Hajek Tomas, Kozeny Jiri, Kopecek Miloslav, Alda Martin, Höschl Cyril
Department of Psychiatry, Dalhousie University, Halifax, NS.
J Psychiatry Neurosci. 2008 Mar;33(2):91-9.
Converging evidence suggests that the subgenual cingulate (SGC) is implicated in regulation of mood and in the pathophysiology of mood disorders. Our objective was to carry out the first meta-analysis of SGC volumes in patients with mood disorders.
We reviewed 10 volumetric magnetic resonance imaging studies of SGC volumes in patients with unipolar depression and bipolar disorders. For meta-analysis, we used standardized differences between means (SDMs) and random effects models. In the search for sources of heterogeneity, we subdivided the studies on the basis of diagnosis and presence of family history.
The volumes of left and right SGC in patients with mood disorders were significantly reduced relative to healthy control subjects (SDM -0.38, 95% confidence interval [CI] -0.67 to -0.1 and SDM -0.2, 95% CI -0.4 to -0.007, respectively). There were significant SGC volume reductions in patients with unipolar (left SGC SDM -0.5, 95% CI -0.92 to -0.07; right SGC SDM -0.33, 95% CI -0.64 to -0.02,), but not bipolar, disorder. Patients with a positive family history of mood disorders showed significant left SGC volume decrease (SDM -0.52, 95% CI -0.96 to -0.07), which was not present among subjects without family history of mood disorders. There was no association between age and SGC volumes.
The available evidence suggests the existence of left and less robust right SGC volumetric reductions in patients with mood disorders, predominantly in those with unipolar depression. The effect size of this difference was moderate and increased in more homogeneous subgroups of patients with a positive family history. The clustering of SGC abnormalities in patients with a family history, their presence early in the illness course and their lack of progression with age make SGC a candidate for a primary vulnerability marker, although studies in unaffected high-risk subjects are missing.
越来越多的证据表明，膝下扣带回（SGC）与情绪调节及情绪障碍的病理生理学有关。我们的目的是对情绪障碍患者的SGC体积进行首次荟萃分析。
我们回顾了10项关于单相抑郁症和双相情感障碍患者SGC体积的容积磁共振成像研究。对于荟萃分析，我们使用了均值标准化差异（SDM）和随机效应模型。为了寻找异质性来源，我们根据诊断和家族史的有无对研究进行了细分。
与健康对照受试者相比，情绪障碍患者左右SGC的体积显著减小（SDM分别为-0.38，95%置信区间[CI]-0.67至-0.1；SDM为-0.2，95%CI-0.4至-0.007）。单相障碍（左SGC的SDM为-0.5，95%CI-0.92至-0.07；右SGC的SDM为-0.33，95%CI-0.64至-0.02）而非双相障碍患者的SGC体积有显著减小。有情绪障碍家族史阳性的患者左SGC体积显著减小（SDM为-0.52，95%CI-0.96至-0.07），而无情绪障碍家族史的受试者中未出现这种情况。年龄与SGC体积之间没有关联。
现有证据表明，情绪障碍患者存在左侧SGC体积减小，右侧SGC体积减小的情况较弱，主要见于单相抑郁症患者。这种差异的效应大小适中，在家族史阳性的更同质亚组患者中有所增加。有家族史患者的SGC异常聚集、在病程早期出现且不随年龄进展，这使得SGC成为一个主要易损标志物的候选者，尽管缺乏对未受影响的高危受试者的研究。
