War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA.
War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA.
Neurotoxicology. 2020 May;78:71-79. doi: 10.1016/j.neuro.2020.02.006. Epub 2020 Feb 17.
Gulf War Illness (GWI) is a condition that affects about 30 % of veterans who served in the 1990-91 Persian Gulf War. Given its broad symptomatic manifestation, including chronic pain, fatigue, neurological, gastrointestinal, respiratory, and skin problems, it is of interest to examine whether GWI is associated with changes in the brain. Existing neuroimaging studies, however, have been limited by small sample sizes, inconsistent GWI diagnosis criteria, and potential comorbidity confounds.
Using a large cohort of US veterans with GWI, we assessed regional brain volumes for their associations with GWI, and quantified the relationships between any regional volumetric changes and GWI symptoms.
Structural magnetic resonance imaging (MRI) scans from 111 veterans with GWI (Age = 49 ± 6, 88 % Male) and 59 healthy controls (age = 51 ± 9, 78 % male) were collected at the California War Related Illness and Injury Study Center (WRIISC-CA) and from a multicenter study of the Parkinson's Progression Marker Initiative (PPMI), respectively. Individual MRI volumes were segmented and parcellated using FreeSurfer. Regional volumes of 19 subcortical, 68 cortical, and 3 brainstem structures were evaluated in the GWI cohort relative to healthy controls. The relationships between regional volumes and GWI symptoms were also assessed.
We found significant subcortical atrophy, but no cortical differences, in the GWI group relative to controls, with the largest effect detected in the brainstem, followed by the ventral diencephalon and the thalamus. In a subsample of 58 veterans with GWI who completed the Chronic Fatigue Scale (CFS) inventory of Centers for Disease Control and Prevention (CDC), smaller brainstem volumes were significantly correlated with increased severities of fatigue and depressive symptoms.
The findings suggest that brainstem volume may be selectively affected by GWI, and that the resulting atrophy could in turn mediate or moderate GWI-related symptoms such as fatigue and depression. Consequently, the brain stem should be carefully considered in future research focusing on GWI pathology.
海湾战争综合征（Gulf War Illness，GWI）是一种影响约 30%参加 1990-1991 年波斯湾战争的退伍军人的病症。鉴于其广泛的症状表现，包括慢性疼痛、疲劳、神经、胃肠道、呼吸和皮肤问题，研究 GWI 是否与大脑变化有关是很有意义的。然而，现有的神经影像学研究受到样本量小、GWI 诊断标准不一致以及潜在的合并症混杂因素的限制。
利用美国退伍军人中患有 GWI 的大量队列，我们评估了大脑区域的体积与 GWI 的关系，并量化了任何区域性容积变化与 GWI 症状之间的关系。
分别从加利福尼亚战争相关疾病和伤害研究中心（WRIISC-CA）收集了 111 名患有 GWI 的退伍军人（年龄=49±6，88%男性）和 59 名健康对照者（年龄=51±9，78%男性）的结构磁共振成像（MRI）扫描，以及帕金森病进展标志物倡议（PPMI）的多中心研究。使用 FreeSurfer 对个体 MRI 体积进行分割和分区。在 GWI 队列中相对于健康对照组评估了 19 个皮质下、68 个皮质和 3 个脑干结构的区域体积。还评估了区域体积与 GWI 症状之间的关系。
我们发现 GWI 组相对于对照组存在明显的皮质下萎缩，但没有皮质差异，最大的影响出现在脑干，其次是腹侧间脑和丘脑。在完成疾病控制与预防中心（CDC）慢性疲劳量表（CFS）的 58 名 GWI 退伍军人亚组中，较小的脑干体积与疲劳和抑郁症状的严重程度增加显著相关。
这些发现表明，脑干体积可能被 GWI 选择性地影响，而由此产生的萎缩反过来可能介导或调节 GWI 相关的症状，如疲劳和抑郁。因此，在关注 GWI 病理的未来研究中，应仔细考虑脑干。
