童年期焦虑障碍中男孩而非女孩的钩束纤维微观结构改变。
Altered Uncinate Fasciculus Microstructure in Childhood Anxiety Disorders in Boys But Not Girls.
机构信息
The Department of Psychiatry (Tromp, Williams, Oler, Roseboom, Rogers, Alexander, Kalin), the Neuroscience Training Program (Tromp, Kalin), the Department of Medical Physics (Alexander), and the HealthEmotions Research Institute (Tromp, Williams, Oler, Roseboom, Kalin), University of Wisconsin, Madison; the Department of Psychology and the California National Primate Research Center, University of California, Davis (Fox); and the Section on Development and Affective Neuroscience, NIMH, Bethesda, Md. (Benson, Pine).
出版信息
Am J Psychiatry. 2019 Mar 1;176(3):208-216. doi: 10.1176/appi.ajp.2018.18040425. Epub 2019 Jan 18.
OBJECTIVE
Anxiety disorders are common, can result in lifelong suffering, and frequently begin before adolescence. Evidence from adults suggests that altered prefrontal-limbic connectivity is a pathophysiological feature of anxiety disorders. More specifically, in adults with anxiety disorders, decreased fractional anisotropy (FA), a measure of white matter integrity, has been observed in the uncinate fasciculus, the major tract that connects limbic and prefrontal regions. Because of the early onset of anxiety disorders and the increased incidence in anxiety disorders in females during their reproductive years, it is important to understand whether the reduction in uncinate fasciculus FA exists in children with anxiety disorders and the extent to which this alteration is sex related. To address these issues, the authors assessed FA in the uncinate fasciculus in unmedicated boys and girls with anxiety disorders.
METHODS
FA measures were derived from diffusion tensor images that were acquired from 98 unmedicated children (ages 8-12); 52 met criteria for generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, or anxiety disorder not otherwise specified, and 46 were matched control subjects.
RESULTS
Tract-based results demonstrated that children with anxiety disorders have significant reductions in uncinate fasciculus FA. A significant sex-by-group interaction and post hoc testing revealed that this effect was evident only in boys. No other main effects or sex-by-group interactions were found for other white matter tracts.
CONCLUSIONS
These findings provide evidence of uncinate fasciculus white matter alterations in boys with anxiety disorders. The data demonstrate that anxiety disorder-related alterations in prefrontal-limbic structural connectivity are present early in life, are not related to psychotropic medication exposure, and are sex specific. Building on these findings, future research has the potential to provide insights into the genesis and sexual dimorphism of the pathophysiology that leads to anxiety disorders, as well as to identify sex-specific early-life treatment targets.
目的
焦虑障碍较为常见，可导致终生痛苦，并常于青春期前起病。来自成人的证据表明，前额叶-边缘连接改变是焦虑障碍的一种病理生理特征。更具体地说，在患有焦虑障碍的成年人中，观察到连接边缘和前额叶区域的主要束——钩束的各向异性分数（FA）降低，FA 是衡量白质完整性的指标。由于焦虑障碍起病早，以及女性在生育期焦虑障碍的发病率增加，了解患有焦虑障碍的儿童中是否存在钩束 FA 减少以及这种改变在多大程度上与性别相关非常重要。为了解决这些问题，作者评估了未用药的患有焦虑障碍的男孩和女孩钩束的 FA。
方法
从扩散张量图像中得出 FA 测量值，这些图像是从 98 名未用药的儿童（年龄 8-12 岁）中获取的；其中 52 名符合广泛性焦虑障碍、分离性焦虑障碍、社交焦虑障碍或未特定指明的焦虑障碍标准，46 名是匹配的对照受试者。
结果
基于束的分析结果表明，患有焦虑障碍的儿童的钩束 FA 显著降低。显著的性别-组间交互作用和事后检验表明，这种效应仅在男孩中明显。对于其他白质束，没有发现其他主要效应或性别-组间交互作用。
结论
这些发现为患有焦虑障碍的男孩的钩束白质改变提供了证据。数据表明，与焦虑障碍相关的前额叶-边缘结构连接改变在生命早期就存在，与精神药物暴露无关，并且具有性别特异性。在此基础上，未来的研究有可能深入了解导致焦虑障碍的病理生理学的起源和性别二态性，并确定具有性别特异性的生命早期治疗靶点。
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