Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Affect Disord. 2018 Jan 1;225:599-606. doi: 10.1016/j.jad.2017.08.078. Epub 2017 Aug 30.
The goal of this meta-analysis was to quantitatively summarize the evidence available on the differences in grey matter volume between lithium-treated and lithium-free bipolar patients.
A systematic search was conducted in Cochrane Central, Embase, MEDLINE, and PsycINFO databases for original peer-reviewed journal articles that reported on global grey matter volume in lithium-medicated and lithium-free bipolar patients. Standard mean difference and Hedges' g were used to calculate effect size in a random-effects model. Risk of publication bias was assessed using Egger's test and quality of evidence was assessed using standard criteria.
There were 15 studies with a total of 854 patients (368 lithium-medicated, 486 lithium-free) included in the meta-analysis. Global grey matter volume was significantly larger in lithium-treated bipolar patients compared to lithium-free patients (SMD: 0.17, 95% CI: 0.01-0.33; z = 2.11, p = 0.035). Additionally, there was a difference in global grey matter volume between groups in studies that employed semi-automated segmentation methods (SMD: 0.66, 95% CI: 0.01-1.31; z = 1.99, p = 0.047), but no significant difference in studies that used fully-automated segmentation. No publication bias was detected (bias coefficient = - 0.65, p = 0.46).
Variability in imaging methods and lack of high-quality evidence limits the interpretation of the findings.
Results suggest that lithium-treated patients have a greater global grey matter volume than those who were lithium-free. Further study of the relationship between lithium and grey matter volume may elucidate the therapeutic potential of lithium in conditions characterized by abnormal changes in brain structure.
本荟萃分析的目的是定量总结锂治疗与无锂双相患者之间灰质体积差异的现有证据。
系统检索 Cochrane 中央、Embase、MEDLINE 和 PsycINFO 数据库中关于锂治疗和无锂双相患者全脑灰质体积的原始同行评议期刊文章。使用标准均数差和 Hedges'g 计算随机效应模型中的效应量。使用 Egger 检验评估发表偏倚风险，使用标准标准评估证据质量。
共有 15 项研究，总计 854 名患者（368 名锂治疗，486 名无锂）纳入荟萃分析。与无锂组相比，锂治疗的双相患者的全脑灰质体积明显更大（SMD：0.17，95%CI：0.01-0.33；z=2.11，p=0.035）。此外，在采用半自动分割方法的研究中，两组之间的全脑灰质体积存在差异（SMD：0.66，95%CI：0.01-1.31；z=1.99，p=0.047），但在采用全自动分割的研究中无显著差异。未发现发表偏倚（偏倚系数=-0.65，p=0.46）。
成像方法的变异性和缺乏高质量证据限制了对研究结果的解释。
结果表明，锂治疗患者的全脑灰质体积大于无锂患者。进一步研究锂与灰质体积之间的关系可能阐明锂在以大脑结构异常变化为特征的疾病中的治疗潜力。
