From the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine (Zucker, Wagner, Merwin, LaBar), Durham, North Carolina; Department of Psychology and Neuroscience, Duke University (Zucker, Kragel, Keeling, Wang, Kang, LaBar), Durham, North Carolina; Departments of Medicine, Physiology, Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Mayer), Los Angeles, California; and Laureate Institute, University of Tulsa (Simmons), Tulsa, Oklahoma.
Psychosom Med. 2017 Nov/Dec;79(9):1025-1035. doi: 10.1097/PSY.0000000000000510.
The diagnostic criterion disturbance in the experience of the body remains a poorly understood and persistent feature of anorexia nervosa (AN). Increased sophistication in understanding the structure of the insular cortex-a neural structure that receives and integrates visceral sensations with action and meaning-may elucidate the nature of this disturbance. We explored age, weight status, illness severity, and self-reported body dissatisfaction associations with insular cortex volume.
Structural magnetic resonance imaging data were collected from 21 adolescents with a history of AN and 20 age-, sex-, and body mass index-matched controls. Insular cortical volumes (bilateral anterior and posterior regions) were identified using manual tracing.
Volumes of the right posterior insula demonstrated the following: (a) a significant age by clinical status interaction (β = -0.018 [0.008]; t = 2.32, p = .02) and (b) larger volumes were associated with longer duration of illness (r = 0.48, p < .04). In contrast, smaller volumes of the right anterior insula were associated with longer duration of illness (r = -0.50, p < .03). The associations of insular volume with body dissatisfaction were of moderate effect size and also of opposite direction, but a statistical trend in right posterior (r = 0.40, p < .10 in right posterior; r = -0.49, p < .04 in right anterior).
In this exploratory study, findings of atypical structure of the right posterior insular cortex point to the importance of future work investigating the role of visceral afferent signaling in understanding disturbance in body experience in AN.
躯体感觉体验障碍仍然是厌食症（AN）的一个尚未被充分理解且持续存在的特征。对脑岛皮层结构的理解日益深入，脑岛皮层是接收和整合内脏感觉、动作和意义的神经结构，这可能有助于阐明这种障碍的本质。我们探讨了年龄、体重状况、疾病严重程度和自我报告的身体不满与脑岛皮层体积的关系。
从 21 名有 AN 病史的青少年和 20 名年龄、性别和体重指数匹配的对照组中收集了结构磁共振成像数据。使用手动追踪法确定脑岛皮质体积（双侧前、后区）。
右侧后岛叶的体积表现出以下特征：（a）年龄与临床状态的交互作用具有显著意义（β=-0.018[0.008]；t=2.32，p=0.02）；（b）较长的病程与更大的体积相关（r=0.48，p<.04）。相比之下，右侧前岛叶的体积与病程的长短呈负相关（r=-0.50，p<.03）。脑岛体积与身体不满的相关性具有中等效应量，且方向相反，但右侧后岛叶的相关性具有统计学趋势（r=0.40，p<.10；r=-0.49，p<.04）。
在这项探索性研究中，右侧后岛叶结构异常的发现表明，未来的研究工作应重视内脏传入信号在理解 AN 中躯体感觉体验障碍方面的作用。
