Jiang Haiteng, Zhu Rongxin, Tian Shui, Wang Huan, Chen Zhilu, Wang Xinyi, Shao Junneng, Qin Jiaolong, Shi Jiabo, Liu Haiyan, Chen Yu, Yao Zhijian, Lu Qing
Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China.
School of Biological Sciences and Medical Engineering, Southeast University, 2 Sipailou Street, Nanjing, 210096, China.
Neuropsychopharmacology. 2020 Sep;45(10):1735-1742. doi: 10.1038/s41386-020-0753-5. Epub 2020 Jun 30.
Bipolar disorder (BD) is associated with a high risk of suicidality, and it is challenging to predict suicide attempts in clinical practice to date. Although structural and functional connectivity alterations from neuroimaging studies have been previously reported in BD with suicide attempts, little is known about how abnormal structural and functional connectivity relates to each other. Here, we hypothesize that structure connectivity constrains functional connectivity, and structural-functional coupling is a more sensitive biomarker to detect subtle brain abnormalities than any single modality in BD patients with a current major depressive episode who had attempted suicide. By investigating structural and resting-state fMRI connectivity, as well as their coupling among 191 BD depression patients with or without a history of suicide attempts and 113 healthy controls, we found that suicide attempters in BD depression patients showed significantly decreased central-temporal structural connectivity, increased frontal-temporal functional connectivity, along with decreased structural-functional coupling compared with non-suicide attempters. Crucially, the altered structural connectivity network predicted the abnormal functional connectivity network profile, and the structural-functional coupling was significantly correlated with suicide risk but not with depression or anxiety severity. Our findings suggest that the structural connectome is the key determinant of brain dysfunction, and structural-functional coupling could serve as a valuable trait-like biomarker for BD suicidal predication over and above the intramodality network connectivity. Such a measure can have clinical implications for early identification of suicide attempters with BD depression and inform strategies for prevention.
双相情感障碍（BD）与自杀风险高相关，迄今为止，在临床实践中预测自杀企图具有挑战性。尽管先前已有神经影像学研究报道了有自杀企图的双相情感障碍患者存在结构和功能连接改变，但对于异常的结构和功能连接如何相互关联却知之甚少。在此，我们假设结构连接制约功能连接，并且在有过自杀企图的当前处于重度抑郁发作的双相情感障碍患者中，结构 - 功能耦合是一种比任何单一模态更敏感的生物标志物，用于检测细微的脑异常。通过研究191名有或无自杀企图史的双相情感障碍抑郁患者以及113名健康对照者的结构和静息态功能磁共振成像连接，以及它们之间的耦合，我们发现双相情感障碍抑郁患者中的自杀企图者与无自杀企图者相比，中央 - 颞叶结构连接显著降低，额 - 颞叶功能连接增加，同时结构 - 功能耦合降低。至关重要的是，改变的结构连接网络预测了异常的功能连接网络概况，并且结构 - 功能耦合与自杀风险显著相关，但与抑郁或焦虑严重程度无关。我们的研究结果表明，结构连接组是脑功能障碍的关键决定因素，并且结构 - 功能耦合可以作为双相情感障碍自杀预测的一种有价值的特质样生物标志物，超越模态内网络连接。这样一种测量方法对于早期识别双相情感障碍抑郁的自杀企图者具有临床意义，并为预防策略提供依据。
