Knedeisen Felicitas, Stapel Britta, Heitland Ivo, Lichtinghagen Ralf, Schweiger Ulrich, Hartung Dagmar, Kahl Kai G
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 Affect Disord. 2023 Mar 1;324:410-417. doi: 10.1016/j.jad.2022.12.072. Epub 2022 Dec 30.
Unipolar major depressive disorder (MDD) and bipolar disorder (BD) are associated with elevated mortality risk secondary to natural causes. Cardiovascular disease (CVD) constitutes the most prevalent underlying condition. Patients with BD display higher CVD-associated excess mortality than MDD patients. Epicardial adipose tissue (EAT) volume, a known predictor of premature CV morbidity and adrenal gland (AG) volume, an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation, were compared in BD and MDD patients.
Magnetic resonance imaging was performed to assess EAT and AG volume in age-, gender-, and body mass index (BMI)-matched MDD (N = 27) and BD (N = 27) patients. Ten-year CV mortality risk and diabetes risk were assessed by PROCAM, ESC-SCORE, and FINDRISK, respectively; metabolic syndrome (MetS) was determined following NCEP/ATP III criteria.
Cardiometabolic risk scores and frequency of MetS were comparable, and scores of cardiometabolic risk indices did not significantly differ in both groups. After adjustment for age, BMI, and physical activity, EAT and AG volumes were significantly higher in BD compared to MDD. Partial correlation analyses showed a significant positive association of EAT and AG volumes in BD but not in the MDD.
The modest sample size warrants confirmation in a larger cohort and the cross-sectional design does not allow for temporal or causal inferences.
Our study indicates increased EAT accumulation in BD patients. This was associated with HPA axis dysregulation. Therapeutic lifestyle interventions that reduce EAT volume should be considered in clinical BD management.
单相重度抑郁症（MDD）和双相情感障碍（BD）与自然原因导致的死亡率升高有关。心血管疾病（CVD）是最常见的潜在疾病。BD患者的心血管疾病相关超额死亡率高于MDD患者。比较了BD和MDD患者的心外膜脂肪组织（EAT）体积（已知的心血管疾病过早发病预测指标）和肾上腺（AG）体积（慢性下丘脑 - 垂体 - 肾上腺（HPA）轴激活指标）。
对年龄、性别和体重指数（BMI）匹配的MDD患者（N = 27）和BD患者（N = 27）进行磁共振成像，以评估EAT和AG体积。分别通过PROCAM、ESC - SCORE和FINDRISK评估10年心血管疾病死亡率风险和糖尿病风险；根据NCEP/ATP III标准确定代谢综合征（MetS）。
心血管代谢风险评分和MetS频率相当，两组心血管代谢风险指数评分无显著差异。在调整年龄、BMI和身体活动后，BD患者的EAT和AG体积显著高于MDD患者。偏相关分析显示BD患者中EAT和AG体积呈显著正相关，而MDD患者中则无。
样本量较小，需要在更大的队列中进行验证，且横断面设计不允许进行时间或因果推断。
我们的研究表明BD患者的EAT积累增加。这与HPA轴失调有关。在BD临床管理中应考虑采取减少EAT体积的治疗性生活方式干预措施。
