Dager S R, Richards T, Strauss W, Artru A
Department of Psychiatry, University of Washington School of Medicine, Seattle 98105-6099, USA.
Psychiatry Res. 1997 Dec 30;76(2-3):89-99. doi: 10.1016/s0925-4927(97)00066-8.
Intravenous sodium lactate infusion is a robust laboratory technique for eliciting panic in susceptible individuals. The objective for this study was to replicate previous work which found differential brain lactate rises among lactate-sensitive panic subjects relative to control subjects using single-voxel 1H-magnetic resonance spectroscopy (MRS). Single-voxel 1H-MRS was used to measure brain lactate changes in the insular cortex region among 13 panic disorder subjects and 10 healthy control subjects during the infusion. One panic subject prematurely terminated the study due to a panic response during lactate infusion. Data from two additional control subjects and one panic subject were lost due to technical problems. Four panic subjects were reinfused with lactate while panic-free under treatment with fluoxetine (20 mg/day). At the time of initial infusion, all subjects were medication-free for at least 1 month. Ten panic subjects, but no control subjects, panicked during lactate infusion. In comparison to control subjects, panic subjects demonstrated significantly greater and prolonged brain lactate rises in the insular cortex region. Three of four medicated panic subjects experienced blockage of panic symptoms during lactate reinfusion but all exhibited persistent excesses in brain lactate rise. Consistent with our prior observations, greater and prolonged lactate rises in the insular brain region occur during and following lactate infusion among panic subjects compared to control subjects. This differential brain metabolic response did not appear to normalize when a small subset of panic patients were reinfused following resolution of panic symptoms during treatment over 3-4 months with fluoxetine.
静脉输注乳酸钠是一种在易感个体中引发恐慌的成熟实验室技术。本研究的目的是重复之前的工作，该工作使用单体素氢磁共振波谱（MRS）发现，乳酸敏感的恐慌受试者与对照受试者相比，大脑乳酸升高存在差异。在输注过程中，使用单体素氢磁共振波谱测量了13名恐慌症受试者和10名健康对照受试者岛叶皮质区域的大脑乳酸变化。一名恐慌症受试者在乳酸输注期间因恐慌反应提前终止了研究。另外两名对照受试者和一名恐慌症受试者的数据因技术问题丢失。四名恐慌症受试者在接受氟西汀（20毫克/天）治疗且无恐慌症状的情况下再次输注乳酸。在初次输注时，所有受试者至少1个月未服用药物。10名恐慌症受试者在乳酸输注期间出现恐慌，但对照受试者均未出现。与对照受试者相比，恐慌症受试者在岛叶皮质区域的大脑乳酸升高更为显著且持续时间更长。四名接受药物治疗的恐慌症受试者中有三名在乳酸再次输注期间恐慌症状受阻，但所有受试者的大脑乳酸升高均持续存在。与我们之前的观察结果一致，与对照受试者相比，恐慌症受试者在乳酸输注期间及之后，岛叶脑区的乳酸升高幅度更大且持续时间更长。在用氟西汀治疗3 - 4个月后，一小部分恐慌症患者在恐慌症状缓解后再次输注乳酸时，这种大脑代谢反应差异似乎并未恢复正常。
