双向障碍患者神经递质与分子影像学临床病例比较研究
A Comparative Study of Neurotransmitter and Molecular Imaging Clinical Cases in Patients with Bipolar Disorder

双向障碍患者存在神经生化学功能失调，例如前扣带回、基底节、海马回等谷氨酸能突触传递异常，在患者情绪状态研究和尸检报告中证实谷氨酸能参与了双向障碍患者前扣带回环路密切参与情感调节任务。另外，前扣带回的乙酰胆碱水平对躁狂症患者普遍下降。与前扣带回环路成分相关的肌醇磷脂与尾状核肌醇水平已经发生改变，同时，双向障碍患者前扣带回环路的磷代谢并未出现结构性的变化，双向障碍患者虽然前扣带回的N-乙酰天门冬氨酸(NAA)并未发生变化，但是基底节、尾状核、丘脑的NAA和肌酸均出现变化，其中颞叶、海马的NAA和肌酸均普遍下降。双向障碍患者壳核、尾状核的多巴胺转化受到影响，特别是双向障碍抑郁相患者在丘脑、岛叶、扣带回背侧的5-HT受体结合力下降。本文最终侧重在明确双向障碍患者神经生化学异常与临床表现的对比，在参照其他临床病例相关研究中，关注双向障碍亚型患者的心境状态、药物治疗和其他疾病严重程度等个体化的差异，藉此尝试描绘神经生化学功能失调模式并提供给未来研究者临床治疗时的生物标记物参考。
Patients with bipolar disorder have neurochemical dysfunction, such as anterior cingulate gyrus, basal ganglia, hippocampal gyrus, and other abnormal glutamatergic synaptic transmission, which is confirmed in the patient’s emotional state study and autopsy report that glutamic acid participates in the anterior cingulate loop in patients with bipolar disorder and is closely involved in emotional regulation tasks. In addition, the level of acetylcholine in the anterior cingulate gyrus is generally reduced in patients with mania. The levels of inositol phospholipids and caudate nucleus inositol related to the components of the anterior cingulate gyrus have changed. At the same time, the phosphorus metabolism of the anterior cingulate gyrus in patients with bipolar disorder has not undergone structural changes. N-acetyl-aspartate in the anterior cingulate gyrus did not change, but NAA (N-acetyl-aspartate) and Creatine in the basal ganglia, caudate nucleus, and thalamus were all present changes, including temporal lobe, hippocampus NAA (N-acetyl-aspartate) and Creatine are generally decreased. The dopamine conversion of the putamen and caudate nucleus of patients with bipolar disorder is affected, especially the binding capacity of 5-HT (5-hyd- roxytryptamine) receptors in the thalamus, insula, and dorsal cingulate gyrus of patients with depressive phase of bipolar disorder decreases. This article finally focuses on clarifying the comparison of neurobiochemical abnormalities and clinical manifestations in patients with bipolar disorder. In reference to other clinical case-related studies, we focus on individualized differences in the mood state, drug treatment, and severity of other diseases in patients with bipolar disorder subtypes. In this way, we try to describe the pattern of neurobiochemical dysfunction and provide future researchers with biomarker reference for clinical treatment.