Naiberg Melanie R, Hatch Jessica K, Selkirk Beth, Fiksenbaum Lisa, Yang Victor, Black Sandra, Kertes Peter J, Goldstein Benjamin I
Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada.
The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada.
J Affect Disord. 2017 Aug 15;218:227-237. doi: 10.1016/j.jad.2017.04.066. Epub 2017 Apr 29.
The burden of cardiovascular disease in bipolar disorder (BD) exceeds what can be explained by traditional cardiovascular risk factors (CVRFs), lifestyle, and/or medications. Moreover, neurocognitive deficits are a core feature of BD, and are also related to CVRFs. We examined retinal vascular photography, a proxy for cerebral microvasculature, in relation to CVRFs, peripheral microvascular function, and neurocognition among BD adolescents.
Subjects were 30 adolescents with BD and 32 healthy controls (HC). Retinal photography was conducted using a Topcon TRC 50 DX, Type IA camera, following pupil dilation. Retinal arteriolar and venular caliber was measured, from which the arterio-venular ratio (AVR) was computed. All measures were conducted masked to participant diagnosis. Peripheral arterial tonometry measured endothelial function. Neurocognition was assessed using the Cambridge Neuropsychological Tests Automated Battery.
AVR was not significantly different between groups (Cohen's d=0.18, p=0.103). Higher diastolic blood pressure (BP) was associated with lower (worse) AVR in BD (r=-0.441, p=0.015) but not HC (r=-0.192, p=0.293). Similarly, in the BD group only, higher (better) endothelial function was associated with higher AVR (r=0.375, p=0.041). Hierarchical regression models confirmed that, independent of covariates, retinal vascular caliber was significantly associated with diastolic BP and endothelial function in BD. Within the BD group, mood scores were significantly negatively correlated with AVR (β=-0.451, p=0.044).
This study's limitations include a small sample size, a cross-sectional study design, and a heterogeneous sample.
Retinal photography may offer unique insights regarding the cardiovascular and neurocognitive burden of BD. Larger longitudinal studies are warranted.
双相情感障碍（BD）患者的心血管疾病负担超过了传统心血管危险因素（CVRF）、生活方式和/或药物所能解释的范围。此外，神经认知缺陷是BD的核心特征，且与CVRF相关。我们研究了视网膜血管摄影（一种脑微血管的替代指标）与BD青少年的CVRF、外周微血管功能和神经认知之间的关系。
研究对象为30名BD青少年和32名健康对照（HC）。使用Topcon TRC 50 DX IA型相机在瞳孔散大后进行视网膜摄影。测量视网膜小动脉和小静脉管径，并计算动静脉比（AVR）。所有测量均在对参与者诊断不知情的情况下进行。外周动脉张力测量法评估内皮功能。使用剑桥神经心理测试自动成套系统评估神经认知。
两组之间的AVR无显著差异（科恩d值=0.18，p=0.103）。在BD患者中，较高的舒张压（BP）与较低（较差）的AVR相关（r=-0.441，p=0.015），但在HC中无此相关性（r=-0.192，p=0.293）。同样，仅在BD组中，较高（较好）的内皮功能与较高的AVR相关（r=0.375，p=0.041）。分层回归模型证实，独立于协变量，BD患者的视网膜血管管径与舒张压和内皮功能显著相关。在BD组内，情绪评分与AVR显著负相关（β=-0.451，p=0.044）。
本研究的局限性包括样本量小、横断面研究设计和样本异质性。
视网膜摄影可能为BD的心血管和神经认知负担提供独特见解。有必要进行更大规模的纵向研究。
