Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
J Psychiatr Res. 2021 Dec;144:323-330. doi: 10.1016/j.jpsychires.2021.10.039. Epub 2021 Oct 23.
Borderline personality disorder (BPD) is associated with an elevated mortality risk that is partially attributed to suicide, but few studies examined other possible causes of premature death. The present study compared epicardial adipose tissue (EAT) volume as a known early predictor of premature cardiovascular morbidity, cardiovascular risk indices, and adrenal gland volume (AGV) as an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation in females with borderline personality disorder (BPD), major depressive disorder (MDD) and in healthy individuals. Twenty-eight patients with BPD comorbid with MDD (BPD/MDD), 22 MDD patients and 26 healthy females (CTRL) of comparable age were included. EAT and AGV were assessed by magnetic resonance tomography; 10-year cardiovascular risk and diabetes risk were determined by PROCAM and FINDRISK score; metabolic syndrome was defined following National Cholesterol Education Adult Treatment Panel III R (NCEP/ATP III) criteria. MADRS was used to assess depression severity. After adjustment for age, body mass index (BMI), and physical activity, EAT and AGV were significantly increased in BPD/MDD compared to MDD and CTRL. EAT and AGV displayed a positive correlation. Finally, diabetes risk in BPD/MDD was elevated compared to CTRL and MDD. The present study highlights the increased cardiometabolic risk of BPD patients. We identify EAT accumulation as an early predictor and potential mediator of cardiovascular disease in BPD that appears to be driven at least in part by HPA axis dysregulation. Therefore, interventions that reduce EAT volume (i.e. exercise and diet) should be considered in the clinical management of BPD.
边缘型人格障碍（BPD）与死亡率升高相关，部分原因是自杀，但很少有研究探讨其他可能导致过早死亡的原因。本研究比较了心外膜脂肪组织（EAT）体积作为预测心血管疾病过早发病的已知早期指标、心血管风险指数，以及肾上腺体积（AGV）作为慢性下丘脑-垂体-肾上腺（HPA）轴激活的指标，在边缘型人格障碍（BPD）、重性抑郁障碍（MDD）女性患者和健康个体中的表现。共纳入 28 例伴有 MDD 的 BPD 患者（BPD/MDD）、22 例 MDD 患者和 26 例年龄匹配的健康女性（CTRL）。通过磁共振断层扫描评估 EAT 和 AGV；采用 PROCAM 和 FINDRISK 评分评估 10 年心血管风险和糖尿病风险；采用美国国家胆固醇教育计划成人治疗专家组 III R（NCEP/ATP III）标准定义代谢综合征；采用 MADRS 评估抑郁严重程度。在调整年龄、体重指数（BMI）和体力活动后，BPD/MDD 患者的 EAT 和 AGV 明显高于 MDD 和 CTRL。EAT 和 AGV 呈正相关。最后，BPD/MDD 的糖尿病风险高于 CTRL 和 MDD。本研究强调了 BPD 患者心血管代谢风险增加。我们发现 EAT 堆积是 BPD 心血管疾病的早期预测指标和潜在介质，其似乎至少部分是由 HPA 轴失调驱动的。因此，在 BPD 的临床管理中，应考虑减少 EAT 体积的干预措施（即运动和饮食）。
