单相抑郁与双相抑郁的临床及神经影像差异

Clinical and Neuroimaging Distinction Between Unipolar Depression and Bipolar Depression

单相抑郁(unipolar disorder)和双相障碍(bipolar disorder,BD)的共同特征是抑郁发作,首发为抑郁的BD常误诊为单相抑郁。因此,寻找两种疾病间的临床表现及生物标记差异或将有助于临床诊断。本文回顾了两种疾病的临床及大脑神经影像结构和功能的相关研究,发现在临床上,双相抑郁有相对更低的起病年龄,更常伴有精神病性特征及家族病史等特征。而神经影像方面的研究则显示,双相抑郁患者在灰质、白质及皮层下区域中均显示了更严重的脑结构变化。功能上,两者间的差异主要集中于前额叶与边缘系统如杏仁核、纹状体及丘脑等脑区。这些发现为日后临床的诊断提供了一定的支持。

The shared feature of unipolar depression and bipolar disorder(BD)is the depressive episode,which often leads to high misdiagnosing of patients with bipolar depression as unipolar depression.Therefore,searching for the clinical performance and biomarkers differences between the two diseases would be helpful for clinical diagnosis.The paper reviews the clinical and neuroimaging distinction of brain structure and function between the two diseases,finding that clinically bipolar depressive patients showed earlier onset,and were more likely with psychosis and family history.In terms of neuroimaging,bipolar depressive patients emerged more severe alterations in gray matter,white matter and subcortical areas than unipolar depression patients.Differences from functional neuroimaging abnormalities mostly centralized in the circuit of prefrontal-limbic system,including amygdala,striatal and thalamus.These findings may provide appropriate support for future clinical diagnosis.