Atmaca Murad, Yildirim Hanefi, Ozdemir Huseyin, Ogur Erkin, Tezcan Ertan
Department of Psychiatry, School of Medicine, Firat University, Elazig, Turkey.
Psychol Med. 2007 Jan;37(1):121-9. doi: 10.1017/S0033291706008968. Epub 2006 Nov 9.
No study to date has examined the effects of mood stabilizer alone and the combination of mood stabilizer and atypical antipsychotic, quetiapine, on hippocampal neurochemical markers of bipolar disordered patients concurrently. We therefore undertook a proton magnetic resonance spectroscopy (1H MRS) study of drug-free patients with bipolar disorder (drug-free group), patients undergoing valproate treatment (valproate group), patients administered valproate+quetiapine (valprote+quetiapine group) and healthy controls, focusing on the in vivo neuroanatomy of the hippocampus.
Thirty patients from the Firat University School of Medicine Department of Psychiatry and 10 healthy controls gave written informed consent to participate in the study. The patients and controls underwent proton magnetic resonance spectroscopic imaging (1H MRSI), and measures of N-acetylaspartate (NAA), choline-containing compounds (CHO), and creatine+phosphocreatine (CRE) in hippocampal regions were obtained.
The drug-free patients had significantly lower NAA/CRE and NAA/CHO ratios compared with the valproate and valproate+quetiapine groups and the healthy controls. The lower NAA/CRE and NAA/CHO ratios remained statistically significant even after covarying for age or whole brain volume compared with the valproate and valproate+quetiapine groups and healthy controls. In post hoc comparisons, a significant difference was found between the valproate+quetiapine group and the valproate group only with regard to NAA/CHO.
Our findings suggest that valproate has a neuroprotective effect. In post hoc comparisons, a significant difference was found between the valproate+quetiapine and the valproate group with regard to NAA/CHO, indicating that the addition of quetiapine further increases the level of NAA and provides an additional neuroprotective effect.
迄今为止，尚无研究同时考察单独使用心境稳定剂以及心境稳定剂与非典型抗精神病药物喹硫平联合使用对双相情感障碍患者海马神经化学标志物的影响。因此，我们对双相情感障碍未用药患者（未用药组）、接受丙戊酸盐治疗的患者（丙戊酸盐组）、接受丙戊酸盐+喹硫平治疗的患者（丙戊酸盐+喹硫平组）以及健康对照者进行了质子磁共振波谱（1H MRS）研究，重点关注海马的活体神经解剖结构。
来自菲拉特大学医学院精神病学系的30名患者和10名健康对照者书面知情同意参与本研究。患者和对照者接受了质子磁共振波谱成像（1H MRSI），并获取了海马区域中N-乙酰天门冬氨酸（NAA）、含胆碱化合物（CHO）以及肌酸+磷酸肌酸（CRE）的测量值。
与丙戊酸盐组、丙戊酸盐+喹硫平组以及健康对照者相比，未用药患者的NAA/CRE和NAA/CHO比值显著更低。即便在对年龄或全脑体积进行协变量调整后，与丙戊酸盐组、丙戊酸盐+喹硫平组以及健康对照者相比，较低的NAA/CRE和NAA/CHO比值仍具有统计学意义。在事后比较中，仅在NAA/CHO方面发现丙戊酸盐+喹硫平组与丙戊酸盐组之间存在显著差异。
我们的研究结果表明丙戊酸盐具有神经保护作用。在事后比较中，发现丙戊酸盐+喹硫平组与丙戊酸盐组在NAA/CHO方面存在显著差异，表明添加喹硫平可进一步提高NAA水平并提供额外的神经保护作用。
