton, Canada; the Department of Neural Computation for Decision Making, ATR Brain Information Communiciation Research Laboratory Group, Kyoto, Japan; the Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome; the Center of Mathematics, Computation, and Cognition, Universidade Federal Do ABC, Santo Andre, Brazil; the Center for OCD and Related Disorders, New York State Psychiatric Institute, New York; the Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain; the Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.; the Clinical Neuroscience and Development Laboratory, Olin Neuropsychiatry Research Center, Hartford, Conn.; the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the James J. Peters VA Medical Center, Bronx, New York; the Institute of Living/Hartford Hospital, Hartford, Conn.; the Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; the Shanghai Key Laboratory of Psychotic Disorders, Shanghai; and the Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China.
出版信息
Am J Psychiatry. 2017 Jan 1;174(1):60-69. doi: 10.1176/appi.ajp.2016.16020201. Epub 2016 Sep 9.
OBJECTIVE
Structural brain imaging studies in obsessive-compulsive disorder (OCD) have produced inconsistent findings. This may be partially due to limited statistical power from relatively small samples and clinical heterogeneity related to variation in illness profile and developmental stage. To address these limitations, the authors conducted meta- and mega-analyses of data from OCD sites worldwide.
METHOD
T images from 1,830 OCD patients and 1,759 control subjects were analyzed, using coordinated and standardized processing, to identify subcortical brain volumes that differ between OCD patients and healthy subjects. The authors performed a meta-analysis on the mean of the left and right hemisphere measures of each subcortical structure, and they performed a mega-analysis by pooling these volumetric measurements from each site. The authors additionally examined potential modulating effects of clinical characteristics on morphological differences in OCD patients.
RESULTS
The meta-analysis indicated that adult patients had significantly smaller hippocampal volumes (Cohen's d=-0.13; % difference=-2.80) and larger pallidum volumes (d=0.16; % difference=3.16) compared with adult controls. Both effects were stronger in medicated patients compared with controls (d=-0.29, % difference=-4.18, and d=0.29, % difference=4.38, respectively). Unmedicated pediatric patients had significantly larger thalamic volumes (d=0.38, % difference=3.08) compared with pediatric controls. None of these findings were mediated by sample characteristics, such as mean age or scanning field strength. The mega-analysis yielded similar results.
CONCLUSIONS
The results indicate different patterns of subcortical abnormalities in pediatric and adult OCD patients. The pallidum and hippocampus seem to be of importance in adult OCD, whereas the thalamus seems to be key in pediatric OCD. These findings highlight the potential importance of neurodevelopmental alterations in OCD and suggest that further research on neuroplasticity in OCD may be useful.
目的
强迫症（OCD）的脑结构成像研究结果并不一致。这可能部分归因于相对较小样本的统计效力有限，以及与疾病特征和发育阶段差异相关的临床异质性。为解决这些局限性，作者对来自全球强迫症研究点的数据进行了荟萃分析和大样本分析。
方法
对1830例强迫症患者和1759例对照者的T图像进行分析，采用协调一致的标准化处理，以确定强迫症患者与健康受试者之间存在差异的皮层下脑容量。作者对每个皮层下结构左右半球测量值的均值进行了荟萃分析，并通过汇总各研究点的这些体积测量值进行了大样本分析。作者还研究了临床特征对强迫症患者形态学差异的潜在调节作用。
结果
荟萃分析表明，与成年对照组相比，成年强迫症患者的海马体积显著更小（科恩d值=-0.13；差异百分比=-2.80），苍白球体积更大（d=0.16；差异百分比=3.16）。与对照组相比，药物治疗的患者中这两种效应更强（分别为d=-0.29，差异百分比=-4.18，以及d=0.29，差异百分比=4.38）。与儿科对照组相比，未接受药物治疗的儿科患者丘脑体积显著更大（d=0.38，差异百分比=3.08）。这些发现均未受样本特征（如平均年龄或扫描场强）的影响。大样本分析得出了相似的结果。
结论
结果表明儿童和成年强迫症患者皮层下异常模式不同。苍白球和海马在成年强迫症中似乎很重要，而丘脑在儿童强迫症中似乎起关键作用。这些发现凸显了强迫症中神经发育改变的潜在重要性，并表明对强迫症神经可塑性的进一步研究可能会有所帮助。
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