Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
JAMA Netw Open. 2021 Dec 1;4(12):e2139759. doi: 10.1001/jamanetworkopen.2021.39759.
White matter (WM) abnormalities are commonly reported in psychiatric disorders. Whether peripartum insufficiencies in brain oxygenation, known as birth asphyxia, are associated with WM of patients with severe mental disorders is unclear.
To examine the association between birth asphyxia and WM in adult patients with schizophrenia and bipolar disorders (BDs) compared with healthy adults.
DESIGN, SETTING, AND PARTICIPANTS: In this case-control study, all individuals participating in the ongoing Thematically Organized Psychosis project were linked to the Medical Birth Registry of Norway (MBRN), where a subset of 271 patients (case group) and 529 healthy individuals (control group) had undergone diffusion-weighted imaging (DWI). Statistical analyses were performed from June 16, 2020, to March 9, 2021.
Birth asphyxia was defined based on measures from standardized reporting at birth in the MBRN.
Associations between birth asphyxia and WM regions of interest diffusion metrics, ie, fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD), were compared between groups using analysis of covariance, adjusted for age, age squared, and sex.
Of the 850 adults included in the study, 271 were in the case group (140 [52%] female individuals; mean [SD] age, 28.64 [7.43] years) and 579 were in the control group (245 [42%] female individuals; mean [SD] age, 33.54 [8.31] years). Birth asphyxia measures were identified in 15% to 16% of participants, independent of group. The posterior limb of the internal capsule (PLIC) showed a significant diagnostic group × birth asphyxia interaction (F(1, 843) = 11.46; P = .001), reflecting a stronger association between birth asphyxia and FA in the case group than the control group. RD, but not AD, also displayed a significant diagnostic group × birth asphyxia interaction (F(1, 843) = 9.28; P = .002) in the PLIC, with higher values in patients with birth asphyxia and similar effect sizes as observed for FA.
In this case-control study, abnormalities in the PLIC of adult patients with birth asphyxia may suggest a greater susceptibility to hypoxia in patients with severe mental illness, which could lead to myelin damage or impeded brain development. Echoing recent early-stage schizophrenia studies, abnormalities of the PLIC are relevant to psychiatric disorders, as the PLIC contains important WM brain pathways associated with language, cognitive function, and sensory function, which are impaired in schizophrenia and BDs.
在精神疾病中，常报道有脑白质（WM）异常。围产期脑缺氧不足，即出生窒息，是否与严重精神障碍患者的 WM 有关尚不清楚。
与健康成年人相比，检查围产期脑缺氧不足（出生窒息）与精神分裂症和双相障碍（BD）成年患者 WM 之间的关系。
设计、地点和参与者：在这项病例对照研究中，所有参加正在进行的主题组织精神病学项目的个体都与挪威医学出生登记处（MBRN）相关联，其中 271 名患者（病例组）和 529 名健康个体（对照组）接受了弥散加权成像（DWI）。统计分析于 2020 年 6 月 16 日至 2021 年 3 月 9 日进行。
出生窒息是根据 MBRN 出生时标准化报告中的措施定义的。
使用协方差分析比较了病例组和对照组之间 WM 感兴趣区弥散指标（即各向异性分数（FA）、轴向弥散度（AD）和径向弥散度（RD））与出生窒息之间的关系，调整了年龄、年龄平方和性别。
在纳入的 850 名成年人中，271 人在病例组（140[52%]名女性；平均[SD]年龄 28.64[7.43]岁），579 人在对照组（245[42%]名女性；平均[SD]年龄 33.54[8.31]岁）。在研究人群中，15%至 16%的参与者存在出生窒息的指标，与分组无关。后内囊肢（PLIC）显示出显著的诊断组×出生窒息的交互作用（F（1,843）=11.46；P=.001），反映了病例组中出生窒息与 FA 之间的关联强于对照组。RD，但不是 AD，在 PLIC 中也显示出显著的诊断组×出生窒息的交互作用（F（1,843）=9.28；P=.002），有出生窒息的患者 RD 值更高，其影响大小与观察到的 FA 相似。
在这项病例对照研究中，有出生窒息的成年患者 PLIC 的异常可能表明严重精神疾病患者对缺氧的敏感性更高，这可能导致髓鞘损伤或大脑发育受阻。与最近的早期精神分裂症研究相呼应，PLIC 的异常与精神障碍有关，因为 PLI 包含与语言、认知功能和感觉功能相关的重要 WM 脑通路，这些在精神分裂症和 BDs 中受到损害。
