针对患有抑郁症的儿童和青少年的磁共振波谱研究：一项系统评价与荟萃分析。
Magnetic resonance spectroscopy studies in children and adolescents with depression: A systematic review and meta-analysis.
作者信息
Zhou Hong, Gao Yao, Dong Tao, Wang Jie, Liu Zhi-Fen
机构信息
Department of Neurology, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.
Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.
出版信息
J Affect Disord. 2025 Nov 15;389:119747. doi: 10.1016/j.jad.2025.119747. Epub 2025 Jun 22.
BACKGROUND
Numerous studies have focused on the levels of brain metabolites in patients with depression. However, there are relatively few studies on magnetic resonance spectroscopy (MRS) of adolescent depression and the related neurobiological mechanisms lack consistent conclusions. To summarize the nature of brain metabolite changes in adolescents with depression, we conducted meta-analyses of metabolite levels in proton magnetic resonance spectroscopy (H-MRS) studies.
METHODS
We searched the PubMed, Cochrane Library, Scopus, Embase, and Web of Science databases from January 1965 to December 2023. Heterogeneity across studies was evaluated using the Q and I tests, and the random-effects model was used for analysis. Subgroup analyses were also conducted to explore potential sources of inconsistency.
RESULTS
A total of 26 studies involving 465 adolescent patients with depression and 409 healthy controls (HC) were included in this systematic review. N-acetyl aspartate (NAA) levels (SMD: -0.20, 95%CI: -0.34 to -0.05) were decreased in adolescents with depression when all brain areas were combined. In the dorsolateral prefrontal cortex white matter region, right-sided NAA (SMD: -0.76, 95 % CI: -1.36 to -0.15) and left-sided choline (Cho) levels (SMD: -0.54, 95 % CI: -0.96 to -0.12) were decreased. The levels of NAA (SMD: -0.35, 95 % CI: -0.65 to -0.05), Cho (SMD: -0.34, 95 % CI: -0.67 to -0.00) and creatine (Cr) (SMD: -0.50, 95 % CI: -0.96 to -0.03) in the anterior cingulate cortex (ACC) are reduced. The NAA/Cr levels (SMD: -1.67, 95 % CI: -3.29 to -0.05) in the left prefrontal cortex (PFC) are decreased.
CONCLUSIONS
Our results suggest that the reduction in NAA levels throughout the brain regions, especially in the prefrontal cortex, among adolescent patients with depression may be due to neuronal loss. The decrease in Cr concentration indicates that using relative creatine concentration may affect the study results. The PFC and ACC may play an important role in adolescent depression.
背景
众多研究聚焦于抑郁症患者大脑代谢物水平。然而，关于青少年抑郁症的磁共振波谱（MRS）研究相对较少，且相关神经生物学机制缺乏一致结论。为总结青少年抑郁症患者大脑代谢物变化的本质，我们对质子磁共振波谱（H-MRS）研究中的代谢物水平进行了荟萃分析。
方法
我们检索了1965年1月至2023年12月的PubMed、Cochrane图书馆、Scopus、Embase和Web of Science数据库。使用Q检验和I²检验评估研究间的异质性，并采用随机效应模型进行分析。还进行了亚组分析以探索不一致的潜在来源。
结果
本系统评价共纳入26项研究，涉及465例青少年抑郁症患者和409例健康对照（HC）。当合并所有脑区时，青少年抑郁症患者的N-乙酰天门冬氨酸（NAA）水平（标准化均数差：-0.20，95%置信区间：-0.34至-0.05）降低。在背外侧前额叶皮质白质区域，右侧NAA（标准化均数差：-0.76，95%置信区间：-1.36至-0.15）和左侧胆碱（Cho）水平（标准化均数差：-0.54，95%置信区间：-0.96至-0.12）降低。前扣带回皮质（ACC）中的NAA（标准化均数差：-0.35，95%置信区间：-0.65至-0.05）、Cho（标准化均数差：-0.34，95%置信区间：-0.67至-0.00）和肌酸（Cr）（标准化均数差：-0.50，95%置信区间：-0.96至-0.03）水平降低。左侧前额叶皮质（PFC）中的NAA/Cr水平（标准化均数差：-1.67，95%置信区间：-3.29至-0.05）降低。
结论
我们的结果表明，青少年抑郁症患者全脑区域，尤其是前额叶皮质中NAA水平的降低可能是由于神经元丢失。Cr浓度的降低表明使用相对肌酸浓度可能会影响研究结果。PFC和ACC可能在青少年抑郁症中起重要作用。
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