School of Public Health, Fudan University, Shanghai, China; Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China.
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China.
J Affect Disord. 2023 Nov 15;341:219-227. doi: 10.1016/j.jad.2023.08.128. Epub 2023 Aug 30.
Differentiating depression in major depressive disorder and bipolar disorder is challenging in clinical practice. Therefore, reliable biomarkers are urgently needed to differentiate between these diseases. This study's main objective was to assess whether cardiac autonomic function can distinguish patients with unipolar depression (UD), bipolar depression (BD), and bipolar mania (BM).
We recruited 791 patients with mood disorders, including 191 with UD, 286 with BD, and 314 with BM, who had been drug free for at least 2 weeks. Cardiovascular status was measured using heart rate variability (HRV) and pulse wave velocity (PWV) indicators via finger photoplethysmography during a 5-min rest period.
Patients with BD showed lower HRV but higher heart rates than those with UD and BM. The PWV indicators were lower in the UD group than in the bipolar disorder group. The covariates of age, sex, and body mass index affected the cardiovascular characteristics. After adjusting for covariates, the HRV and PWV variations among the three groups remained significant. Comparisons between the UD and BD groups showed that the variable with the largest effect size was the frequency-domain indices of HRV, very low and high frequency, followed by heart rate. The area under the receiver operating characteristic curve (AUC) for each cardiovascular variable ranged from 0.661 to 0.714. The High-frequency index reached the highest AUC.
Cross-sectional design and the magnitude of heterogeneity across participants with mood disorders limited our findings.
Patients with BD, but not BM, had a greater extent of cardiac imbalance than those with UD. Thus, HRV may serve as a psychophysiological biomarker for the differential diagnosis of UD and BD.
在临床实践中，区分单相抑郁障碍和双相情感障碍中的抑郁是具有挑战性的。因此，迫切需要可靠的生物标志物来区分这些疾病。本研究的主要目的是评估心脏自主神经功能是否可以区分单相抑郁（UD）、双相抑郁（BD）和双相躁狂（BM）患者。
我们招募了 791 名患有心境障碍的患者，包括 191 名 UD 患者、286 名 BD 患者和 314 名 BM 患者，这些患者在至少 2 周内没有服用药物。通过手指光电容积脉搏波描记法在 5 分钟的休息期间使用心率变异性（HRV）和脉搏波速度（PWV）指标测量心血管状态。
BD 患者的 HRV 较低，但心率高于 UD 和 BM 患者。UD 组的 PWV 指标低于双相障碍组。年龄、性别和体重指数等协变量影响心血管特征。在调整协变量后，三组之间的 HRV 和 PWV 变化仍然显著。UD 和 BD 组之间的比较表明，具有最大效应量的变量是 HRV 的频域指数，非常低和高频，其次是心率。每个心血管变量的接收者操作特征曲线（ROC）下面积（AUC）范围为 0.661 至 0.714。高频指数达到了最高的 AUC。
心境障碍患者的横断面设计和异质性大小限制了我们的发现。
BD 患者而不是 BM 患者的心脏失衡程度大于 UD 患者。因此，HRV 可能作为 UD 和 BD 的鉴别诊断的心理生理生物标志物。
