无抗抑郁药物治疗的强迫症患者杏仁核亚核区的解剖学改变。
Anatomic alterations across amygdala subnuclei in medication-free patients with obsessive-compulsive disorder.
机构信息
From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang).
出版信息
J Psychiatry Neurosci. 2020 Sep 1;45(5):334-343. doi: 10.1503/jpn.190114.
BACKGROUND
The amygdala has been implicated in obsessive-compulsive disorder (OCD), a common, disabling illness. However, the regional distribution of anatomic alterations in this structure and their association with the symptoms of OCD remains to be established.
METHODS
We collected high-resolution 3D T1-weighted images from 81 untreated patients with OCD and no lifetime history of comorbid psychotic, affective or anxiety disorders, and from 95 age- and sex-matched healthy controls. We extracted the volume of the central nucleus of the amygdala (CeA) and the basolateral complex of the amygdala (BLA) and compared them across groups using FreeSurfer 6.0. In exploratory analyses, we evaluated other subnuclei, including the cortical medial nuclei, the anterior amygdaloid area, and the corticoamygdaloid transition area.
RESULTS
Patients with OCD had reduced amygdala volume bilaterally compared with healthy controls (left, p = 0.034; right, p = 0.002). Volume reductions were greater in the CeA (left: -11.9%, p = 0.002; right: -13.3%, p < 0.001) than in the BLA (left lateral nucleus: -3.3%, p = 0.029; right lateral nucleus: -3.9%, p = 0.018; right basal nucleus: -4.1%, p = 0.017; left accessory basal nucleus: -6.5%, p = 0.001; right accessory basal nucleus: -9.3%, p < 0.001). Volume reductions in the CeA were associated with illness duration. Exploratory analysis revealed smaller medial (left: -15.4%, p < 0.001, η2 = 0.101) and cortical (left: -9.1%, p = 0.001, η2 = 0.058; right: -15.4%, p < 0.001, η2 = 0.175) nuclei in patients with OCD compared with healthy controls.
LIMITATIONS
Although the strict exclusion criteria used in the study helped us to identify OCD-specific alterations, they may have limited generalizability to the broader OCD population.
CONCLUSION
Our results provide a comprehensive anatomic profile of alterations in the amygdala subnuclei in untreated patients with OCD and highlight a distinctive pattern of volume reductions across subnuclei in OCD. Based on the functional properties of the amygdala subnuclei established from preclinical research, CeA impairment may contribute to behavioural inflexibility, and BLA disruption may be responsible for altered fear conditioning and the affective components of OCD.
背景
杏仁核与强迫症（OCD）有关，这是一种常见的致残性疾病。然而，该结构的解剖结构改变的区域分布及其与 OCD 症状的关联仍有待确定。
方法
我们从 81 名未经治疗的 OCD 患者和 95 名年龄和性别匹配的健康对照者中收集了高分辨率 3D T1 加权图像。我们提取了杏仁核中央核（CeA）和基底外侧复合体（BLA）的体积，并使用 FreeSurfer 6.0 对它们进行了比较。在探索性分析中，我们评估了其他亚核，包括皮质内侧核、前杏仁核区和皮质杏仁核过渡区。
结果
与健康对照组相比，OCD 患者双侧杏仁核体积减小（左侧，p = 0.034；右侧，p = 0.002）。CeA 体积减小更为明显（左侧：-11.9%，p = 0.002；右侧：-13.3%，p < 0.001），而 BLA 体积减小较小（左侧外侧核：-3.3%，p = 0.029；右侧外侧核：-3.9%，p = 0.018；右侧基底核：-4.1%，p = 0.017；左侧辅助基底核：-6.5%，p = 0.001；右侧辅助基底核：-9.3%，p < 0.001）。CeA 体积减小与疾病持续时间有关。探索性分析显示，与健康对照组相比，OCD 患者的内侧（左侧：-15.4%，p < 0.001，η2 = 0.101）和皮质（左侧：-9.1%，p = 0.001，η2 = 0.058；右侧：-15.4%，p < 0.001，η2 = 0.175）核体积较小。
局限性
尽管研究中使用的严格排除标准有助于确定 OCD 特异性改变，但它们可能限制了对更广泛的 OCD 人群的普遍性。
结论
我们的研究结果提供了未经治疗的 OCD 患者杏仁核亚核改变的全面解剖结构图谱，并强调了 OCD 中跨亚核体积减小的独特模式。基于临床前研究中确定的杏仁核亚核的功能特性，CeA 损伤可能导致行为灵活性降低，而 BLA 破坏可能导致恐惧条件反射和 OCD 的情感成分改变。
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