惊恐障碍患者脑恐惧网络的多模态磁共振成像

Multimodal MRI of fear network in panic disorder

惊恐障碍(panic disorder,PD)的病因和病理机制尚不明确,阻碍了临床诊疗的发展。为明确PD的发病机制、生物学诊断标记、疗效预测并最终实现个体化治疗提供依据,结合"恐惧网络模型"假说回顾了近5年关于PD的磁共振成像(magnetic resonance imaging,MRI)研究,发现PD患者的脑功能和结构异常不仅仅局限于经典的"恐惧网络模型",更广泛的脑区(如背侧扣带回、额顶颞叶皮质、脑岛、纹状体、感觉运动相关脑区和小脑)与杏仁核等经典脑区共同构成了拓展的恐惧网络。其中,杏仁核、岛叶、内侧前额叶以及感觉运动网络(somato-motor network,SMN)、小脑是PD区别于其他常见焦虑障碍的特异性脑区。而恐惧网络模型所包含的额叶-边缘环路的活动变化可预测不同方法治疗PD的疗效,完善了PD的恐惧网络假说,更精细识别了可用于PD精准诊断和疗效预测的生物学指标,为最终实现PD的个性化诊疗奠定了基础。

The etiology and pathological mechanism of panic disorder(PD)are still unclear,which hinders the development of clinical diagnosis and treatment.In order to clarify the pathogenesis,biological diagnostic markers,curative effect prediction of PD,and ultimately provide a basis for individualized treatment,this article reviews the magnetic resonance imaging(MRI)research on PD in the past 5 years in conjunction with the hypothesis of the"fear network model".It is found that the brain function and structural abnormalities of PD patients are not limited to the classic"fear network model",but also a wider range of brain areas such as the cingulate gyrus,fronto-temporal cortex,insula,striatum,thalamus,sensorimotor related brain regions and cerebellum,together with classic brain regions such as the amygdala,form an expanded fear network.Among them,the amygdala,insula,medial prefrontal lobe,somato-motor network(SMN)and cerebellum are specific brain areas that differentiate PD from other anxiety disorders.The changes in the activity of the frontal lobe-limbic loop included in the fear network model can predict the treatment outcome of different methods for PD.This article improved the fear network hypothesis of PD,and more accurately identifies the biological indicators that can be used for accurate diagnosis and efficacy prediction of PD,which lays the foundation for the ultimate realization of personalized diagnosis and treatment of PD.