Table_5_Gray Matter Structural Alterations in Social Anxiety Disorder: A Voxel-Based Meta-Analysis.doc

The current insight into the neurobiological pathogenesis underlying social anxiety disorder (SAD) is still rather limited. We implemented a meta-analysis to explore the neuroanatomical basis of SAD. We undertook a systematic search of studies comparing gray matter volume (GMV) differences between SAD patients and healthy controls (HC) using a whole-brain voxel-based morphometry (VBM) approach. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of SAD patients compared with HC. We included eleven studies with 470 SAD patients and 522 HC in the current meta-analysis. In the main meta-analysis, relative to HC, SAD patients showed larger GMVs in the left precuneus, right middle occipital gyrus (MOG) and supplementary motor area (SMA), as well as smaller GMV in the left putamen. In the subgroup analyses, compared with controls, adult patients (age ≥ 18 years) with SAD exhibited larger GMVs in the left precuneus, right superior frontal gyrus (SFG), angular gyrus, middle temporal gyrus (MTG), MOG and SMA, as well as a smaller GMV in the left thalamus; SAD patients without comorbid depressive disorder exhibited larger GMVs in the left superior parietal gyrus and precuneus, right inferior temporal gyrus, fusiform gyrus, MTG and superior temporal gyrus (STG), as well as a smaller GMV in the bilateral thalami; and currently drug-free patients with SAD exhibited a smaller GMV in the left thalamus compared with HC while no larger GMVs were found. For SAD patients with different clinical features, our study revealed directionally consistent larger cortical GMVs and smaller subcortical GMVs, including locationally consistent larger precuneus and thalamic deficits in the left brain. Age, comorbid depressive disorder and concomitant medication use of the patients might be potential confounders of SAD at the neuroanatomical level.

目前学界对社交焦虑障碍（social anxiety disorder, SAD）的神经生物学发病机制的认知仍较为有限。本研究开展了一项元分析，以探究社交焦虑障碍的神经解剖学基础。我们系统检索了采用全脑基于体素的形态测量学（voxel-based morphometry, VBM）方法，对比社交焦虑障碍患者与健康对照（healthy controls, HC）灰质体积（gray matter volume, GMV）差异的相关研究。采用各向异性效应量版本的基于种子点的d映射（anisotropic effect size version of seed-based d mapping, AES-SDM）元分析方法，对比分析社交焦虑障碍患者与健康对照的灰质体积差异。本次元分析共纳入11项研究，涉及470名社交焦虑障碍患者与522名健康对照。主元分析结果显示，相较于健康对照，社交焦虑障碍患者在左侧楔前叶、右侧枕中回（middle occipital gyrus, MOG）及补充运动区（supplementary motor area, SMA）的灰质体积显著升高，而左侧壳核的灰质体积显著降低。亚组分析结果表明：与健康对照相比，成年（年龄≥18岁）社交焦虑障碍患者在左侧楔前叶、右侧额上回（superior frontal gyrus, SFG）、角回、颞中回（middle temporal gyrus, MTG）、枕中回及补充运动区的灰质体积显著升高，左侧丘脑的灰质体积显著降低；无共病抑郁障碍的社交焦虑障碍患者在左侧顶上回、楔前叶、右侧颞下回、梭状回、颞中回及颞上回（superior temporal gyrus, STG）的灰质体积显著升高，双侧丘脑的灰质体积显著降低；当前未服药的社交焦虑障碍患者相较于健康对照仅表现为左侧丘脑灰质体积降低，未观察到灰质体积升高的脑区。针对具有不同临床特征的社交焦虑障碍患者，本研究发现其皮层灰质体积呈方向性升高、皮层下灰质体积呈方向性降低的模式，包括左侧脑区一致的楔前叶体积升高与丘脑体积缺陷。患者的年龄、共病抑郁障碍情况及合并用药情况，可能是社交焦虑障碍神经解剖学层面的潜在混杂因素。