小儿双相情感障碍中的躁狂、谷氨酸/谷氨酰胺与利培酮：前扣带回皮质的质子磁共振波谱研究
Mania, glutamate/glutamine and risperidone in pediatric bipolar disorder: a proton magnetic resonance spectroscopy study of the anterior cingulate cortex.
作者信息
Moore Constance M, Biederman Joseph, Wozniak Janet, Mick Eric, Aleardi Megan, Wardrop Megan, Dougherty Meghan, Harpold Terri, Hammerness Paul, Randall Edin, Lyoo In Kyoon, Renshaw Perry F
机构信息
Brain Imaging Center, McLean Hospital, Belmont, MA 02478, USA.
出版信息
J Affect Disord. 2007 Apr;99(1-3):19-25. doi: 10.1016/j.jad.2006.08.023. Epub 2006 Sep 26.
BACKGROUND
The purpose of this study was to investigate the anterior cingulate cortex (ACC) glutamate/glutamine (Glx) to creatine ratio (Glx/Cr) in two groups of children with Bipolar Disorder (BPD): those exhibiting manic symptoms requiring treatment and those being stably treated with the atypical antipsychotic risperidone. Atypical antipsychotics have been shown to increase serum glutamate levels and ACC Glx/Cr in subjects with schizophrenia. In this study, we hypothesized that the children with BPD in need of treatment would have lower Glx/Cr compared with the children with BPD being stably treated with risperidone.
METHODS
Proton MR spectra were acquired, at 1.5 T, from the ACC of eighteen subjects with a DSM-IV diagnosis of BPD: ten (11.10+/-3.48 years; five female) were manic and not medicated with any antipsychotic and eight (10.88+/-2.99 years; one female) were medicated with the atypical antipsychotic risperidone.
RESULTS
Children with BPD exhibiting manic symptoms requiring treatment had lower Glx/Cr than children with BPD being stably treated with the atypical antipsychotic risperidone. The children treated with risperidone also had significantly lower YMRS and CGI-Mania scores than the children not treated with risperidone. Both YMRS and CGI-Mania scores correlated negatively with ACC Glx/Cr levels.
LIMITATIONS
The cross-sectional design, small sample size, the use of Glx rather than glutamate or glutamine and the use of Cr ratios rather than absolute concentrations are limitations of this study.
CONCLUSIONS
Children with mania have lower Glx/Cr levels than children with BPD being stably treated with the atypical antipsychotic risperidone. Mania may be associated with reduced glutamate/glutamine levels in the ACC: other imaging studies have shown mania associated with hypometabolism in the ACC. These reductions in glutamate/glutamine may be increased following successful treatment with glutamatergic agents.
背景
本研究旨在调查两组双相情感障碍（BPD）儿童前扣带回皮质（ACC）中谷氨酸/谷氨酰胺（Glx）与肌酸的比率（Glx/Cr）：一组表现出需要治疗的躁狂症状，另一组正在接受非典型抗精神病药物利培酮的稳定治疗。研究表明，非典型抗精神病药物可增加精神分裂症患者的血清谷氨酸水平和ACC的Glx/Cr。在本研究中，我们假设与接受利培酮稳定治疗的BPD儿童相比，需要治疗的BPD儿童的Glx/Cr会更低。
方法
在1.5T条件下，从18名符合DSM-IV诊断标准的BPD受试者的ACC获取质子磁共振波谱：其中10名（年龄11.10±3.48岁；5名女性）处于躁狂状态且未服用任何抗精神病药物，8名（年龄10.88±2.99岁；1名女性）正在服用非典型抗精神病药物利培酮。
结果
表现出需要治疗的躁狂症状的BPD儿童的Glx/Cr低于接受非典型抗精神病药物利培酮稳定治疗的BPD儿童。接受利培酮治疗的儿童的Young躁狂评定量表（YMRS）和临床总体印象-躁狂量表（CGI-Mania）评分也显著低于未接受利培酮治疗的儿童。YMRS和CGI-Mania评分均与ACC的Glx/Cr水平呈负相关。
局限性
本研究的局限性在于采用横断面设计、样本量小、使用Glx而非谷氨酸或谷氨酰胺以及使用Cr比率而非绝对浓度。
结论
与接受非典型抗精神病药物利培酮稳定治疗的BPD儿童相比，躁狂儿童的Glx/Cr水平更低。躁狂可能与ACC中谷氨酸/谷氨酰胺水平降低有关：其他影像学研究表明躁狂与ACC代谢减退有关。谷氨酸能药物成功治疗后，这些谷氨酸/谷氨酰胺的降低可能会增加。
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