Department of Psychiatry, G/F Multicentre, Tai Po Hospital, The Chinese University of Hong Kong, Tai Po, Hong Kong, SAR, China.
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, SAR, China.
Sci Rep. 2021 Jan 19;11(1):1816. doi: 10.1038/s41598-021-81355-9.
It is unknown if young medication-naïve bipolar II (BPII) depressed patients have increased white matter (WM) disruptions. 27 each of young (average 23 years) and treatment-naïve BPII depressed, unipolar depressed (UD) patients and age-sex-education matched healthy controls (HC) underwent 3 T MRIs with diffusion tensor imaging. Diagnostic ratings included Structured Clinical Interview for DSM Disorders (SCID), Montgomery-Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Hamilton Anxiety Rating Scale (HAM-A). Patients were clinically depressed (MADRS-BPII: 26.15 [SD9.25], UD: 25.56 [5.24], p = 0.86). Compared to UD, BPII had increased family bipolarity (BPII 13.6% vs UD 2.5%, p = 0.01, φc = 0.28), hypomanic symptoms (YMRS-BPII: 4.22 [4.24], UD: 1.33 [2], p = 0.02, d = 0.87), lifetime number of depressive episodes (BPII: 2.37 [1.23], UD: 1.44 [0.75], p = 0.02, d = 0.91), lifetime and current-year number of episodes (lifetime BPII: 50.85 [95.47], UD: 1.7 [1.03]; current-year BPII: 9.93 [16.29], UD: 1.11 [0.32], ps = 0.04, ds = 0.73-0.77) and longer illness duration (BPII: 4.96 years [3.96], UD: 2.99 [3.33], p = 0.15, d = 0.54). BPII showed no increased WM disruptions vs UD or HC in any of the 15 a priori WM tracts. UD had lower right superior longitudinal fasciculus (SLF) (temporal) axial diffusivity (AD) (1.14 vs 1.17 (BPII), 1.16 (HC); F = 6.93, 95% CI of [Formula: see text]: 0.00073, 5.22, ηp = 0.15). Principal component analysis followed by exploratory linear discriminant analysis showed that increased R-SLF (temporal) AD, YMRS and family bipolarity distinguished BPII from UD (81.5% sensitivity, 85.2% specificity) independent of episode number and frequency. Young, medication-naïve adults with BPII depression did not show the WM disruptions distinguishing more chronically ill BP patients from UD. These WM disruptions may therefore be partly attributable to illness chronicity. Longitudinal studies should examine the trajectory of WM changes in BPII and UD and predictive validity of these baseline clinical and imaging parameters.
目前尚不清楚年轻的初次用药双相情感障碍 II 型（BPII）抑郁患者是否存在更多的白质（WM）破坏。27 名年轻（平均年龄 23 岁）且未经药物治疗的 BPII 抑郁、单相抑郁（UD）患者和年龄、性别、教育程度匹配的健康对照（HC）接受了 3T MRI 弥散张量成像检查。诊断评分包括 DSM 疾病的结构临床访谈（SCID）、蒙哥马利-阿斯伯格抑郁评定量表（MADRS）、杨氏躁狂评定量表（YMRS）和汉密尔顿焦虑评定量表（HAM-A）。患者均处于临床抑郁状态（MADRS-BPII：26.15 [9.25]，UD：25.56 [5.24]，p=0.86）。与 UD 相比，BPII 存在更高的家族双相性（BPII 13.6% vs UD 2.5%，p=0.01，φc=0.28）、轻躁狂症状（YMRS-BPII：4.22 [4.24]，UD：1.33 [2]，p=0.02，d=0.87）、一生中抑郁发作次数（BPII：2.37 [1.23]，UD：1.44 [0.75]，p=0.02，d=0.91）、一生中及当前年度的发作次数（一生中 BPII：50.85 [95.47]，UD：1.7 [1.03]；当前年度 BPII：9.93 [16.29]，UD：1.11 [0.32]，p=0.04，ds=0.73-0.77）和更长的病程（BPII：4.96 年[3.96]，UD：2.99 年[3.33]，p=0.15，d=0.54）。与 UD 或 HC 相比，BPII 在任何 15 个预先设定的 WM 束中均未显示出更多的 WM 破坏。UD 右侧上纵束（SLF）（颞叶）轴向弥散度（AD）（1.14 比 1.17（BPII），1.16（HC）；F=6.93，95%置信区间为[公式：见文本]：0.00073，5.22，ηp=0.15）更低。主成分分析后进行探索性线性判别分析显示，增加的右侧 SLF（颞叶）AD、YMRS 和家族双相性可将 BPII 与 UD 区分开来（敏感性 81.5%，特异性 85.2%），与发作次数和频率无关。年轻、初次用药的 BPII 抑郁成人未显示出可将病情更严重的 BP 患者与 UD 区分开来的 WM 破坏。因此，这些 WM 破坏可能部分归因于疾病的慢性化。纵向研究应检查 BPII 和 UD 中 WM 变化的轨迹，以及这些基线临床和影像学参数的预测效度。
