Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada.
Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
J Affect Disord. 2023 Jun 15;331:342-351. doi: 10.1016/j.jad.2023.03.040. Epub 2023 Mar 21.
Individuals with a severe mental illness (SMI), such as bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ), have increased rates of cardiovascular and cerebrovascular disease. Interestingly, it has been reported that retinal microvessels, a proxy cerebrovascular measure, non-invasively assessed via retinal imaging, predict future cardiovascular disease, with some studies also showing anomalous retinal microvascular caliber in SMI. Therefore, this review and meta-analysis evaluated whether retinal microvascular caliber differs between individuals with SMI vs controls and summarized current findings.
A systematic literature search for retinal microvascular caliber and SMI was conducted in Embase and MEDLINE. Studies needed to be published in English before 2022 December 1st and examine retinal microvascular caliber in individuals diagnosed with a SMI. Finally, a meta-analysis of arteriolar and venular caliber in SMI case-controlled studies was also conducted.
The search yielded 65 unique articles, 11 were included in the review and 6 in the meta-analysis. The meta-analysis found that the SMI group had significantly wider venules than controls (SMD = 0.53; 95 % CI = 0.24, 0.81; p = 0.0004) but not arterioles (SMD = 0.07; 95 % CI = -0.29, 0.44; p = 0.70). Additionally, the systematic review found that poorer retinal microvascular health is associated with greater illness severity.
Large heterogeneity of findings and small sample size.
This systematic review and meta-analysis found that SMI, specifically SZ, is associated with wider retinal venules. Retinal imaging, a fast, cost-effective, and non-invasive assay of cerebrovascular health, may provide insight into the pathophysiological processes of SMI. However, future longitudinal studies investigating these findings are warranted.
患有严重精神疾病（SMI）的个体，如双相情感障碍（BD）、重性抑郁障碍（MDD）和精神分裂症（SZ），心血管和脑血管疾病的发病率较高。有趣的是，据报道，视网膜微血管，一种通过视网膜成像无创评估的脑血管替代指标，可以预测未来的心血管疾病，一些研究还表明 SMI 存在异常的视网膜微血管口径。因此，本综述和荟萃分析评估了 SMI 个体与对照组之间的视网膜微血管口径是否存在差异，并总结了当前的研究结果。
在 Embase 和 MEDLINE 中对视网膜微血管口径和 SMI 进行了系统的文献检索。研究需要在 2022 年 12 月 1 日之前以英文发表，并检查诊断为 SMI 的个体的视网膜微血管口径。最后，还对 SMI 病例对照研究的动脉和静脉口径进行了荟萃分析。
搜索结果产生了 65 篇独特的文章，其中 11 篇被纳入综述，6 篇被纳入荟萃分析。荟萃分析发现，SMI 组的静脉比对照组更宽（SMD=0.53；95%CI=0.24，0.81；p=0.0004），但动脉没有（SMD=0.07；95%CI=-0.29，0.44；p=0.70）。此外，系统评价发现，视网膜微血管健康状况较差与疾病严重程度增加有关。
研究结果存在较大的异质性和小样本量。
本系统评价和荟萃分析发现，SMI，特别是 SZ，与更宽的视网膜静脉有关。视网膜成像作为一种快速、经济有效的脑血管健康检测方法，可能为 SMI 的病理生理过程提供见解。然而，需要进行未来的纵向研究来调查这些发现。
