Institute of Psychiatry, Department of Psychosis Studies, King's College London, London, United Kingdom.
J Psychiatry Neurosci. 2012 May;37(3):170-84. doi: 10.1503/jpn.110061.
Although early interventions in individuals with bipolar disorder may reduce the associated personal and economic burden, the neurobiologic markers of enhanced risk are unknown.
Neuroimaging studies involving individuals at enhanced genetic risk for bipolar disorder (HR) were included in a systematic review. We then performed a region of interest (ROI) analysis and a whole-brain meta-analysis combined with a formal effect-sizes meta-analysis in a subset of studies.
There were 37 studies included in our systematic review. The overall sample for the systematic review included 1258 controls and 996 HR individuals. No significant differences were detected between HR individuals and controls in the selected ROIs: striatum, amygdala, hippocampus, pituitary and frontal lobe. The HR group showed increased grey matter volume compared with patients with established bipolar disorder. The HR individuals showed increased neural response in the left superior frontal gyrus, medial frontal gyrus and left insula compared with controls, independent from the functional magnetic resonance imaging task used. There were no publication biases. Sensitivity analysis confirmed the robustness of these results.
As the included studies were cross-sectional, it remains to be determined whether the observed neurofunctional and structural alterations represent risk factors that can be clinically used in preventive interventions for prodromal bipolar disorder.
Accumulating structural and functional imaging evidence supports the existence of neurobiologic trait abnormalities in individuals at genetic risk for bipolar disorder at various scales of investigation.
尽管早期干预双相情感障碍患者可能会降低相关的个人和经济负担，但增强风险的神经生物学标志物尚不清楚。
系统综述中纳入了具有双相情感障碍增强遗传风险的个体的神经影像学研究。然后，我们在一部分研究中进行了感兴趣区域（ROI）分析和全脑荟萃分析，并结合了正式的效应大小荟萃分析。
我们的系统综述共纳入 37 项研究。系统综述的总体样本包括 1258 名对照和 996 名 HR 个体。在选定的 ROI 中，HR 个体与对照组之间未检测到显著差异：纹状体、杏仁核、海马体、垂体和额叶。与已确诊的双相情感障碍患者相比，HR 组的灰质体积增加。与对照组相比，HR 个体在左侧额上回、内侧额回和左侧脑岛表现出更高的神经反应，而与所使用的功能磁共振成像任务无关。没有发现发表偏倚。敏感性分析证实了这些结果的稳健性。
由于纳入的研究是横断面的，因此仍需要确定观察到的神经功能和结构改变是否代表可以在前驱期双相情感障碍的预防性干预中临床应用的风险因素。
越来越多的结构和功能影像学证据支持在各种研究规模上，具有双相情感障碍遗传风险的个体存在神经生物学特征异常。
