Associations Between Brain Morphology, Inflammatory Markers, and Symptoms of Fatigue, Depression, or Anxiety in Active and Remitted Crohn's Disease.

Anne K Thomann, Mike M Schmitgen, Jule C Stephan, Matthias P Ebert, Philipp A Thomann, Kristina Szabo, Wolfgang Reindl, R Christian Wolf
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Abstract

Background: Fatigue and psychosocial impairments are highly prevalent in IBD, particularly during active disease. Disturbed brain-gut interactions may contribute to these symptoms. This study examined associations between brain structure, faecal calprotectin, and symptoms of fatigue, depression, and anxiety in persons with Crohn's disease [CD] in different disease states.

Methods: In this prospective observational study, n = 109 participants [n = 67 persons with CD, n = 42 healthy controls] underwent cranial magnetic resonance imaging, provided stool samples for analysis of faecal calprotectin, and completed questionnaires to assess symptoms of fatigue, depression, and anxiety. We analysed differences in grey matter volume [GMV] between patients and controls, and associations between regional GMV alterations, neuropsychiatric symptoms, and faecal calprotectin.

Results: Symptoms of fatigue, depression, and anxiety were increased in patients with CD compared with controls, with highest scores in active CD. Patients exhibited regionally reduced GMV in cortical and subcortical sensorimotor regions, occipitotemporal and medial frontal areas. Regional GMV differences showed a significant negative association with fatigue, but not with depression or anxiety. Subgroup analyses revealed symptom-GMV associations for fatigue in remitted but not in active CD, whereas fatigue was positively associated with faecal calprotectin in active but not in remitted disease.

Conclusion: Our findings support disturbed brain-gut interactions in CD which may be particularly relevant for fatigue during remitted disease. Reduced GMV in the precentral gyrus and other sensorimotor areas could reflect key contributions to fatigue pathophysiology in CD. A sensorimotor model of fatigue in CD could also pave the way for novel treatment approaches.

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活动期和缓解期克罗恩病患者大脑形态、炎症标志物与疲劳、抑郁或焦虑症状之间的关系。
背景:疲劳和社会心理障碍在 IBD 患者中非常普遍,尤其是在疾病活动期。脑-肠相互作用紊乱可能是导致这些症状的原因之一。本研究探讨了不同疾病状态下克罗恩病(CD)患者的大脑结构、粪便热拉稀与疲劳、抑郁和焦虑症状之间的关联:在这项前瞻性观察研究中,约109名参与者(约67名克罗恩病患者,约42名健康对照者)接受了头颅磁共振成像检查,提供了粪便样本以分析粪便钙蛋白,并填写了调查问卷以评估疲劳、抑郁和焦虑症状。我们分析了患者和对照组之间灰质体积(GMV)的差异,以及区域GMV改变、神经精神症状和粪便钙蛋白之间的关联:与对照组相比,CD 患者的疲劳、抑郁和焦虑症状有所增加,其中活动性 CD 患者的得分最高。患者皮层和皮层下感觉运动区、枕颞区和内侧额叶区的GMV呈区域性降低。区域 GMV 差异与疲劳有显著负相关,但与抑郁或焦虑无关。亚组分析显示,缓解期而非活动期CD患者的疲劳与症状-GMV相关,而活动期而非缓解期CD患者的疲劳与粪便钙蛋白呈正相关:我们的研究结果表明,CD患者的脑-肠相互作用紊乱,这可能与疾病缓解期的疲劳特别相关。前中央回和其他感觉运动区GMV的降低可能是CD患者疲劳病理生理学的关键因素。CD 疲劳的感觉运动模型还可为新型治疗方法铺平道路。
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