Wang Xiuli, Cheng Bochao, Luo Qiang, Qiu Lihua, Wang Song
Department of Clinical Psychology, the Fourth People's Hospital of Chengdu, Chengdu, China.
Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China.
Front Psychiatry. 2018 Sep 21;9:449. doi: 10.3389/fpsyt.2018.00449. eCollection 2018.
The current insight into the neurobiological pathogenesis underlying social anxiety disorder (SAD) is still rather limited. We implemented a meta-analysis to explore the neuroanatomical basis of SAD. We undertook a systematic search of studies comparing gray matter volume (GMV) differences between SAD patients and healthy controls (HC) using a whole-brain voxel-based morphometry (VBM) approach. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of SAD patients compared with HC. We included eleven studies with 470 SAD patients and 522 HC in the current meta-analysis. In the main meta-analysis, relative to HC, SAD patients showed larger GMVs in the left precuneus, right middle occipital gyrus (MOG) and supplementary motor area (SMA), as well as smaller GMV in the left putamen. In the subgroup analyses, compared with controls, adult patients (age ≥ 18 years) with SAD exhibited larger GMVs in the left precuneus, right superior frontal gyrus (SFG), angular gyrus, middle temporal gyrus (MTG), MOG and SMA, as well as a smaller GMV in the left thalamus; SAD patients without comorbid depressive disorder exhibited larger GMVs in the left superior parietal gyrus and precuneus, right inferior temporal gyrus, fusiform gyrus, MTG and superior temporal gyrus (STG), as well as a smaller GMV in the bilateral thalami; and currently drug-free patients with SAD exhibited a smaller GMV in the left thalamus compared with HC while no larger GMVs were found. For SAD patients with different clinical features, our study revealed directionally consistent larger cortical GMVs and smaller subcortical GMVs, including locationally consistent larger precuneus and thalamic deficits in the left brain. Age, comorbid depressive disorder and concomitant medication use of the patients might be potential confounders of SAD at the neuroanatomical level.
目前对社交焦虑障碍（SAD）潜在神经生物学发病机制的认识仍然相当有限。我们进行了一项荟萃分析，以探索SAD的神经解剖学基础。我们采用全脑基于体素的形态学测量（VBM）方法，对比较SAD患者与健康对照（HC）之间灰质体积（GMV）差异的研究进行了系统检索。采用基于种子点的d映射各向异性效应量版本（AES-SDM）荟萃分析，以探索SAD患者与HC相比的GMV差异。在当前的荟萃分析中，我们纳入了11项研究，其中包括470例SAD患者和522例HC。在主要的荟萃分析中，与HC相比，SAD患者在左侧楔前叶、右侧枕中回（MOG）和辅助运动区（SMA）的GMV较大，而在左侧壳核的GMV较小。在亚组分析中，与对照组相比，成年（年龄≥18岁）SAD患者在左侧楔前叶、右侧额上回（SFG）、角回、颞中回（MTG）、MOG和SMA的GMV较大，而在左侧丘脑的GMV较小；无共病抑郁症的SAD患者在左侧顶上叶和楔前叶、右侧颞下回、梭状回、MTG和颞上回（STG）的GMV较大，而在双侧丘脑的GMV较小；目前未用药的SAD患者与HC相比，左侧丘脑的GMV较小，未发现较大的GMV。对于具有不同临床特征的SAD患者，我们的研究揭示了方向一致的较大皮质GMV和较小的皮质下GMV，包括在左脑位置一致的较大楔前叶和丘脑缺陷。患者的年龄、共病抑郁症和同时使用药物可能是SAD在神经解剖学水平上的潜在混杂因素。
