哮喘患者的情感神经元回路及精神-躯体的影响
2009/07/10
哮喘患者患情绪异常和焦虑的风险是无哮喘人群的2倍。上述心理因素与患者预后较差及对医疗的需求增加相关。而且，心理应激增加也可导致哮喘发作或症状的恶化。若患者抑郁减轻，则能改善哮喘症状，降低药物的使用频率。针对哮喘生物学基础的研究主要关注于外周系统。大量文献阐述了哮喘与情绪的关系，但较少研究情感神经回路在哮喘症状表现中的作用。
在有关影响哮喘症状表现因素的研究中，本文对其中与神经影像有关的研究进行了综述，其中研究因素包括对内脏信号敏感性的个体差异、期望与情绪对症状感知的影响以及与疾病慢性化相关的变化（条件反射和可塑性）。
结果显示，除了其他之前研究参与情绪调节的区域，前扣带回和岛叶对哮喘相关躯体变化较为敏感，在哮喘症状的出现和持续过程中起到重要作用。
（苏楠 审校）
Rosenkranz M, et al. Neuroimage. 2009 May 21. [Epub ahead of print]
Affective neural circuitry and mind-body influences in asthma.
Rosenkranz M, Davidson RJ.
University of Wisconsin-Madison.
Individuals with asthma have twice the risk of developing mood and anxiety disorders as individuals without asthma and these psychological factors are associated with worse outcomes and greater need for medical intervention. Similarly, asthma symptom onset and exacerbation often occur during times of increased psychological stress. Remission from depression, on the other hand, is associated with improvement in asthma symptoms and decreased usage of asthma medication. Yet research aimed at understanding the biological underpinnings of asthma has focused almost exclusively on the periphery. An extensive literature documents the relationship between emotion and asthma, but little work has explored the function of affective neural circuitry in asthma symptom expression. Therefore, the following review integrates neuroimaging research related to factors that may impact symptom expression in asthma, such as individual differences in sensitivity to visceral signals, the influence of expectation and emotion on symptom perception, and changes related to disease chronicity, such as conditioning and plasticity. The synthesis of these literatures suggests that the insular and anterior cingulate cortices, in addition to other brain regions previously implicated in the regulation of emotion, may be both responsive to asthma-related bodily changes and important in influencing the appearance and persistence of symptom expression in asthma.
