Department of Biomedicine - Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, Porto, Portugal.
Department of Psychiatry and Mental Health, São João University Hospital Centre, Alameda Professor Hernani Monteiro, Porto, Portugal.
Nord J Psychiatry. 2022 Jan;76(1):1-11. doi: 10.1080/08039488.2021.1921264. Epub 2021 May 9.
Several studies revealed changes in the microstructure of white matter in bipolar disorder patients. Lithium has been reported as having neuroprotective effects. However, its effect on the white matter remains unclear. This systematic review aims to identify the existing clinical evidence of lithium's effect on the white matter from bipolar disorder patients.
PRISMA guidelines were followed for a systematic literature review to assess the effect of lithium on the white matter of patients with bipolar disorder. From a total of 204 studies screened, 16 were included in the final systematic review. The quality assessment of the included records was assessed by the Newcastle-Ottawa scale.
Most studies included (13 out of 16) evaluated diffusion tensor imaging measures to assess white matter integrity. Of these, eleven reported a positive effect of lithium on the integrity of white matter of bipolar disorder patients. Two reported no effect. Two studies evaluated white matter volume. The first reported that lithium attenuates the reduction of white matter volume over time, and the second reported significantly smaller white matter volume in non-lithium-using patients. The last evaluated ventricular brain ratio and reported that patients treated with lithium did not have a significantly greater ventricular size than their normal control counterparts.
Lithium appears to positively influence the evolution of the white matter abnormalities described in bipolar disorder patients. Should this information be confirmed in future research, and given its important mood stabilizer effect, it could further reinforce the use of lithium in the treatment of bipolar disorder.
多项研究揭示了双相障碍患者大脑白质微观结构的变化。有报道称锂具有神经保护作用。然而，其对大脑白质的影响尚不清楚。本系统综述旨在确定现有临床证据中锂对双相障碍患者大脑白质的作用。
按照 PRISMA 指南对系统文献进行综述，以评估锂对双相障碍患者大脑白质的影响。从总共筛选出的 204 项研究中，有 16 项最终纳入系统综述。采用纽卡斯尔-渥太华量表评估纳入研究的质量。
大多数研究（16 项研究中有 13 项）评估了弥散张量成像指标来评估大脑白质的完整性。其中，11 项研究报告了锂对双相障碍患者大脑白质完整性的积极影响。两项研究报告了无影响。两项研究评估了大脑白质体积。第一项研究报告锂可减轻大脑白质体积随时间减少，第二项研究报告未使用锂的患者大脑白质体积明显较小。最后一项研究评估了脑室脑比率，并报告锂治疗组患者的脑室大小与正常对照组无显著差异。
锂似乎对双相障碍患者大脑白质异常的演变有积极影响。如果这一信息在未来的研究中得到证实，并且考虑到其重要的情绪稳定剂作用，这可能会进一步加强锂在双相障碍治疗中的应用。
