Colla M, Schubert F, Bubner M, Heidenreich J O, Bajbouj M, Seifert F, Luborzewski A, Heuser I, Kronenberg G
Department of Psychiatry, Charité, Campus Benjamin Franklin, Berlin, Germany.
Mol Psychiatry. 2009 Jul;14(7):696-704, 647. doi: 10.1038/mp.2008.26. Epub 2008 Mar 18.
While an excess of glucocorticoids is associated with hippocampal pathology in mood disorders, lithium exerts robust neuroprotective and neurotrophic effects. Here, 21 stably remitted bipolar I patients who had been on chronic lithium maintenance therapy, on average, for more than a decade, and 19 carefully matched healthy controls were studied using 3 T (1)H-magnetic resonance spectroscopy of left and right hippocampus. Salivary cortisol samples were obtained to assess activity of the hypothalamus-pituitary-adrenal system. Absolute concentrations of N-acetylaspartate (NAA), choline-containing compounds and total creatine were similar in euthymic bipolar patients and healthy controls. Hippocampal glutamate concentrations were significantly increased as an effect of patient status (patients>controls) and laterality (left hippocampus>right hippocampus). Hippocampal glutamate content (Glu) was strongly correlated with NAA. Across groups and within the patient group, diurnal saliva cortisol levels showed a significant inverse relationship with both Glu and NAA. Taken together, these results add to the concept of bipolar disorder as an illness involving disturbed hippocampal structural plasticity under the opposing influences of lithium and glucocorticoids.
虽然糖皮质激素过量与情绪障碍中的海马体病变有关，但锂具有强大的神经保护和神经营养作用。在此，对21名平均接受慢性锂维持治疗超过十年的稳定缓解的双相I型障碍患者以及19名精心匹配的健康对照者进行了研究，采用3T氢磁共振波谱对左右海马体进行检测。采集唾液皮质醇样本以评估下丘脑 - 垂体 - 肾上腺系统的活性。在心境正常的双相障碍患者和健康对照者中，N - 乙酰天门冬氨酸（NAA）、含胆碱化合物和总肌酸的绝对浓度相似。海马体谷氨酸浓度因患者状态（患者＞对照）和脑区（左侧海马体＞右侧海马体）而显著升高。海马体谷氨酸含量（Glu）与NAA密切相关。在各研究组之间以及患者组内部，日间唾液皮质醇水平与Glu和NAA均呈现显著的负相关关系。综上所述，这些结果进一步支持了双相情感障碍是一种在锂和糖皮质激素的相反影响下涉及海马体结构可塑性紊乱的疾病这一概念。
