Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2A1.
Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2A1; Department of Psychiatry, Dresden University of Technology, Dresden, Germany.
J Affect Disord. 2021 Aug 1;291:198-208. doi: 10.1016/j.jad.2021.04.051. Epub 2021 May 7.
While widespread grey matter (GM) changes are seen in bipolar I disorder (BD-I), it is unclear how early in the illness such changes emerge. To date there has been little synthesis of findings regarding longitudinal grey matter changes early in the course of BD-I. We conducted a systematic review to examine the evolution of GM changes in BD-I patients following the first episode of mania (FEM).
Following PRISMA guidelines, we conducted a systematic review of studies examining longitudinal changes in GM volume (GMV), cortical thickness and/or surface area in BD-I patients following FEM. We qualitatively synthesized results regarding longitudinal GM changes in BD-I patients.
Fifteen studies met inclusion criteria, all examining GMV changes. Longitudinal ACC volume decrease following FEM was the most replicated finding, but was only reported in 4 out of 7 studies that examined this region as part of a whole brain/region of interest analysis, with 2 of these positive studies using an overlapping patient sample. The impact of episode recurrence, medications, and other clinical factors was inconsistently examined.
The literature regarding GM changes early in BD-I is highly inconsistent, likely due to heterogeneity in participant characteristics, imaging methodology/analysis and duration of follow up.
Though there was some suggestion that structural ACC changes may represent a marker for neuroprogression following FEM, results were too inconsistent to draw any conclusions. Larger longitudinal studies examining cortical thickness/surface area, and the influence of relevant clinical factors, are needed to better understand neuroprogression in early BD-I.
在双相情感障碍 I 型（BD-I）中广泛存在灰质（GM）变化，但尚不清楚这些变化在疾病早期何时出现。迄今为止，关于 BD-I 早期病程中纵向灰质变化的研究结果综合较少。我们进行了一项系统评价，以检查 FEM 后 BD-I 患者 GM 变化的演变。
根据 PRISMA 指南，我们对检查 FEM 后 BD-I 患者 GM 体积（GMV）、皮质厚度和/或表面积纵向变化的研究进行了系统评价。我们对 BD-I 患者纵向 GM 变化的结果进行了定性综合。
符合纳入标准的 15 项研究均检查了 GMV 变化。FEM 后 ACC 体积减少是最常见的重复发现，但仅在 7 项研究中的 4 项中报告了这一区域，这些研究将其作为全脑/感兴趣区域分析的一部分进行了检查，其中 2 项阳性研究使用了重叠的患者样本。发作复发、药物和其他临床因素的影响未得到一致检查。
BD-I 早期 GM 变化的文献高度不一致，这可能是由于参与者特征、成像方法/分析和随访时间的异质性所致。
尽管有一些证据表明，结构上的 ACC 变化可能代表 FEM 后神经进展的标志物，但结果过于不一致，无法得出任何结论。需要更大的纵向研究来检查皮质厚度/表面积以及相关临床因素的影响，以更好地了解早期 BD-I 中的神经进展。
