Liu D D, Zhou W, Li P L, Zhang J L, Chen W, Gu W J, Pei Y, Du J, Zang L, Ba J M, Lü Z H, Mu Y M, Shan B C, Zhang Y L, Ma L, Dou J T
Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China( is working in the Department of Endocrinology, Baoding First Central Hospital, Baoding 071000, China).
Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2019 Feb 26;99(8):593-598. doi: 10.3760/cma.j.issn.0376-2491.2019.08.006.
To compare the differences of brain functional damage of subtypes of patients with Cushing's syndrome (CS). A total of 11 adrenocorticotropic hormone (ACTH)-dependent CS patients and 29 ACTH-independent CS patients were recruited from Chinese PLA General Hospital between September 2015 and March 2017 with confirmed CS. The psychiatric scales and brain task functional magnetic resonance imaging (fMRI) were evaluated. A total of 40 patients (34 females, 6 males) with a mean age of (39.20±12.10) years and a median education level of 12 (9, 16) years were enrolled. ACTH-dependent patients had significantly worse performance than the ACTH-independent patients in response to the depression evaluation (64.6±6.1 vs 56.2±12.8, 0.008), positive emotion (17.8±4.2 vs 24.3±7.2, 0.008) and CS life quality [31(29,33) vs 42(29,51), 0.040]. In the reaction to positive target pictures, ACTH-dependent CS patients showed stronger activation in left superior temporal gyrus compared with patients in ACTH-independent group, while the activation degree of their bilateral dorsal anterior cingulate cortex, bilateralsuperior frontal gyrus and left middle frontal gyrus was much worse. In the reactions to negative target pictures, ACTH-dependent CS patients had weaker activation in bilateral cerebellum, left superior frontal gyrus, left middle frontal gyrus, left precuneus and right postcentral gyrus, compared with patients in the ACTH-independent CS group (0.01, AlphaSim corrected). The activation degree of some regions whose brain function was different between the two groups was correlated to the cortisol level, ACTH level, 24 h urinary free cortisol (UFC) level, depression evaluation and negative emotion assessment (all 0.05). The severity of the depression and the life quality of patients in ACTH-dependent group are worse than ACTH-independent CS patients. The brain function of ACTH-dependent CS patients is much weaker.
比较库欣综合征（CS）患者各亚型脑功能损害的差异。2015年9月至2017年3月期间，从中国人民解放军总医院招募了11例促肾上腺皮质激素（ACTH）依赖性CS患者和29例ACTH非依赖性CS患者，均确诊为CS。对其进行精神量表评估和脑功能任务磁共振成像（fMRI）检查。共纳入40例患者（34例女性，6例男性），平均年龄（39.20±12.10）岁，中位受教育年限为12（9，16）年。在抑郁评估方面，ACTH依赖性患者的表现显著差于ACTH非依赖性患者（64.6±6.1 vs 56.2±12.8，P = 0.008），在积极情绪方面（17.8±4.2 vs 24.3±7.2，P = 0.008）以及CS生活质量方面[31（29，33）vs 42（29，51），P = 0.040]。在对积极目标图片的反应中，与ACTH非依赖性组患者相比，ACTH依赖性CS患者左侧颞上回激活更强，而其双侧背侧前扣带回皮质、双侧额上回和左侧额中回的激活程度则差得多。在对消极目标图片的反应中，与ACTH非依赖性CS组患者相比，ACTH依赖性CS患者双侧小脑、左侧额上回、左侧额中回、左侧楔前叶和右侧中央后回的激活较弱（P = 0.01，经AlphaSim校正）。两组间脑功能存在差异的部分区域的激活程度与皮质醇水平、ACTH水平、24小时尿游离皮质醇（UFC）水平、抑郁评估及消极情绪评估均相关（均P < 0.05）。ACTH依赖性组患者的抑郁严重程度和生活质量均差于ACTH非依赖性CS患者。ACTH依赖性CS患者的脑功能更弱。
