Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan; Center for Biomedical Ethics and Law, University of Tokyo, Tokyo, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Feb;8(2):140-150. doi: 10.1016/j.bpsc.2022.09.017. Epub 2022 Oct 23.
The glutamatergic system is thought to play an important role in the pathophysiology of bipolar disorder (BD). While there has been an increase in proton magnetic resonance spectroscopy studies examining this neurotransmission system, the results are inconsistent. Possible reasons for the inconsistency, including clinical features such as mood state and childhood versus adulthood age, were not addressed in previous meta-analyses.
This systematic review and meta-analysis of proton magnetic resonance spectroscopy studies of BD included 40 studies, with 1135 patients with BD and 964 healthy control (HC) subjects.
Glutamate plus glutamine and glutamine levels in the anterior cingulate cortex of patients with BD were significantly elevated compared with those of HC subjects (standardized mean difference = 0.42, 0.48, respectively). Subgroup analyses showed that adult BD patients had significantly higher levels of glutamate plus glutamine than adult HC subjects, but this was not the case in pediatric patients. For mood states, anterior cingulate cortex glutamate plus glutamine levels were higher in patients with bipolar depression than those in HC subjects.
Our results imply that glutamatergic dysfunction in the anterior cingulate cortex may be implicated in the pathophysiology of BD, which is most evident in adult BD patients and patients with bipolar depression.
谷氨酸能系统被认为在双相情感障碍（BD）的病理生理学中发挥重要作用。虽然质子磁共振波谱研究检查这种神经递质系统的研究有所增加，但结果并不一致。以前的荟萃分析没有涉及到不一致的可能原因，包括临床特征，如情绪状态和儿童与成年年龄。
这项对 BD 的质子磁共振波谱研究的系统评价和荟萃分析包括 40 项研究，共 1135 名 BD 患者和 964 名健康对照（HC）受试者。
BD 患者的前扣带回皮质中的谷氨酸加谷氨酰胺和谷氨酰胺水平明显高于 HC 受试者（标准化均数差分别为 0.42、0.48）。亚组分析显示，成年 BD 患者的谷氨酸加谷氨酰胺水平明显高于成年 HC 受试者，但在儿科患者中并非如此。对于情绪状态，前扣带回皮质中的谷氨酸加谷氨酰胺水平在双相抑郁患者中高于 HC 受试者。
我们的结果表明，前扣带回皮质中的谷氨酸能功能障碍可能与 BD 的病理生理学有关，在成年 BD 患者和双相抑郁患者中最为明显。
