Despite the rapid increase of reports of exhaustion syndrome (ES) due to daily occupational stress, the mechanisms underlying ES are unknown. We used voxel-based 1H-MR spectroscopy to examine the potential role of glutamate in this condition. The levels of glutamate were found to be elevated among ES patients (n = 30, 16 females) compared with controls (n = 31, 15 females). Notably, this increase was detected only in the anterior cingulate and mesial prefrontal cortex (ACC/mPFC), and the glutamate levels were linearly correlated with the degree of perceived stress. Furthermore, there was a sex by group interaction, as the glutamate elevation was present only in female patients. Female but not male ES patients also showed an increase in N-acetyl aspartate (NAA) levels in the amygdala. No group differences were detected in glutamine concentration (also measured). These data show the key role of glutamate in stress-related neuronal signaling and the specific roles of the amygdala and ACC/mPFC. The data extend previous reports about the neurochemical basis of stress and identify a potential neural marker and mediator of ES due to occupational stress. The observation of specific sex differences provides a tentative explanation to the well-known female predominance in stress-related psychopathology.

中文翻译：

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MRS 显示因职业压力导致的疲惫综合征患者的谷氨酸水平升高。

尽管由于日常职业压力导致的疲惫综合征 (ES) 报告迅速增加，但 ES 的潜在机制尚不清楚。我们使用基于体素的 1 H-MR 光谱来检查谷氨酸在这种情况下的潜在作用。与对照组（n = 31、15 名女性）相比，ES 患者（n = 30、16 名女性）的谷氨酸水平升高。值得注意的是，这种增加仅在前扣带回和内侧前额叶皮层 (ACC/mPFC) 中检测到，并且谷氨酸水平与感知压力的程度呈线性相关。此外，群体互动存在性别差异，因为谷氨酸升高仅存在于女性患者中。女性而非男性 ES 患者的杏仁核中 N-乙酰天冬氨酸 (NAA) 水平也有所增加。在谷氨酰胺浓度（也测量）中没有检测到组差异。这些数据显示了谷氨酸在压力相关神经元信号传导中的关键作用以及杏仁核和 ACC/mPFC 的具体作用。这些数据扩展了先前关于压力的神经化学基础的报告，并确定了由于职业压力导致 ES 的潜在神经标志物和介质。对特定性别差异的观察为压力相关精神病理学中众所周知的女性占主导地位提供了初步解释。