创伤后应激障碍随机临床试验中静息态功能连接与治疗反应的相关性。
Associations between resting-state functional connectivity and treatment response in a randomized clinical trial for posttraumatic stress disorder.
机构信息
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
出版信息
Depress Anxiety. 2020 Oct;37(10):1037-1046. doi: 10.1002/da.23075. Epub 2020 Jul 15.
BACKGROUND
Alterations in resting-state functional connectivity (rsFC) have been reported in posttraumatic stress disorder (PTSD). Here, we examined pre- and post-treatment rsFC during a randomized clinical trial to characterize alterations and examine predictors of treatment response.
METHODS
Sixty-four combat veterans with PTSD were randomly assigned to prolonged exposure (PE) plus placebo, sertraline plus enhanced medication management, or PE plus sertraline. Symptom assessment and resting-state functional magnetic resonance imaging (fMRI) scans occurred before and after treatment. Twenty-nine trauma-exposed combat veterans without PTSD served as a control group at intake. Seed-based and region of interest (ROI)-to-ROI connectivities, as well as an exploratory connectome-based approach were used to analyze rsFC patterns. Based on previously reported findings, analyses focused on Salience Network (SN) and Default-Mode Network (DMN).
RESULTS
At intake, patients with PTSD showed greater DMN-dorsal attention network (DAN) connectivity (between ventromedial prefrontal cortex and superior parietal lobule; family-wise error corrected p = .011), greater SN-DAN connectivity (between insula and middle frontal gyrus; corrected p = .003), and a negative correlation between re-experiencing symptoms and within-DMN connectivity (between posterior cingulate cortex (PCC) and middle temporal gyrus; corrected p < .001). We also found preliminary evidence for associations between rsFC and treatment response. Specifically, high responders (≥50% PTSD symptom improvement), compared with low responders, had greater SN-DMN segregation (i.e., less pre-treatment amygdala-PCC connectivity; p = .011) and lower pre-treatment global centrality (p = .042).
CONCLUSIONS
Our findings suggest neural abnormalities in PTSD and may inform future research examining neural biomarkers of PTSD treatment response.
背景
创伤后应激障碍（PTSD）患者的静息态功能连接（rsFC）发生了改变。在此，我们在一项随机临床试验中检查了治疗前后的 rsFC，以描述改变并检查治疗反应的预测因子。
方法
64 名患有 PTSD 的退伍军人被随机分配到延长暴露（PE）加安慰剂、舍曲林加增强药物管理或 PE 加舍曲林组。在治疗前后进行症状评估和静息态功能磁共振成像（fMRI）扫描。29 名无 PTSD 的创伤暴露的退伍军人作为对照组在摄入时进行评估。基于先前的报告结果，分析侧重于显着性网络（SN）和默认模式网络（DMN）。
结果
在摄入时，PTSD 患者的 DMN-背侧注意网络（DAN）连接性（腹内侧前额叶皮质和顶叶上回之间；校正后的全脑错误率 p=0.011）、SN-DAN 连接性（岛叶和额中回之间；校正后的 p=0.003）较高，并且重新体验症状与 DMN 内连接性之间存在负相关（后扣带回皮层（PCC）和颞中回之间；校正后的 p<0.001）。我们还发现了 rsFC 与治疗反应之间关联的初步证据。具体来说，与低反应者（≥50% PTSD 症状改善）相比，高反应者（≥50% PTSD 症状改善）具有更大的 SN-DMN 分离（即，治疗前杏仁核-PCC 连接性较低；p=0.011）和较低的治疗前全局中心性（p=0.042）。
结论
我们的研究结果表明 PTSD 存在神经异常，可能为未来研究 PTSD 治疗反应的神经生物标志物提供信息。
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