Mood Disorders Unit (GRUDA), Institute of Psychiatry, School of Medicine, University of São Paulo (IPq-FMUSP), Brazil; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Wales, UK.
Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Wales, UK.
Eur Neuropsychopharmacol. 2021 Jun;47:62-73. doi: 10.1016/j.euroneuro.2021.01.096. Epub 2021 Feb 11.
The anterior cingulate cortex (ACC), a brain region that mediates affect and cognition by connecting the frontal cortex to limbic structures, has been consistently implicated in the neurobiology of Bipolar Disorder (BD). Proton magnetic resonance spectroscopy (H-MRS) studies have extensively compared in vivo neurometabolite levels of BD patients and healthy controls (HC) in the ACC. However, these studies have not been analyzed in a systematic review or meta-analysis and nor has the influence of mood state and medication on neurometabolites been examined in this cortical region. A systematic review and a meta-analysis of H-MRS studies comparing ACC neurometabolite profiles of adult BD patients and HC subjects was conducted, retrieving 27 articles published between 2000 and 2018. Overall increased ACC levels of Glx [glutamine (Gln) + glutamate)/Creatine], Gln, choline (Cho) and Cho/Creatine were found in BD compared to HC. Bipolar depression was associated with higher Cho levels, while euthymia correlated with higher glutamine (Gln) and Cho. Mood stabilizers appeared to affect ACC Glu and Gln metabolites. Increased ACC Cho observed in euthymia, depression and in medication-free groups could be considered a trait marker in BD and attributed to increased cell membrane phospholipid turnover. Overall increased ACC Glx was associated with elevated Gln levels, particularly influenced by euthymia, but no abnormality in Glu was detected. Further H-MRS studies, on other voxels, should assess more homogeneous (mood state-specific), larger BD samples and account for medication status using more sensitive H-MRS techniques.
前扣带皮层（ACC）是连接额叶皮层和边缘结构的大脑区域，通过调节情感和认知参与双相情感障碍（BD）的神经生物学。质子磁共振波谱（H-MRS）研究广泛比较了 BD 患者和健康对照组（HC）在前扣带皮层中的神经代谢物水平。然而，这些研究尚未在系统评价或荟萃分析中进行分析，也没有检查情绪状态和药物对皮质区域神经代谢物的影响。对比较成年 BD 患者和 HC 受试者前扣带皮层神经代谢物图谱的 H-MRS 研究进行了系统评价和荟萃分析，检索了 2000 年至 2018 年期间发表的 27 篇文章。与 HC 相比，BD 患者的 ACC 水平总体上增加了 Glx[谷氨酰胺（Gln）+谷氨酸）/肌酸]、Gln、胆碱（Cho）和 Cho/肌酸。双相抑郁与更高的 Cho 水平相关，而病情稳定与更高的谷氨酰胺（Gln）和 Cho 相关。心境稳定剂似乎影响 ACC 的 Glu 和 Gln 代谢物。在病情稳定、抑郁和无药物治疗组中观察到的 ACC Cho 增加，可被认为是 BD 的特征标志物，归因于细胞膜磷脂周转率增加。总体上，ACC Glx 增加与 Gln 水平升高相关，尤其是与病情稳定相关，但未检测到 Glu 异常。使用更敏感的 H-MRS 技术，进一步的 H-MRS 研究应评估其他体素、更同质（特定于情绪状态）、更大的 BD 样本，并考虑药物状态。
