Dretsch Michael N, Lange Rael T, Katz Jeffery S, Goodman Adam, Daniel Thomas A, Deshpande Gopikrishna, Denney Thomas S, Iverson Grant L, Robinson Jennifer L
US Army Aeromedical Research Laboratory, Fort Rucker, AL; Human Dimension Division, Headquarters Training and Doctrine Command, 950 Jefferson Ave, Fort Eustis, VA, 23612, USA.
National Intrepid Center of Excellence, Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Palmer Road, Bethesda, MD, 20814, USA.
Open Neuroimag J. 2017 Sep 6;11:46-57. doi: 10.2174/1874440001711010046. eCollection 2017.
There is a high comorbidity of posttraumatic stress (PTS) and mild traumatic brain injury (mTBI), with largely overlapping symptomatology, in military service members.
To examine white matter integrity associated with PTS and mTBI as assessed using diffusion tensor imaging (DTI).
Seventy-four active-duty U.S. soldiers with PTS (n = 16) and PTS with co-morbid history of mTBI (PTS/mTBI; n = 28) were compared to a military control group (n = 30). Participants received a battery of neurocognitive and clinical symptom measures. The number of abnormal DTI values was determined (>2 SDs from the mean of the control group) for fractional anisotropy (FA) and mean diffusivity (MD), and then compared between groups. In addition, mean DTI values from white matter tracts falling into three categories were compared between groups: (i) projection tracts: superior, middle, and inferior cerebellar peduncles, pontine crossing tract, and corticospinal tract; (ii) association tracts: superior longitudinal fasciculus; and (iii) commissure tracts: cingulum bundle (cingulum-cingulate gyrus and cingulum-hippocampus), and corpus callosum.
The comorbid PTS/mTBI group had significantly greater traumatic stress, depression, anxiety, and post-concussive symptoms, and they performed worse on neurocognitive testing than those with PTS alone and controls. The groups differed greatly on several clinical variables, but contrary to what we hypothesized, they did not differ greatly on primary and exploratory analytic approaches of hetero-spatial whole brain DTI analyses.
The findings suggest that psychological health conditions rather than pathoanatomical changes may be contributing to symptom presentation in this population.
在军人中，创伤后应激障碍（PTS）和轻度创伤性脑损伤（mTBI）的共病率很高，症状在很大程度上重叠。
使用扩散张量成像（DTI）来检查与PTS和mTBI相关的白质完整性。
将74名患有PTS（n = 16）和有mTBI共病史的PTS（PTS/mTBI；n = 28）的现役美国士兵与一个军事对照组（n = 30）进行比较。参与者接受了一系列神经认知和临床症状测量。确定了分数各向异性（FA）和平均扩散率（MD）的异常DTI值数量（超过对照组平均值2个标准差），然后在组间进行比较。此外，还比较了分为三类的白质束的平均DTI值：（i）投射束：上、中、下小脑脚、脑桥交叉束和皮质脊髓束；（ii）联合束：上纵束；（iii）连合束：扣带束（扣带-扣带回和扣带-海马）和胼胝体。
PTS/mTBI共病组的创伤应激、抑郁、焦虑和脑震荡后症状明显更严重，并且他们在神经认知测试中的表现比仅患有PTS的人和对照组更差。这些组在几个临床变量上有很大差异，但与我们的假设相反，在异空间全脑DTI分析的主要和探索性分析方法上，它们没有很大差异。
研究结果表明，心理健康状况而非病理解剖学变化可能是导致该人群症状表现的原因。
