Gulf War Illness

Some veterans who served in the Gulf War subsequently complained of a wide
variety of physical and neuro-psychological symptoms, termed Gulf War
Illness (GWI). Several investigators have attributed these symptoms to
stress. In contrast, Haley and coworkers reported clusters of symptoms
into three primary syndromes and reported reductions of the neuronal
marker NAcetyl aspartate (NAA, a marker of neuron integrity and density)
in the basal ganglia and pons of some GWI subjects. Based on this and
other data they suggested that GWI has a neurological component. One
limitation of previous studies is that post traumatic stress disorder
(PTSD), depresssion, and alcoholism also cause structural and metabolic
changes in the brain; the previous studies did not carefully control for
these confounds. The primary goal of this project was to test the
hypothesis that: subjects with GWI have metabolic and/or morphological
changes in their brain, which are not accounted for by confounds such as
post traumatic stress disorder (PTSD), alcohol abuse, and depression. A
secondary goal was to determine: if these brain changes correlate with CNS
signs and symptoms of GWI. This project studied 200 subjects with GWI and
200 Gulf War Veteran (GWV) controls drawn from Northern California and
surrounding regions. GWI was defined by the same criteria used in previous
VA cooperative studies. The extent of alcohol abuse and PTSD symptoms was
measured. MRI/MRS, audiovestibular, neuro-psychological and other
measurements were also made.

曾服役于海湾战争的退伍军人后续出现了多种躯体及神经心理症状，此类症状被称为海湾战争疾病（Gulf War Illness, GWI）。既往已有多项研究将此类症状归因于应激反应。与之相反，Haley及其团队将症状归纳为三类核心综合征，并报道部分GWI患者的基底神经节与脑桥内神经元标志物N-乙酰天门冬氨酸（N-acetyl aspartate, NAA，一种反映神经元完整性与密度的标志物）水平出现下降。基于上述发现及其他相关数据，他们提出GWI存在神经学层面的致病组分。

既往研究存在一项局限：创伤后应激障碍（Post Traumatic Stress Disorder, PTSD）、抑郁症与酒精成瘾同样会引发大脑结构与代谢改变，但既往研究未针对这些混杂因素进行严格控制。

本项目的首要目标为验证如下假说：GWI患者的大脑存在代谢和/或形态学改变，且此类改变无法由创伤后应激障碍、酒精滥用及抑郁症等混杂因素所解释。本项目的次要目标为明确：上述大脑改变是否与GWI的中枢神经系统（Central Nervous System, CNS）相关体征及症状存在关联。

本项目共招募200名GWI患者与200名海湾战争退伍军人（Gulf War Veteran, GWV）对照受试者，招募范围覆盖加利福尼亚州北部及其周边区域。GWI的诊断标准沿用了既往美国退伍军人事务部（Veterans Affairs, VA）合作研究中采用的统一标准。研究人员对受试者的酒精滥用程度与PTSD症状严重程度进行了评估，同时采集了磁共振成像/磁共振波谱（MRI/MRS）、前庭听力学、神经心理学及其他相关检测数据。