Hajek Tomas, Kopecek Miloslav, Kozeny Jiri, Gunde Eva, Alda Martin, Höschl Cyril
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
J Affect Disord. 2009 Jun;115(3):395-410. doi: 10.1016/j.jad.2008.10.007. Epub 2008 Nov 18.
The amygdala plays an important role in the regulation of emotions and has been implicated in the pathophysiology of mood disorders. Studies of amygdala volumes in mood disorders have been conflicting, with findings of increased, decreased and unchanged amygdala volumes in patients relative to controls. We present the largest meta-analysis of amygdala volumes in mood disorders and the first one to investigate modifying effects of clinical, demographic and methodological variables.
We reviewed 40 magnetic resonance imaging studies investigating amygdala volumes in patients with unipolar or bipolar disorders. For meta-analysis we used standardized differences in means (SDM) and random effect models. In the search for sources of heterogeneity, we subdivided the studies based on diagnosis, setting, age, medication status, sex, duration of illness, slice thickness, interrater reliability of tracing and anatomical definitions used.
The volumes of the left and right amygdala in bipolar (N=215) or unipolar (N=409) patients were comparable to controls. Bipolar children and adolescents had significantly smaller left amygdala volumes relative to controls (SDM=-0.34, 95%CI=-0.65; -0.04, z=-2.20, p=0.03), whereas bipolar adults showed a trend for left amygdala volume increases (SDM=0.46, 95%CI=-0.03; 0.96, z=1.83, p=0.07). Unipolar inpatients had significantly larger left (SDM=0.35, 95%CI=0.03; 0.67, z=-2.17, p=0.03) amygdala volumes than controls, with no significant amygdala volume changes in unipolar outpatients.
Heterogeneity of included studies.
The absence of overall differences in amygdala volumes, in the presence of significant and sometimes mirror changes in patient subgroups, demonstrates marked heterogeneity among mood disorders. Amygdala volume abnormalities may not be associated with mood disorders per se, but rather may underlie only some dimensions of illness or represent artifacts of medication or comorbid conditions.
杏仁核在情绪调节中起重要作用，且与情绪障碍的病理生理学有关。关于情绪障碍患者杏仁核体积的研究结果相互矛盾，有研究发现患者的杏仁核体积相对于对照组增加、减少或无变化。我们进行了关于情绪障碍患者杏仁核体积的最大规模荟萃分析，也是首个研究临床、人口统计学和方法学变量调节作用的分析。
我们回顾了40项调查单相或双相情感障碍患者杏仁核体积的磁共振成像研究。荟萃分析采用标准化均值差异（SDM）和随机效应模型。为寻找异质性来源，我们根据诊断、研究背景、年龄、用药情况、性别、病程、切片厚度、追踪的评分者间信度以及所使用的解剖学定义对研究进行了细分。
双相情感障碍（N = 215）或单相情感障碍（N = 409）患者的左右杏仁核体积与对照组相当。双相情感障碍儿童和青少年相对于对照组，左侧杏仁核体积显著更小（SDM = -0.34，95%CI = -0.65；-0.04，z = -2.20，p = 0.03），而双相情感障碍成年人左侧杏仁核体积有增加趋势（SDM = 0.46，95%CI = -0.03；0.96，z = 1.83，p = 0.07）。单相情感障碍住院患者的左侧杏仁核体积显著大于对照组（SDM = 0.35，95%CI = 0.03；0.67，z = -2.17，p = 0.03），单相情感障碍门诊患者的杏仁核体积无显著变化。
纳入研究存在异质性。
在患者亚组存在显著且有时呈镜像变化的情况下，杏仁核体积无总体差异，这表明情绪障碍之间存在明显异质性。杏仁核体积异常可能并非与情绪障碍本身相关，而可能仅为疾病某些维度的基础，或代表药物或共病情况的假象。
