Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.
Imaging Division, Lawson Health Research Institute, London, Ontario, Canada.
Hum Brain Mapp. 2018 Mar;39(3):1367-1379. doi: 10.1002/hbm.23925. Epub 2017 Dec 20.
The bed nucleus of the stria terminals (BNST) is a subcortical structure involved in anticipatory and sustained reactivity to threat and is thus essential to the understanding of anxiety and stress responses. Although chronic stress and anxiety represent a hallmark of post-traumatic stress disorder (PTSD), to date, few studies have examined the functional connectivity of the BNST in PTSD. Here, we used resting state functional Magnetic Resonance Imaging (fMRI) to investigate the functional connectivity of the BNST in PTSD (n = 70), its dissociative subtype (PTSD + DS) (n = 41), and healthy controls (n = 50). In comparison to controls, PTSD showed increased functional connectivity of the BNST with regions of the reward system (ventral and dorsal striatum), possibly underlying stress-induced reward-seeking behaviors in PTSD. By contrast, comparing PTSD + DS to controls, we observed increased functional connectivity of the BNST with the claustrum, a brain region implicated in consciousness and a primary site of kappa-opioid receptors, which are critical to the dynorphin-mediated dysphoric stress response. Moreover, PTSD + DS showed increased functional connectivity of the BNST with brain regions involved in attention and salience detection (anterior insula and caudate nucleus) as compared to PTSD and controls. Finally, BNST functional connectivity positively correlated with default-mode network regions as a function of state identity dissociation, suggesting a role of BNST networks in the disruption of self-relevant processing characterizing the dissociative subtype. These findings represent an important first step in elucidating the role of the BNST in aberrant functional networks underlying PTSD and its dissociative subtype.
终纹床核（BNST）是一个与威胁的预期和持续反应有关的皮质下结构，因此对理解焦虑和应激反应至关重要。尽管慢性应激和焦虑是创伤后应激障碍（PTSD）的标志之一，但迄今为止，很少有研究检查 PTSD 中 BNST 的功能连接。在这里，我们使用静息态功能磁共振成像（fMRI）研究了 PTSD（n=70）、其分离型亚型（PTSD+DS）（n=41）和健康对照组（n=50）的 BNST 功能连接。与对照组相比，PTSD 显示 BNST 与奖励系统区域（腹侧和背侧纹状体）的功能连接增加，这可能是 PTSD 中应激诱导的奖励寻求行为的基础。相比之下，与对照组相比，我们观察到 BNST 与大脑皮层的功能连接增加，大脑皮层与意识有关，是κ-阿片受体的主要部位，κ-阿片受体对dynorphin 介导的抑郁应激反应至关重要。此外，与 PTSD 和对照组相比，PTSD+DS 显示 BNST 与涉及注意力和突显检测的大脑区域的功能连接增加（前岛叶和尾状核）。最后，BNST 功能连接与默认模式网络区域呈正相关，作为状态身份分离的函数，这表明 BNST 网络在破坏特征分离亚型的自我相关处理中起作用。这些发现代表了阐明 BNST 在 PTSD 及其分离型亚型异常功能网络中的作用的重要第一步。
