Locatelli Giulia, Matus Austin, Lin Chin-Yen, Vellone Ercole, Riegel Barbara
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Heart Lung. 2025 Mar-Apr;70:122-140. doi: 10.1016/j.hrtlng.2024.11.004. Epub 2024 Dec 10.
To perform self-care, individuals with a chronic illness must be able to perceive bodily changes (ie., interoception) so they can respond to symptoms when they arise. Interoception is regulated by the insular cortex of the brain. Symptom perception is poor in various physical diseases, which may be associated with impairments in the insular cortex.
The purpose of this study was to explore whether patterns of insular impairment exist among adults with chronic physical diseases and to analyze the relationship with disease-related symptoms.
We identified studies that assessed the structure and/or activity of the insula through MRI and/or (f)MRI in adults with chronic physical diseases (vs. healthy controls) by searching five databases. Results are reported as a narrative synthesis.
Fifty studies were conducted to investigate the structure or activity of the insula among adults with diabetes, cancer, heart failure, or chronic pulmonary disease. In 19 studies investigators found that patients with a chronic disease had lower/damaged insular volume/density/thickness than healthy controls or reduced insular blood flow. When insular activity was explored in 22 studies, most investigators reported higher insular activity and lower neural connectivity. Five studies explored the association between insular volume/activity and symptom severity: four reported a positive trend.
People with chronic physical diseases have lower insular grey matter volume/density/thickness and abnormal insular activity when compared to healthy people. Insular activity may be related to symptom severity. These results suggest that insular structure and/or activity may explain poor symptom perception.
为了进行自我护理，慢性病患者必须能够感知身体变化（即内感受），以便在症状出现时做出反应。内感受由大脑的岛叶皮质调节。在各种身体疾病中，症状感知较差，这可能与岛叶皮质的损伤有关。
本研究的目的是探讨慢性身体疾病成年人中是否存在岛叶损伤模式，并分析其与疾病相关症状的关系。
我们通过检索五个数据库，确定了通过MRI和/或（f）MRI评估慢性身体疾病成年人（与健康对照相比）岛叶结构和/或活动的研究。结果以叙述性综述的形式报告。
共进行了50项研究，以调查糖尿病、癌症、心力衰竭或慢性肺病成年人的岛叶结构或活动。在19项研究中，研究人员发现慢性病患者的岛叶体积/密度/厚度低于健康对照或受损/血流量减少。在22项研究中探讨岛叶活动时，大多数研究人员报告岛叶活动增加和神经连接减少。五项研究探讨了岛叶体积/活动与症状严重程度之间的关联：四项报告了正相关趋势。
与健康人相比，慢性身体疾病患者的岛叶灰质体积/密度/厚度较低，岛叶活动异常。岛叶活动可能与症状严重程度有关。这些结果表明，岛叶结构和/或活动可能解释了症状感知较差的原因。
