Dialysis and plasmapheresis for schizophrenia: a systematic review.
Dialysis and plasmapheresis for schizophrenia: a systematic review.
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精神分裂症的透析和血浆置换：系统评价。
DOI：
10.1017/s0033291720001324
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发表时间：
2020
影响因子：
6.9
通讯作者：
Cox ER
中科院分区：
文献类型：
--
作者：
Cox ER
越来越多的证据表明，循环因子和免疫功能紊乱可能参与了精神分裂症的发病。特别是，促炎细胞因子，补体和自身抗体对中枢神经系统抗原决定簇最近已与精神病。在过去的几十年里，相关的概念导致了几项关于透析和血浆置换治疗精神分裂症的临床试验。这些试验可能与目前对精神分裂症的理解有关。我们的目的是确定透析或血浆置换是否是有益的干预精神分裂症。我们在主要的电子数据库中进行了一次系统性检索，以获得高质量的研究（双盲随机试验，假对照），这些研究将血液透析或血浆置换作为精神分裂症患者的干预措施，从记录开始到2018年9月以英文发表。我们发现9项研究符合纳入标准，共报告了105例接受假干预或积极干预的患者。八分之一的研究报告了血液透析对精神分裂症的有益影响，一个有害影响，六个没有影响。唯一的血浆置换试验发现它是无效的。23%的患者报告了不良事件。研究的偏倚不明确或风险较高。血液透析不太可能是精神分裂症的有益治疗，尽管这些研究规模较小，无法考虑潜在的亚组。血浆置换术仅在一项研究中提出，值得进一步探索作为精神分裂症的治疗方式。
Increasing evidence suggests that circulating factors and immune dysfunction may contribute to the pathogenesis of schizophrenia. In particular, proinflammatory cytokines, complement and autoantibodies against CNS epitopes have recently been associated with psychosis. Related concepts in previous decades led to several clinical trials of dialysis and plasmapheresis as treatments for schizophrenia. These trials may have relevance for the current understanding of schizophrenia. We aimed to identify whether dialysis or plasmapheresis are beneficial interventions in schizophrenia. We conducted a systematic search in major electronic databases for high-quality studies (double-blinded randomised trials with sham controls) applying either haemodialysis or plasmapheresis as an intervention in patients with schizophrenia, published in English from the start of records until September 2018. We found nine studies meeting inclusion criteria, reporting on 105 patients in total who received either sham or active intervention. One out of eight studies reported a beneficial effect of haemodialysis on schizophrenia, one a detrimental effect and six no effect. The sole trial of plasmapheresis found it to be ineffective. Adverse events were reported in 23% of patients. Studies were at unclear or high risk of bias. It is unlikely that haemodialysis is a beneficial treatment in schizophrenia, although the studies were of small size and could not consider potential subgroups. Plasmapheresis was only addressed by one study and warrants further exploration as a treatment modality in schizophrenia.