Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, New York.
Stony Brook University, Stony Brook, NY.
J Am Acad Child Adolesc Psychiatry. 2017 Oct;56(10):866-874.e7. doi: 10.1016/j.jaac.2017.08.008. Epub 2017 Aug 19.
Cross-sectional data suggest functional and anatomical disturbances in inferior and orbital frontal regions in bulimia nervosa (BN). Using longitudinal data, we investigated whether reduced cortical thickness (CT) in these regions arises early and persists over adolescence in BN, independent of symptom remission, and whether CT reductions are markers of BN symptoms.
A total of 33 adolescent females with BN symptoms (BN or other specified feeding or eating disorder) and 28 healthy adolescents participated in this study. Anatomical magnetic resonance imaging and clinical data were acquired at 3 time points within 2-year intervals over adolescence, with 31% average attrition between assessments. Using a region-of-interest approach, we assessed group differences in CT at baseline and over time, and tested whether between- and within-subject variations in CT were associated with the frequency of BN symptoms.
Reduced CT in the right inferior frontal gyrus persisted over adolescence in BN compared to healthy adolescents, even in those who achieved full or partial remission. Within the BN group, between-subject variations in CT in the inferior and orbital frontal regions were inversely associated with specific BN symptoms, suggesting, on average over time, greater CT reductions in individuals with more frequent BN symptoms.
Reduced CT in inferior frontal regions may contribute to illness persistence into adulthood. Reductions in the thickness of the inferior and orbital frontal regions may be markers of specific BN symptoms. Because our sample size precluded correcting for multiple comparisons, these findings should be replicated in a larger sample. Future study of functional changes in associated fronto-striatal circuits could identify potential circuit-based intervention targets.
横断面数据表明神经性贪食症（BN）患者下额和眶额区域存在功能和解剖学紊乱。本研究采用纵向数据，旨在探究 BN 患者这些区域的皮质厚度（CT）减少是否在青春期早期出现，并持续存在，且独立于症状缓解，以及 CT 减少是否为 BN 症状的标志物。
本研究共纳入 33 名有 BN 症状（BN 或其他特定的进食或饮食障碍）的青春期女性和 28 名健康的青春期女性。在 2 年内进行了 3 次磁共振成像和临床数据采集，评估之间的平均失访率为 31%。使用感兴趣区方法，我们在基线和随访期间评估了 CT 组间差异，并检验了 CT 的组间和组内变化是否与 BN 症状的频率有关。
与健康青少年相比，BN 患者右侧下额额回的 CT 减少在青春期持续存在，即使是那些完全或部分缓解的患者。在 BN 组中，下额和眶额区域的 CT 组间变化与特定的 BN 症状呈负相关，表明随着时间的推移，BN 症状更频繁的个体 CT 减少更明显。
下额区域 CT 减少可能导致疾病持续到成年期。下额和眶额区域 CT 减少可能是 BN 特定症状的标志物。由于我们的样本量不能进行多次比较的校正，这些发现需要在更大的样本中进行复制。未来对相关额-纹状体回路的功能变化的研究可能会确定潜在的基于回路的干预靶点。
