Insulin resistance in bipolar disorder: A systematic review of illness course and clinical correlates.
Insulin resistance in bipolar disorder: A systematic review of illness course and clinical correlates.
复制标题
双相情感障碍的胰岛素抵抗：对病程和临床相关性的系统评价。
DOI：
10.1016/j.jad.2023.04.068
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发表时间：
2023
影响因子：
6.6
通讯作者：
McElroy,Susa
中科院分区：
文献类型：
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作者：
Miola,Alessandro;Alvarez-Villalobos,NeriA;Ruiz-Hernandez,FernandoGerardo;DeFilippis,Eleanna;Veldic,Marin;Prieto,MiguelL;Singh,Balwinder;SanchezRuiz,JorgeA;Nunez,NicolasA;Resendez,ManuelGardea;Romo-Nava,Francisco;McElroy,Susa
背景虽然胰岛素抵抗（IR）和心脏代谢综合征在双相情感障碍（BD）患者中普遍存在，但只有少数研究试图精确评估BD.MethodsA的IR程度和临床影响，根据预定义的协议（PROSPERO：CRD 42022359259），从多个研究数据库中进行全面检索，直至2022年5月。我们提取的神经影像学，认知，病程和治疗反应的结果，从个人与BD与IR的证据相比，血糖正常的BD individual.ResultsOf 1436确定的文章，10个报告符合纳入标准（n= 1183）。与血糖正常的BD患者相比，伴有IR的BD患者表现出更差的复合语言记忆评分和更差的执行功能，并且表现出更小的海马体积沿着前额叶神经化学改变。固定效应荟萃分析显示，与血糖正常的BD患者相比，糖代谢受损（IGM）的BD患者更可能发展为慢性和快速循环过程（k = 2，OR = 2.96，95% CI 1.69-5.17，OR = 2.88，95% CI 1.59-5.21，p < 0.001），总体功能评估评分有显著降低的趋势（k = 5，MD = −4，95% CI −8.23-0.23，p = 0.06）。与血糖正常的BD患者相比，伴IGM的BD患者对情绪稳定剂反应不良的发生率更高（k = 2，OR = 6.74，95%CI 1.04-43.54，p = 0.04）。实施预防和治疗BD IR的策略对于改善这种难以治疗人群的预后至关重要。
BackgroundAlthough insulin resistance (IR) and cardiometabolic syndrome are prevalent in patients with bipolar disorder (BD), only a few studies have attempted to precisely assess the degree and clinical impact of IR in BD.MethodsA comprehensive search was conducted from multiple research databases through May 2022, following a pre-defined protocol (PROSPERO: CRD42022359259). We extracted neuroimaging, cognition, illness course, and treatment response findings from individuals with BD with evidence of IR compared with euglycemic BD individuals.ResultsOf 1436 identified articles, 10 reports fulfilling inclusion criteria were included (n= 1183). BD patients with IR displayed worse composite verbal memory scores and worse executive function and exhibited smaller hippocampal volumes along with prefrontal neurochemical alterations compared to euglycemic BD patients. Fixed-effect meta-analysis revealed that BD patients with impaired glucose metabolism (IGM) were more likely to develop a chronic and rapid cycling course when compared with euglycemic BD patients (k = 2, OR = 2.96, 95 % CI 1.69–5.17, OR = 2.88, 95 % CI 1.59–5.21, p < 0.001, respectively), with a trend for significantly lower Global Assessment of Functioning scores (k = 5, MD = −4, 95 % CI −8.23–0.23, p = 0.06). BD patients with IGM displayed a higher rate of poor response to mood stabilizers when compared with euglycemic BD patients (k = 2, OR = 6.74, 95 % CI 1.04–43.54, p = 0.04).LimitationsCross-sectional design and small sample sizes of studies included limit the generalizability of results.ConclusionIR is associated with worse clinical outcomes of BD and inadequate treatment response. Implementing strategies to prevent and treat IR in BD is crucial to improve the prognosis of such a difficult-to-treat population.