杏仁核活性能預測心血管事件

情緒壓力與心血管疾病風險增加有關。近日，頂級醫學雜誌Lancet上發表了一篇研究文章，研究者旨在明確杏仁核-參與應激調節的腦區的靜息代謝活動能否預測隨後心血管事件的風險。

來源：梅斯醫學

在2005年1月1日至2008年12月31日期間，研究者納入了在馬薩諸塞州總醫院（波士頓、美國）進行18 F-FDG PET/CT 檢查年齡超過30歲的沒有已知的心血管疾病或癌症的人員作為研究對象進行縱向研究。研究者驗證的方法評估了杏仁核活性、骨髓活性和動脈炎症，在這個橫斷面研究中，研究者分析了感知到的壓力、杏仁核活性、動脈炎症和 C-反應蛋白之間的關係。由相互不知情的研究人員對圖像分析和心血管疾病事件進行裁決。研究者採用 Cox 模型、對數秩檢驗、調解（路徑）分析來評估杏仁核活性與心血管事件之間的關係。

研究者對293例患者（中位年齡為55歲[四分位間距45.0-65.5]）進行縱向研究，在中位隨訪了3.7年（2.7-4.8年）期間，共有22例患者發生心血管疾病事件。杏仁核活性與增加的骨髓活性（r=0.47；P＜0.0001）、動脈炎症（r=0.49；P＜0.0001）以及心血管疾病事件風險（標準化的風險比為1.59，95%可信區間為1.27-1.98；P

在這項橫斷面研究中接受心理分析的患者（n=13）杏仁核的活性與動脈炎症顯著相關（r=0.7，P=0.0083）。感知到的壓力與杏仁核活性（r=0.59，P=0.0485）、動脈炎症（r=0.59；P=0.0345）、C-反應蛋白（r=0.83；P=0.0210）相關。

這是第一個將腦區活性與隨後的心血管疾病相聯繫的研究，杏仁核活性可以獨立地預測心血管事件。杏仁核活性部分被包括增加的骨髓活性和動脈炎症在內的通路所介導，這些發現為人類情感壓力可以導致心血管疾病的機制提供了新的見解。

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【論文基本信息】

題目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?

發表時間: 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

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.

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