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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.2424

摘要内容如下：

重要性

驻扎在国际上的美国政府人员报告了异常健康事件（AHI），一些人出现了持续的衰弱症状。

目的

评估磁共振成像（MRI）检测到的脑损伤在AHIS参与者中的潜在存在，与匹配良好的对照组相比。

设计、设置和参与者

这项探索性研究于2018年6月至2022年11月在美国国立卫生研究院（NIH）临床中心和NIH MRI研究机构进行。81名AHI参与者和48名年龄和性别匹配的对照参与者（其中29人与AHI组的就业情况相似）接受了临床、体积和功能MRI评估。高质量的扩散MRI扫描和第二次容积扫描也在不同的时间段内进行。对结构性MRI采集协议进行了优化，以实现高可重复性。49名患有AHIS的参与者在首次就诊后约6至12个月内至少进行了一次额外的成像检查。

曝光

阿希斯。

主要成果和措施

从多个模态获得的组级定量指标：（1）体积测量，体素方式和感兴趣区（ROI）方式；（2）扩散MRI衍生的度量，体素方式和ROI方式；和（3）使用功能MRI的ROI-wise网络内静息态功能连接。探索性数据分析使用了标准的非参数检验和贝叶斯多水平模型。

结果

在81名AHIS参与者中，平均（SD）年龄为42（9）岁，49%为女性；在48名对照参与者中，平均（SD）年龄为43（11）岁，42%为女性。最早在经历AHIS后14天进行成像扫描，中位延迟期为80（IQR，36-544）天。在对多重比较进行调整后，在任何MRI模式下，AHIS参与者和对照参与者之间均未发现显著差异。在未调整的阈值下（P<.05），与对照组参与者相比，AHIS参与者在显著性网络中具有较低的内部网络连接性，较大的胼胝体，以及胼胝体、上纵束、扣带、小脑下脚和杏仁核的扩散MRI差异。结构MRI测量具有高度可重复性（所有整体体积ROI的中位变异系数<1%，所有白质ROI的扩散指标的中位变异系数<1.5%）。即使是与对照组参与者有较大差异的个体，也表现出稳定的纵向结果（通常，在整个访视中<±1%），这表明没有发生病变。影像学和临床变量之间的关系较弱（中位数Spearmanρ=0.10）。这项研究没有重复先前发表的对AHIS的调查结果。

结论和相关性

在这项探索性神经影像学研究中，在对多重比较进行调整后，报告AHIS的个体和匹配的对照参与者之间的大脑结构或功能的影像学测量没有显著差异。

英文原文如下：

Abstracts

Importance  US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms.

Objective  To assess the potential presence of magnetic resonance imaging (MRI)-detectable brain lesions in participants with AHIs, with respect to a well-matched control group.

Design, Setting, and Participants  This exploratory study was conducted at the National Institutes of Health (NIH) Clinical Center and the NIH MRI Research Facility between June 2018 and November 2022. Eighty-one participants with AHIs and 48 age- and sex-matched control participants, 29 of whom had similar employment as the AHI group, were assessed with clinical, volumetric, and functional MRI. A high-quality diffusion MRI scan and a second volumetric scan were also acquired during a different session. The structural MRI acquisition protocol was optimized to achieve high reproducibility. Forty-nine participants with AHIs had at least 1 additional imaging session approximately 6 to 12 months from the first visit.

Exposure  AHIs.

Main Outcomes and Measures  Group-level quantitative metrics obtained from multiple modalities: (1) volumetric measurement, voxel-wise and region of interest (ROI)-wise; (2) diffusion MRI-derived metrics, voxel-wise and ROI-wise; and (3) ROI-wise within-network resting-state functional connectivity using functional MRI. Exploratory data analyses used both standard, nonparametric tests and bayesian multilevel modeling.

Results  Among the 81 participants with AHIs, the mean (SD) age was 42 (9) years and 49% were female; among the 48 control participants, the mean (SD) age was 43 (11) years and 42% were female. Imaging scans were performed as early as 14 days after experiencing AHIs with a median delay period of 80 (IQR, 36-544) days. After adjustment for multiple comparisons, no significant differences between participants with AHIs and control participants were found for any MRI modality. At an unadjusted threshold (P < .05), compared with control participants, participants with AHIs had lower intranetwork connectivity in the salience networks, a larger corpus callosum, and diffusion MRI differences in the corpus callosum, superior longitudinal fasciculus, cingulum, inferior cerebellar peduncle, and amygdala. The structural MRI measurements were highly reproducible (median coefficient of variation <1% across all global volumetric ROIs and <1.5% for all white matter ROIs for diffusion metrics). Even individuals with large differences from control participants exhibited stable longitudinal results (typically, <±1% across visits), suggesting the absence of evolving lesions. The relationships between the imaging and clinical variables were weak (median Spearman ρ = 0.10). The study did not replicate the results of a previously published investigation of AHIs.

Conclusions and Relevance  In this exploratory neuroimaging study, there were no significant differences in imaging measures of brain structure or function between individuals reporting AHIs and matched control participants after adjustment for multiple comparisons.

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