Department of Experimental, Diagnostic, and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Department of Psychology, University of Bologna, Bologna, Italy.
Neurogastroenterol Motil. 2017 Oct;29(10):1-10. doi: 10.1111/nmo.13108. Epub 2017 May 30.
In Crohn's disease (CD) patients, stress is believed to influence symptoms generation. Stress may act via central nervous system pathways to affect visceral sensitivity and motility thus exacerbating gastrointestinal symptoms. The neural substrate underpinning these mechanisms needs to be investigated in CD. We conducted an explorative functional magnetic resonance imaging (fMRI) study in order to investigate potential differences in the brain stress response in CD patients compared to controls.
17 CD patients and 17 healthy controls underwent a fMRI scan while performing a stressful task consisting in a Stroop color-word interference task designed to induce mental stress in the fMRI environment.
Compared to controls, in CD patients the stress task elicited greater blood oxygen level dependent (BOLD) signals in the midcingulate cortex (MCC).
CONCLUSIONS & INFERENCES: The MCC integrate "high" emotional processes with afferent sensory information ascending from the gut. In light of these integrative functions, the stress-evoked MCC hyperactivity in CD patients might represent a plausible neural substrate for the association between stress and symptomatic disease. The MCC dysfunction might be involved in mechanisms of central disinhibition of nociceptive inputs leading to amplify the visceral sensitivity. Finally, the stress-evoked MCC hyperactivity might affect the regulation of intestinal motility resulting in exacerbation of disease symptoms and the autonomic and neuroendocrine regulation of inflammation resulting in enhanced inflammatory activity.
在克罗恩病（CD）患者中，压力被认为会影响症状的产生。压力可能通过中枢神经系统途径影响内脏敏感性和运动性，从而加重胃肠道症状。需要在 CD 中研究支持这些机制的神经基础。我们进行了一项探索性的功能磁共振成像（fMRI）研究，以调查 CD 患者与对照组相比大脑对应激的反应是否存在差异。
17 名 CD 患者和 17 名健康对照者在 fMRI 环境中进行一项 fMRI 扫描，同时执行一项由 Stroop 颜色-词干扰任务组成的应激任务，旨在诱发心理应激。
与对照组相比，CD 患者在中扣带皮层（MCC）中，应激任务引起更大的血氧水平依赖（BOLD）信号。
MCC 将“高”情绪过程与来自肠道的传入感觉信息整合在一起。鉴于这些整合功能，CD 患者应激引起的 MCC 过度活跃可能代表应激与症状性疾病之间关联的一个合理的神经基础。MCC 功能障碍可能涉及内脏敏感性放大的伤害性传入抑制的中枢机制。最后，MCC 的应激诱导过度活跃可能会影响肠道运动的调节，导致疾病症状恶化，并影响自主神经和神经内分泌对炎症的调节，导致炎症活动增强。
