Maier Simon, Nickel Kathrin, Perlov Evgeniy, Kukies Alina, Zeeck Almut, Elst Ludger Tebartz van, Endres Dominique, Spieler Derek, Holovics Lukas, Hartmann Armin, Dacko Michael, Lange Thomas, Joos Andreas
Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany.
J Clin Med. 2020 Apr 30;9(5):1292. doi: 10.3390/jcm9051292.
An insular involvement in the pathogenesis of anorexia nervosa (AN) has been suggested in many structural and functional neuroimaging studies. This magnetic resonance spectroscopy (MRS) study is the first to investigate metabolic signals in the anterior insular cortex in patients with AN and recovered individuals (REC).
The MR spectra of 32 adult women with AN, 21 REC subjects and 33 healthy controls (HC) were quantified for absolute N-acetylaspartate (NAA), glutamate + glutamine (Glx), total choline, myo-inositol, creatine concentrations (mM/L). After adjusting the metabolite concentrations for age and partial gray/white matter volume, group differences were tested using one-way multivariate analyses of variance (MANOVA). Post-hoc analyses of variance were applied to identify those metabolites that showed significant group effects. Correlations were tested for associations with psychometric measures (eating disorder examination), duration of illness, and body mass index.
The MANOVA exhibited a significant group effect. The NAA signal was reduced in the AN group compared to the HC group. The REC and the HC groups did not differ in metabolite concentrations. In the AN group, lower NAA and Glx signals were related to increased weight concern.
We interpret the decreased NAA availability in the anterior insula as a signal of impaired neuronal integrity or density. The association of weight concern, which is a core feature of AN, with decreased NAA and Glx indicates that disturbances of glutamatergic neurotransmission might be related to core psychopathology in AN. The absence of significant metabolic differences between the REC and HC subjects suggests that metabolic alterations in AN represent a state rather than a trait phenomenon.
许多结构和功能神经影像学研究表明，脑岛参与神经性厌食症（AN）的发病机制。这项磁共振波谱（MRS）研究首次调查了AN患者和康复个体（REC）前脑岛皮质的代谢信号。
对32名成年AN女性、21名REC受试者和33名健康对照（HC）的磁共振波谱进行定量分析，测定绝对N-乙酰天门冬氨酸（NAA）、谷氨酸+谷氨酰胺（Glx）、总胆碱、肌醇、肌酸浓度（mM/L）。在对代谢物浓度进行年龄和部分灰质/白质体积校正后，使用单因素多变量方差分析（MANOVA）检验组间差异。采用事后方差分析来确定那些显示出显著组效应的代谢物。测试相关性以确定其与心理测量指标（饮食失调检查）、病程和体重指数的关联。
MANOVA显示出显著的组效应。与HC组相比，AN组的NAA信号降低。REC组和HC组的代谢物浓度无差异。在AN组中，较低的NAA和Glx信号与体重关注增加有关。
我们将前脑岛中NAA可用性的降低解释为神经元完整性或密度受损的信号。体重关注是AN的核心特征之一，它与NAA和Glx降低之间的关联表明，谷氨酸能神经传递障碍可能与AN的核心精神病理学有关。REC组和HC组之间没有显著的代谢差异，这表明AN中的代谢改变代表一种状态而非特质现象。
