Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
School of Management, Jinan University, Guangzhou 510316, China.
J Affect Disord. 2019 Dec 1;259:82-90. doi: 10.1016/j.jad.2019.07.021. Epub 2019 Jul 5.
Evidence of the relationship between neurometabolic changes in the cortico-striato-cerebellar (CSC) circuit and bipolar disorder (BD) is still limited. To elucidate the pathogenesis of BD, we investigated the underlying neurometabolic changes and their effect on CSC lateralization circuits in unmedicated patients with bipolar II depression.
Forty unmedicated participants with bipolar II depression and forty healthy controls underwent proton magnetic resonance spectroscopy (H-MRS). We obtained bilateral metabolic ratios of N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr in the prefrontal white matter (PWM), anterior cingulate cortex (ACC), basal ganglia (BG) and the cerebellum. Metabolic ratios were characterized using a laterality index (LI) for left-right asymmetry.
Overall, aberrant lateralization in the CSC circuit was characteristic in patients with bipolar II depression. Patients with bipolar II depression showed significantly lower NAA/Cr ratios in the left PWM, right ACC, left BG and left cerebellum when compared with the healthy controls. For bipolar II depression, we found lower NAA/Cr LI in the PWM, BG, and cerebellum, higher NAA/Cr LI in the ACC, and higher Cho/Cr LI in the BG and cerebellum when compared to the standard value (1.0). For healthy controls, we found lower NAA/Cr LI only in the BG and higher Cho/Cr LI in the cerebellum when compared to 1.0.
As a cross-sectional study with a small sample size, progressive changes and complex metabolic interactions with treatment were not observed.
Our findings suggest that abnormal biochemical metabolism with aberrant lateralization in the CSC circuit may be an underlying pathophysiology of bipolar II depression.
皮质纹状体小脑（CSC）回路中神经代谢变化与双相障碍（BD）之间的关系的证据仍然有限。为了阐明 BD 的发病机制，我们研究了未经治疗的双相 II 型抑郁症患者CSC 侧化回路中潜在的神经代谢变化及其对其的影响。
40 名未经治疗的双相 II 型抑郁症患者和 40 名健康对照者接受了质子磁共振波谱（H-MRS）检查。我们获得了前额叶白质（PWM）、前扣带皮层（ACC）、基底节（BG）和小脑双侧 N-乙酰天冬氨酸（NAA）/肌酸（Cr）和胆碱（Cho）/Cr 的代谢比率。使用左右不对称的侧化指数（LI）来描述代谢比率。
总的来说，CSC 回路的异常侧化是双相 II 型抑郁症患者的特征。与健康对照组相比，双相 II 型抑郁症患者左 PWM、右 ACC、左 BG 和左小脑的 NAA/Cr 比率明显较低。对于双相 II 型抑郁症，我们发现 PWM、BG 和小脑的 NAA/Cr LI 较低，ACC 的 NAA/Cr LI 较高，BG 和小脑的 Cho/Cr LI 较高。对于健康对照组，我们发现只有 BG 的 NAA/Cr LI 较低，小脑的 Cho/Cr LI 较高。
由于样本量小且为横断面研究，因此未观察到进行性变化和与治疗相关的复杂代谢相互作用。
我们的研究结果表明，CSC 回路中异常的生化代谢和异常的侧化可能是双相 II 型抑郁症的潜在病理生理学基础。
