杏仁核活性能预测心血管事件 | Lancet 论文推荐

本文转载自微信公众号 MedSci （ID：MedSci_cn）

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情绪压力与心血管疾病风险增加有关。近日，顶级医学杂志 Lancet 上发表了一篇研究文章，研究者旨在明确杏仁核-参与应激调节的脑区的静息代谢活动能否预测随后心血管事件的风险。

来源：梅斯医学

在2005年1月1日至2008年12月31日期间，研究者纳入了在马萨诸塞州总医院（波士顿、美国）进行18 F-FDG PET/CT 检查年龄超过30岁的没有已知的心血管疾病或癌症的人员作为研究对象进行纵向研究。研究者验证的方法评估了杏仁核活性、骨髓活性和动脉炎症，在这个横断面研究中，研究者分析了感知到的压力、杏仁核活性、动脉炎症和 C-反应蛋白之间的关系。由相互不知情的研究人员对图像分析和心血管疾病事件进行裁决。研究者采用 Cox 模型、对数秩检验、调解（路径）分析来评估杏仁核活性与心血管事件之间的关系。

研究者对293例患者（中位年龄为55岁[四分位间距45.0-65.5]）进行纵向研究，在中位随访了3.7年（2.7-4.8年）期间，共有22例患者发生心血管疾病事件。杏仁核活性与增加的骨髓活性（r=0.47；P＜0.0001）、动脉炎症（r=0.49；P＜0.0001）以及心血管疾病事件风险（标准化的风险比为1.59，95%可信区间为1.27-1.98；P<0.0001）相关，对多变量进行调整后这一发现仍然显著。杏仁核活性和心血管疾病事件之间的相关性似乎是通过增加的骨髓活性和血管炎症所介导。

在这项横断面研究中接受心理分析的患者（n=13）杏仁核的活性与动脉炎症显著相关（r=0.7，P=0.0083）。感知到的压力与杏仁核活性（r=0.59，P=0.0485）、动脉炎症（r=0.59；P=0.0345）、C-反应蛋白（r=0.83；P=0.0210）相关。

这是第一个将脑区活性与随后的心血管疾病相联系的研究，杏仁核活性可以独立地预测心血管事件。杏仁核活性部分被包括增加的骨髓活性和动脉炎症在内的通路所介导，这些发现为人类情感压力可以导致心血管疾病的机制提供了新的见解。

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【论文基本信息】

题目 Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study

作者 Richard AP Takx, MD, Amparo L Figueroa, MD, Abdelrahman Ali, MD, Yannick Kaiser, BS, Quynh A Truong, MD, Chloe JE Solomon, BS, Claudia Calcagno, MD, Venkatesh Mani, PhD, Cheuk Y Tang, PhD, Prof Willem JM Mulder, PhD, James W Murrough, MD, Prof Udo Hoffmann, MD, Matthias Nahrendorf, MD, Lisa M Shin, PhD, Prof Zahi A Fayad, PhD†, Prof Roger K Pitman, MD†

发表时间: 11 January 2017

DOI: http://sci-hub.cc/10.1016/S0140-6736(16)31714-7 | 

摘要 Emotional stress is associated with increased risk of cardiovascular disease. We imaged the amygdala, a brain region involved in stress, to determine whether its resting metabolic activity predicts risk of subsequent cardiovascular events.

Methods

Individuals aged 30 years or older without known cardiovascular disease or active cancer disorders, who underwent 18F-fluorodexoyglucose PET/CT at Massachusetts General Hospital (Boston, MA, USA) between Jan 1, 2005, and Dec 31, 2008, were studied longitudinally. Amygdalar activity, bone-marrow activity, and arterial inflammation were assessed with validated methods. In a separate cross-sectional study we analysed the relation between perceived stress, amygdalar activity, arterial inflammation, and C-reactive protein. Image analyses and cardiovascular disease event adjudication were done by mutually blinded researchers. Relations between amygdalar activity and cardiovascular disease events were assessed with Cox models, log-rank tests, and mediation (path) analyses.

Findings

293 patients (median age 55 years [IQR 45·0–65·5]) were included in the longitudinal study, 22 of whom had a cardiovascular disease event during median follow-up of 3·7 years (IQR 2·7–4·8). Amygdalar activity was associated with increased bone-marrow activity (r=0·47; p<0·0001), arterial inflammation (r=0·49; p<0·0001), and risk of cardiovascular disease events (standardised hazard ratio 1·59, 95% CI 1·27–1·98; p<0·0001), a finding that remained significant after multivariate adjustments. The association between amygdalar activity and cardiovascular disease events seemed to be mediated by increased bone-marrow activity and arterial inflammation in series. In the separate cross-sectional study of patients who underwent psychometric analysis (n=13), amygdalar activity was significantly associated with arterial inflammation (r=0·70; p=0·0083). Perceived stress was associated with amygdalar activity (r=0·56; p=0·0485), arterial inflammation (r=0·59; p=0·0345), and C-reactive protein (r=0·83; p=0·0210).

Interpretation

In this first study to link regional brain activity to subsequent cardiovascular disease, amygdalar activity independently and robustly predicted cardiovascular disease events. Amygdalar activity is involved partly via a path that includes increased bone-marrow activity and arterial inflammation. These findings provide novel insights into the mechanism through which emotional stressors can lead to cardiovascular disease in human beings.

链接 http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31714-7.pdf

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