Abstract:

Objective　To investigate the changes in blood lipid levels in adolescents with bipolar disorder and their relationship with regional brain structure as assessed by imaging studies. Method　A retrospective study was conducted involving 72 adolescents with bipolar disorder treated at the Department of Psychiatry, Chang'an Hospital, from May 2022 to May 2024. The observation group consisted of 45 males and 27 females, the age was (13.26±1.51) years old. Patients were divided into a depressive episode group (31 cases) and a manic episode group (41 cases) based on the cause of onset. Treatment effects were assessed after 3 months of therapy. According to the Young Mania Rating Scale (YMRS) and the Montgomery-Asberg Depression Rating Scale (MADRS), patients were classified into a good prognosis group (YMRS score < 13 points, MADRS < 22 points, 45 cases) and a poor prognosis group (YMRS score ≥ 13 points, MADRS ≥ 22 points, 27 cases). A control group of 52 healthy individuals was selected during the same period, comprising 34 males and 18 females, the age was (13.31±1.54) years old. Blood lipid levels [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)] were measured using an automatic biochemical analyzer on the second day after admission for the observation group and on the day of health examination for the control group. All patients underwent resting-state functional magnetic resonance imaging (fMRI) to collect imaging parameters. Correlation analysis was performed using Pearson correlation, and statistical analysis was conducted using t tests. Results　The TC, TG, LDL-C, and HDL-C levels in the observation group were (5.89±0.94, 2.12±0.31, 3.75±0.86, 1.53±0.35) mmol/L, compared to (5.03±0.78, 1.34±0.26, 3.11±0.58, 1.74±0.29) mmol/L in the control group, with all differences being statistically significant (t=5.555, 15.196, 4.946, and 3.645, all P<0.001). No statistically significant differences were found between the depressive episode group and the manic episode group regarding TC, TG, LDL-C, and HDL-C levels (all P>0.05). The TC, TG, and LDL-C levels in the poor prognosis group were higher than those in the good prognosis group, while HDL-C levels were lower in the poor prognosis group (all P<0.05). Regional brain structure regional homogeneity (ReHo) values: the ReHo values for the left cerebellum, right cerebellum, left cuneus, right cuneus, and right superior temporal gyrus in the observation group were 0.23±0.04, -0.21±0.06, 0.12±0.05, -0.05±0.01, and 0.21±0.06, respectively, while the control group had values of 0.51±0.15, -0.42±0.12, -0.28±0.09, -0.19±0.04, and 0.39±0.09, with all differences being statistically significant (t=11.427, 9.714, 23.982, 21.538, and 10.163, all P<0.001). In the depressive episode group, the ReHo values for the left cerebellum, left cuneus, right cuneus, and right superior temporal gyrus were lower than those in the manic episode group, while the ReHo value for the right cerebellum was higher than in the manic episode group (all P<0.05). The ReHo values for the left cerebellum and right superior temporal gyrus in the poor prognosis group were lower than those in the good prognosis group, while the ReHo values for the right cerebellum, left cuneus, and right cuneus were higher than in the good prognosis group (all P<0.05). Pearson correlation results indicated that TC, TG, and LDL-C levels in adolescents with bipolar disorder were positively correlated with the ReHo values of the right cerebellum, left cuneus, and right cuneus, and negatively correlated with the ReHo values of the left cerebellum and right superior temporal gyrus (all P<0.05); HDL-C was negatively correlated with the ReHo values of the right cerebellum, left cuneus, and right cuneus, and positively correlated with the ReHo values of the left cerebellum and right superior temporal gyrus (all P<0.05). Conclusion　The changes of blood lipid levels in patients with adolescent bipolar disorder are obvious, which are correlated with the ReHo value of regional brain structure, which can reflect the neuropathological changes of patients. Strengthening the magnetic resonance imaging examination of patients can evaluate the prognosis of patients.

Key words: Bipolar disorder,  , Adolescent,  , Blood lipid,  , Regional brain structure,  , Correlation,  , resting-state functional magnetic resonance imaging

摘要：

目的　探讨青少年双相情感障碍患者血脂变化分析及与影像学检查区域性脑结构的关系。方法　回顾性选择2022年5月至2024年5月长安医院精神科收治的青少年双相情感障碍患者72例为观察组，男45例、女27例，年龄（13.26±1.51）岁。根据发病原因分为抑郁发作组（31例）和躁狂发作组（41例）。患者治疗3个月后评估治疗效果，根据杨氏躁狂状态评定量表（YMRS）和蒙哥马利-艾森贝格抑郁评定量表（MADRS）评分分为预后良好组（YMRS评分<13分、MADRS<22分，45例）和预后不良组（YMRS评分≥13分、MADRS≥22分，27例）。选择同时间段健康体检者52例为对照组，男34例，女18例，年龄（13.31±1.54）岁。观察组入院后第2天、对照组健康体检当天采用全自动生化分析仪检测血脂水平［总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）］；患者均进行静息态功能磁共振成像检查，收集影像学参数。采用Pearson相关性进行相关性分析，采用t检验进行统计分析。结果　观察组的TC、TG、LDL-C、HDL-C分别为（5.89±0.94、2.12±0.31、3.75±0.86、1.53±0.35）mmol/L，对照组上述指标分别为（5.03±0.78、1.34±0.26、3.11±0.58、1.74±0.29）mmol/L，差异均有统计学意义（t=5.555、15.196、4.946、3.645，均P<0.001）。抑郁发作组和躁狂发作组的TC、TG、LDL-C、HDL-C水平差异均无统计意义（均P>0.05）。预后不良组的TC、TG、LDL-C水平均高于预后良好组，HDL-C水平低于预后良好组（均P<0.05）。观察组左侧小脑、右侧小脑、左侧距状皮质、右侧距状皮质、右侧颞上回的区域性脑结构局部一致性（ReHo）值分别为0.23±0.04、-0.21±0.06、0.12±0.05、-0.05±0.01、0.21±0.06，对照组上述指标分别为0.51±0.15、-0.42±0.12、-0.28±0.09、-0.19±0.04、0.39±0.09，差异均有统计学意义（t=11.427、9.714、23.982、21.538、10.163，均P<0.001）；抑郁发作组左侧小脑、左侧距状皮质、右侧距状皮质、右侧颞上回的ReHo值均低于躁狂发作组，右侧小脑的ReHo值高于躁狂发作组（均P<0.05）；预后不良组左侧小脑、右侧颞上回的ReHo值均低于预后良好组，右侧小脑、左侧距状皮质、右侧距状皮质的ReHo值均高于预后良好组（均P<0.05）。Pearson相关性结果表明，青少年双相情感障碍患者TC、TG、LDL-C水平与右侧小脑、左侧距状皮质、右侧距状皮质的区域性脑结构ReHo值均呈正相关（均P<0.05），与左侧小脑、右侧颞上回的区域性脑结构ReHo值均呈负相关（均P<0.05）；HDL-C与右侧小脑、左侧距状皮质、右侧距状皮质的区域性脑结构ReHo值均呈负相关（均P<0.05），与左侧小脑、右侧颞上回的区域性脑结构ReHo值均呈正相关（均P<0.05）。结论　青少年双相情感障碍患者血脂水平变化明显，与区域性脑结构ReHo值存在相关性，可反映患者神经病理学改变，加强患者磁共振影像学检查能评估患者预后。

关键词: 双相情感障碍,  ,  , 青少年,  ,  , 血脂,  ,  , 区域性脑结构,  ,  , 相关性,  ,  , 静息态功能磁共振