Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Aust N Z J Psychiatry. 2023 Mar;57(3):328-343. doi: 10.1177/00048674221091731. Epub 2022 Apr 11.
Bipolar disorder may undertake a progressive course in a subset of patients, and research efforts have been made to understand the biological basis underlying this process. This systematic review examined the literature available on biological markers associated with illness progression in bipolar disorder.
Peer-reviewed articles were assessed using Embase, PsycINFO and PubMed, as well as from external sources. After initial screening, a total of 871 citations from databases and other sources were identified. Participants with a diagnosis of bipolar disorder were included in our systematic review; however, studies with participants younger than 15 or older than 65 were excluded. All studies were assessed using the Newcastle-Ottawa Scale assessment tool, and data pertaining to the results were extracted into tabular form using Google Sheets and Google Documents. The systematic review was registered on PROSPERO international prospective register of systematic reviews (ID Number: CRD42020154305).
A total of 35 studies were included in the systematic review. Increased ventricular size and reduction of grey matter volume were the most common brain changes associated with illness progression in bipolar disorder. Among the several biomarkers evaluated in this systematic review, findings also indicate a role of peripheral inflammatory markers in this process.
The studies evaluating the biological basis of the illness progression in bipolar disorder are still scarce and heterogeneous. However, current evidence supports the notion of neuroprogression, the pathophysiological process related to progressive brain changes associated with clinical progression in patients with bipolar disorder. The increase in peripheral inflammatory biomarkers and the neuroanatomical changes in bipolar disorder suggest progressive systemic and structural brain alterations, respectively.
在一部分患者中，双相情感障碍可能会呈现进行性病程，因此人们努力研究其潜在的生物学基础。本系统综述考察了与双相情感障碍疾病进展相关的生物标志物的相关文献。
通过 Embase、PsycINFO 和 PubMed 以及其他来源评估同行评议文章。经过初步筛选，从数据库和其他来源共确定了 871 条引文。本系统综述纳入了双相情感障碍诊断患者；但排除了参与者年龄小于 15 岁或大于 65 岁的研究。所有研究均使用纽卡斯尔-渥太华量表评估工具进行评估，并使用 Google Sheets 和 Google Docs 将与结果相关的数据提取到表格中。本系统综述已在 PROSPERO 国际前瞻性系统评价注册库（注册号：CRD42020154305）中注册。
本系统综述共纳入 35 项研究。脑室增大和灰质体积减少是与双相情感障碍疾病进展最相关的常见大脑变化。在本系统综述评估的几种生物标志物中，研究结果还表明外周炎症标志物在这一过程中发挥作用。
评估双相情感障碍疾病进展生物学基础的研究仍然较少且存在异质性。然而，现有证据支持神经进展的概念，即与双相情感障碍患者临床进展相关的进行性大脑变化的病理生理学过程。双相情感障碍外周炎症生物标志物的增加和神经解剖结构的变化分别提示进行性系统性和结构性脑改变。
