Hatch Jessica K, Scola Gustavo, Olowoyeye Omodele, Collins Jordan E, Andreazza Ana C, Moody Alan, Levitt Anthony J, Strauss Bradley H, Lanctot Krista L, Goldstein Benjamin I
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada.
J Clin Psychiatry. 2017 Mar;78(3):e286-e293. doi: 10.4088/JCP.16m10762.
Bipolar disorder (BD) is associated with increased rates of cardiovascular disease (CVD). Brain-derived neurotrophic factor (BDNF) and inflammatory markers are leading biomarkers in BD. We examined whether these biomarkers underlie the link between BD and CVD proxies among adolescents with bipolar spectrum disorders.
Subjects were 60 adolescents, 13-19 years old (40 with BD and 20 healthy controls [HCs]). Semistructured interviews determined diagnoses based on DSM-IV. Serum was assayed for BDNF, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Carotid intima media thickness (cIMT) and flow-mediated dilation were assessed using ultrasound. Procedures were conducted at a subspecialty clinic (January 2011-May 2014).
Adolescents with BD had significantly greater waist circumference (BD: 81.72 cm [11.67 cm], HC: 75.64 cm [8.63 cm]; U = 547.5, P = .021), body mass index (BMI) (BD: 25.50 kg/m²undefined[5.29 kg/m²], HC: 21.76 kg/m² [3.43 kg/m²]; U = 608.5, P < .0001), pulse pressure (BD: 42.31 mm Hg [10.57 mm Hg], HC: 33.84 mm Hg [6.69 mm Hg]; U = 561.5, P < .001), and IL-6 (BD: 8.93 pg/mL [7.71 pg/mL], HC: 4.96 pg/mL [6.38 pg/mL]; U = 516.0, P < .0001) than HC adolescents. Subjects with BD-I (n = 14) and BD-II (n = 16) had greater IL-6 versus HCs (F₃,₅₁ = 5.29, P = .003). Controlling for BMI and age did not alter these findings. IL-6 was higher in symptomatic (n = 19) and asymptomatic BD (n = 21) versus that found in HCs (F₂,₅₂ = 7.96, P = .001). In symptomatic BD, lower BDNF was associated with greater mean cIMT (ρ = -0.507, P = .037).
This study found evidence of increased inflammation among adolescents with BD. While present findings suggest a potential interplay between symptomatic status, biomarkers, and atherosclerosis proxies, there were no significant differences in cIMT or flow-mediated dilation in adolescents with BD compared to HCs. This may indicate that there is potential opportunity for CVD prevention strategies in adolescents with BD.
双相情感障碍（BD）与心血管疾病（CVD）发病率增加相关。脑源性神经营养因子（BDNF）和炎症标志物是BD的主要生物标志物。我们研究了这些生物标志物是否是双相谱系障碍青少年中BD与CVD替代指标之间联系的基础。
研究对象为60名13 - 19岁的青少年（40名BD患者和20名健康对照[HCs]）。通过半结构化访谈根据《精神疾病诊断与统计手册》第四版（DSM-IV）确定诊断。检测血清中的BDNF、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）。使用超声评估颈动脉内膜中层厚度（cIMT）和血流介导的血管舒张功能。研究程序于一家专科诊所进行（2011年1月至2014年5月）。
BD青少年的腰围（BD：81.72厘米[11.67厘米]，HC：75.64厘米[8.63厘米]；U = 547.5，P = 0.021）、体重指数（BMI）（BD：25.50千克/平方米[5.29千克/平方米]，HC：21.76千克/平方米[3.43千克/平方米]；U = 608.5，P < 0.0001）、脉压（BD：42.31毫米汞柱[10.57毫米汞柱]，HC：33.84毫米汞柱[6.69毫米汞柱]；U = 561.5，P < 0.001）和IL-6（BD：8.93皮克/毫升[7.71皮克/毫升]，HC：4.96皮克/毫升[6.38皮克/毫升]；U = 516.0，P < 0.0001）均显著高于HC青少年。I型双相障碍（BD-I）（n = 14）和II型双相障碍（BD-II）（n = 16）患者的IL-6水平高于HCs（F₃,₅₁ = 5.29，P = 0.003）。控制BMI和年龄后，这些结果未改变。有症状的BD患者（n = 19）和无症状的BD患者（n = 21）的IL-6水平高于HCs（F₂,₅₂ = 7.96，P = 0.001）。在有症状的BD患者中，较低的BDNF与较高的平均cIMT相关（ρ = -0.507，P = 0.037）。
本研究发现BD青少年存在炎症增加的证据。虽然目前的研究结果表明症状状态、生物标志物和动脉粥样硬化替代指标之间可能存在相互作用，但与HCs相比，BD青少年的cIMT或血流介导的血管舒张功能没有显著差异。这可能表明BD青少年有实施CVD预防策略的潜在机会。
