Effects of Antipsychotic Administration on Brain Glutamate in Schizophrenia: A Systematic Review of Longitudinal (1)H-MRS Studies.
Effects of Antipsychotic Administration on Brain Glutamate in Schizophrenia: A Systematic Review of Longitudinal (1)H-MRS Studies.
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DOI：
10.3389/fpsyt.2017.00066
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发表时间：
2017
影响因子：
4.7
通讯作者：
McGuire P
中科院分区：
文献类型：
--
作者：
Egerton A;Bhachu A;Merritt K;McQueen G;Szulc A;McGuire P
精神分裂症与脑谷氨酸功能障碍有关，但目前尚不清楚抗精神病药物是否能降低谷氨酸能异常的程度。我们对质子磁共振波谱（1H-MRS）研究进行了系统回顾，以检查抗精神病药物治疗对精神分裂症患者脑谷氨酸水平的影响。检索Medline数据库，以识别截至2016年12月发表的相关文章。纳入要求研究检查精神分裂症患者首次抗精神病药物治疗或转换抗精神病药物治疗前后脑谷氨酸代谢产物的纵向变化。检索确定了8篇合格文章，共有168例患者的基线和随访指标。大多数文章报道了抗精神病药物治疗后大脑谷氨酸代谢物的数量减少，并且整个大脑区域的Glx（谷氨酸和谷氨酰胺的组合信号）估计总体平均减少6.5%。8项研究中有4项报告了至少一个脑区的谷氨酸代谢物显著减少，没有一项研究报告了抗精神病药物给药后谷氨酸代谢物显著增加。谷氨酸变化程度与症状改善程度之间的关系并不一致，但可能提供有限的证据表明，抗精神病药反应可能与治疗前谷氨酸水平降低和治疗期间谷氨酸能降低程度更大有关。进一步的纵向，前瞻性研究谷氨酸和抗精神病药物的反应，需要证实这些发现。
Schizophrenia is associated with brain glutamate dysfunction, but it is currently unclear whether antipsychotic administration can reduce the extent of glutamatergic abnormality. We conducted a systematic review of proton magnetic resonance spectroscopy (1H-MRS) studies examining the effects of antipsychotic treatment on brain glutamate levels in schizophrenia. The Medline database was searched to identify relevant articles published until December 2016. Inclusion required that studies examined longitudinal changes in brain glutamate metabolites in patients with schizophrenia before and after initiation of first antipsychotic treatment or a switch in antipsychotic treatment. The searches identified eight eligible articles, with baseline and follow-up measures in a total of 168 patients. The majority of articles reported a numerical reduction in brain glutamate metabolites with antipsychotic treatment, and the estimated overall mean reduction of 6.5% in Glx (the combined signal from glutamate and glutamine) across brain regions. Significant reductions in glutamate metabolites in at least one brain region were reported in four of the eight studies, and none of the studies reported a significant glutamatergic increase after antipsychotic administration. Relationships between the degree of change in glutamate and the degree of improvement in symptoms have been inconsistent but may provide limited evidence that antipsychotic response may be associated with lower glutamate levels before treatment and a greater extent of glutamatergic reduction during treatment. Further longitudinal, prospective studies of glutamate and antipsychotic response are required to confirm these findings.