Dager S R, Friedman S D, Heide A, Layton M E, Richards T, Artru A, Strauss W, Hayes C, Posse S
Department of Psychiatry, Diagnostic Imaging Sciences Center, University of Washington School of Medicine, Seattle 98105-6099, USA.
Arch Gen Psychiatry. 1999 Jan;56(1):70-7. doi: 10.1001/archpsyc.56.1.70.
A fast, proton echo-planar spectroscopic imaging (PEPSI) technique, capable of simultaneously measuring metabolites from multiple brain regions, was used to investigate the anatomical distribution and magnitude of brain lactate responses to intravenous lactate infusion among subjects with panic disorder and control subjects.
Fifteen subjects with panic disorder and 10 control subjects were studied. All subjects were medication free and met DSM-IV criteria for panic disorder, or, for controls, no Axis I psychiatric disorder. Two-dimensional axial metabolite images having 1-cm3 spatial resolution were acquired at 61/2-minute intervals during 3 conditions: a 20-minute baseline, 20-minute 0.5-mol/L sodium lactate infusion, and 15-minute postinfusion period.
Intravenous lactate infusion increased brain lactate levels throughout the axial brain section studied in all subjects. Panic-disordered subjects had significantly greater global brain lactate increases in response to lactate infusion. Lateralization of brain lactate response did not occur, nor were discrete regional loci of elevated lactate observed. Cerebrospinal fluid lactate changes corresponded to lactate changes in brain tissue. Severity of symptoms provoked by lactate infusion did not directly correlate with brain lactate response.
Greater overall rises in brain lactate among subjects with panic disorder compared with controls occurred in response to lactate infusion. We were unable to detect a distinct regional pattern for magnitude differences in brain lactate rise by which to identify a specific neuroanatomical substrate underlying a lactate-induced panic response. The wide anatomical distribution of these brain lactate increases suggest metabolic and/or neurovascular mechanisms for the abnormal rise in subjects with panic disorder.
一种快速的质子回波平面光谱成像（PEPSI）技术，能够同时测量多个脑区的代谢物，被用于研究惊恐障碍患者和对照受试者静脉输注乳酸后脑乳酸反应的解剖分布和程度。
研究了15名惊恐障碍患者和10名对照受试者。所有受试者均未服用药物，符合惊恐障碍的DSM-IV标准，对于对照组而言，无轴I精神障碍。在三种情况下，每隔6.5分钟采集一次具有1立方厘米空间分辨率的二维轴向代谢物图像：20分钟的基线期、20分钟的0.5摩尔/升乳酸钠输注期和15分钟的输注后期。
静脉输注乳酸使所有受试者研究的整个轴向脑区的脑乳酸水平升高。惊恐障碍患者对乳酸输注的全脑乳酸升高明显更大。未出现脑乳酸反应的侧化，也未观察到乳酸升高的离散区域位点。脑脊液乳酸变化与脑组织中的乳酸变化相对应。乳酸输注引发的症状严重程度与脑乳酸反应无直接相关性。
与对照组相比，惊恐障碍患者在乳酸输注后脑乳酸总体升高幅度更大。我们无法检测到脑乳酸升高幅度差异的明显区域模式，以此来确定乳酸诱导惊恐反应背后的特定神经解剖学底物。这些脑乳酸升高的广泛解剖分布提示了惊恐障碍患者异常升高的代谢和/或神经血管机制。
