University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Biol Psychiatry. 2017 Sep 1;82(5):339-350. doi: 10.1016/j.biopsych.2016.12.032. Epub 2017 Jan 27.
We systematically reviewed and meta-analyzed the association of late-life depression (LLD) with hippocampal volume (HCV) and total brain volume (TBV), and of cortisol levels with HCV, including subgroup analyses of depression characteristics and methodological aspects.
We searched PubMed and Embase for original studies that examined the cross-sectional relationship between LLD and HCV or TBV, and 46 studies fulfilled the inclusion criteria. Standardized mean differences (Hedges' g) between LLD and control subjects were calculated from crude or adjusted brain volumes using random effects. Standardized Fisher transformations of the correlations between cortisol levels and HCVs were calculated using random effects.
We included 2702 LLD patients and 11,165 control subjects from 35 studies examining HCV. Relative to control subjects, patients had significantly smaller HCVs (standardized mean difference = -0.32 [95% confidence interval, -0.44 to -0.19]). Subgroup analyses showed that late-onset depression was more strongly associated with HCV than early-onset depression. In addition, effect sizes were larger for case-control studies, studies with lower quality, and studies with small sample size, and were almost absent in cohort studies and studies with larger sample sizes. For TBV, 2523 patients and 7880 control subjects from 31 studies were included. The standardized mean difference in TBV between LLD and control subjects was -0.10 (95% confidence interval, -0.16 to -0.04). Of the 12 studies included, higher levels of cortisol were associated with smaller HCV (correlation = -0.11 [95% confidence interval, -0.18 to -0.04]).
While an overall measure of LLD may be associated with smaller HCVs, differentiating clinical aspects of LLD and examining methodological issues show that this relationship is not straightforward.
我们系统地回顾和荟萃分析了晚年抑郁症（LLD）与海马体积（HCV）和总脑体积（TBV）的关系，以及皮质醇水平与 HCV 的关系，包括抑郁特征和方法学方面的亚组分析。
我们在 PubMed 和 Embase 上搜索了原始研究，这些研究检查了 LLD 与 HCV 或 TBV 的横断面关系，有 46 项研究符合纳入标准。使用随机效应从原始或调整后的脑容量计算 LLD 和对照组之间的标准化均数差异（Hedges'g）。使用随机效应计算皮质醇水平与 HCVs 之间相关性的标准化 Fisher 变换。
我们纳入了 35 项研究中的 2702 名 LLD 患者和 11165 名对照组，这些研究检查了 HCV。与对照组相比，患者的 HCV 明显较小（标准化均数差异=-0.32[95%置信区间，-0.44 至-0.19]）。亚组分析表明，晚发性抑郁症与 HCV 的相关性强于早发性抑郁症。此外，病例对照研究、质量较低的研究、样本量较小的研究的效应量较大，而队列研究和样本量较大的研究则几乎不存在。对于 TBV，我们纳入了 31 项研究中的 2523 名患者和 7880 名对照组。LLD 和对照组之间 TBV 的标准化均数差异为-0.10（95%置信区间，-0.16 至-0.04）。在纳入的 12 项研究中，皮质醇水平较高与 HCV 较小相关（相关性=-0.11[95%置信区间，-0.18 至-0.04]）。
虽然总体上衡量 LLD 可能与较小的 HCV 相关，但区分 LLD 的临床特征并检查方法学问题表明，这种关系并不简单。
