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中华诊断学电子杂志 ›› 2024, Vol. 12 ›› Issue (04) : 230 -235. doi: 10.3877/cma.j.issn.2095-655X.2024.04.003

专题笔谈

海马与情绪障碍、内脏疾病之间的关系
蒋蔚茹1, 徐三荣1,()   
  1. 1.200040 上海,复旦大学附属华山医院消化内科
  • 收稿日期:2024-08-26 出版日期:2024-11-26
  • 通信作者: 徐三荣

The relationship between hippocampus and emotional disorders,visceral diseases

Weiru Jiang1, Sanrong Xu1,()   

  1. 1.Department of Gastroenterology,Huashan Hospital Affiliated to Fudan University, Shanghai 200040,China
  • Received:2024-08-26 Published:2024-11-26
  • Corresponding author: Sanrong Xu
引用本文:

蒋蔚茹, 徐三荣. 海马与情绪障碍、内脏疾病之间的关系[J]. 中华诊断学电子杂志, 2024, 12(04): 230-235.

Weiru Jiang, Sanrong Xu. The relationship between hippocampus and emotional disorders,visceral diseases[J]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(04): 230-235.

20 世纪70 年代,美国医生恩格尔对临床医学中占据主导位置的生物医学模式作出挑战,提出了“生物-心理-社会医学模式”,从此“心身疾病”的概念进入了人们的视线。在这个概念中,心理疾病是“因”,躯体症状是“果”,尽管心身疾病患者的躯体症状没有明确的生物学异常,但其临床症状是真实存在的,这类疾病被称为“功能性疾病”。到现在为止,人们还是认为,在心身疾病中,作为病因的心理障碍与躯体疾病一样,同样不存在明显的生物学异常。笔者认为心理障碍作为一种疾病,可能存在生物学异常,这种异常与人类大脑边缘系统,尤其是海马的变化有关。同时还进一步认为,边缘系统、海马的变化不仅与躯体的功能性疾病有关,同时与某些躯体器质性疾病也有关。笔者旨在说明,躯体功能性疾病与心理障碍之间并非一种因果关系,两者均可能是海马变化的后果,这些疾病的持续存在又可反过来促使海马病变加重,形成恶性循环。

In the 1970s,the American doctor George L.Engel challenged the dominant biomedical model in clinical medicine and put forward the "bio-psycho-social medical model",from which the concept of "psychosomatic disease" caught people′s attention.In this concept,mental illness is the "cause" and physical symptoms are the "effect",although the physical symptoms of patients with psychosomatic diseases do not have clear biological abnormalities,their clinical symptoms are real,such diseases are called"functional diseases".Until now,it is still believed that in psychosomatic diseases,psychological disorders as a cause of illness,like somatic diseases,do not have obvious biological abnormalities.The author believes that psychological disorders,as a kind of disease,may have biological abnormalities,which are related to the changes in the limbic system of the human brain,especially the hippocampus.At the same time,it is further believed that the changes in the limbic system and hippocampus are not only related to the functional diseases of the body,but also related to some organic diseases of the body.The purpose of this paper is to show that the relationship between physical functional diseases and psychological disorders is not a causal relationship,but both may be the result of changes in the hippocampus,and the persistence of these diseases may in turn promote the deterioration of hippocampal lesions,forming a vicious circle.

图1 海马部分结构图 注:海马体包含齿状回(DG)和包含有CA3、CA2 及CA1 3 个亚区的阿蒙角。DG 呈V 形结构,其内侧和下部覆盖阿蒙角的CA3 亚区。DG 的主要神经元细胞是颗粒细胞,其胞体投射成1 个独立层面(颗粒细胞层,图中gran 所示),其树突状分枝投射于分子层(MOL)。DG 上、下两叶之间为门区(图中hi 所示)。CA3 有不同的分层,神经元层由锥体细胞胞体紧密堆积组成,形成锥体层(S.Pyr)。锥体细胞具有基底树突,基底树突伸入更下层的始层(S.Or),其顶端树突向上投射形成3 层:透明层(S.Luc)、放射层(S.Rad)和腔隙分子层(S.Lac-Mol)。这3 层又称为顶端树突神经纤毛。该图引自参考文献11。
图2 边缘系统、海马损伤与情绪障碍和功能性、器质性躯体疾病之间的关系 注:海马、边缘系统的变化引起情绪障碍和下丘脑-垂体-内分泌腺体轴的改变,轴的改变可以导致功能性躯体症状和自身免疫性疾病、恶性肿瘤等躯体器质性疾病;导致情绪障碍;可使高血压病、糖尿病等疾病加重。这些情况形成一种负反馈。COPD 为慢性阻塞性肺疾病;HPA 为下丘脑-垂体-肾上腺;HPT 为下丘脑-垂体-甲状腺;HPG 为下丘脑-垂体-性腺;SLE 为系统性红斑狼疮;IBD 为炎症性肠病;CRH为促肾上腺皮质释放激素;TRH 为促甲状腺激素释放激素;FGID 为功能性胃肠病
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