C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis
C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis
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DOI：
10.1016/s2215-0366(16)30370-4
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发表时间：
2016-12-01
影响因子：
64.3
通讯作者：
Berk, Michael
中科院分区：
文献类型：
--
作者：
Fernandes, Brisa S.;Steiner, Johann;Berk, Michael
炎症过程和神经免疫相互作用与精神疾病的发病机制有关，但目前对双相情感障碍的研究尚无定论。我们的目的是调查是否外周浓度的C-反应蛋白（CRP），急性时相反应蛋白的炎症活动，是增加在双相情感障碍的整个mood spectrum.Methods在这个系统的回顾和荟萃分析，我们检索了MEDLINE，科克伦图书馆，Scopus，和Web of Knowledge从数据库成立到2016年8月14日，用于测量双相情感障碍（根据DSM-IV-TR定义）成人患者和健康对照者血清和血浆CRP浓度的研究。我们从已发表的报告中提取数据。我们进行了三项组间荟萃分析，比较了躁狂、抑郁或心境正常患者与健康对照组的CRP浓度（横断面研究），并进行了两项组内荟萃分析，比较了躁狂或抑郁发作治疗前后CRP浓度的变化（纵向研究）。我们使用Hedges的调整g来计算效应量，并使用随机效应模型合并结果。我们还做了荟萃回归分析的情绪状态，调查可能的主持人CRP concentration.Findings我们确定了27项研究，代表2161例双相情感障碍患者和81 932名健康对照。与健康个体相比，双相情感障碍患者在抑郁期间CRP浓度中度升高（g 0.67，95% CI 0.23至1.11; p = 0.003）和正常心境（0.65，0.40至0.90; p < 0.0001），在躁狂期间更显著增加（0.87，0.58至1.15; p < 0.0001）。躁狂症和抑郁症患者CRP浓度升高的程度与症状严重程度无关（躁狂症p = 0.256，抑郁症p = 0.626）。在指数躁狂发作消退后，CRP浓度中度降低（-0.36，-0.66至-0.05; p = 0.022），在指数抑郁发作消退后略有下降（-0.18，-0.30至-0.07; p = 0.002）。解释CRP浓度在双相情感障碍中增加而与情绪状态无关，但在躁狂期间高于抑郁和心境正常，提示躁狂症炎症负担增加。
Background Inflammatory processes and neural-immune interactions have been implicated in the pathogenesis of psychiatric conditions, but studies in bipolar disorder are inconclusive so far. We aimed to investigate whether peripheral concentrations of C-reactive protein (CRP), an acute-phase response protein of inflammatory activity, are increased in bipolar disorder across the mood spectrum.Methods In this systematic review and meta-analysis, we searched MEDLINE, the Cochrane Library, Scopus, and Web of Knowledge from database inception to Aug 14, 2016, for studies that measured serum and plasma CRP concentrations in adult patients with bipolar disorder (as defined by DSM-IV-TR) and healthy controls. We extracted data from published reports. We did three between-group meta-analyses comparing CRP concentrations in patients in mania, depression, or euthymia, with those in healthy controls (cross-sectional studies), and two within-group meta-analyses comparing changes in CRP concentrations before and after treatment of an index manic or depressive episode (longitudinal studies). We used Hedges' adjusted g to calculate effect sizes and pooled results using random-effect models. We also did meta-regression analyses by mood state to investigate possible moderators of CRP concentrations.Findings We identified 27 studies representing 2161 patients with bipolar disorder and 81 932 healthy controls. Compared with healthy individuals, CRP concentrations were moderately increased in people with bipolar disorder during depression (g 0.67, 95% CI 0.23 to 1.11; p = 0.003) and euthymia (0.65, 0.40 to 0.90; p < 0.0001) and more substantially increased during mania (0.87, 0.58 to 1.15; p < 0.0001). The extent of the increases in CRP concentrations in mania and depression was not related to symptom severity (p = 0.256 for mania and p = 0.626 for depression). CRP concentrations were moderately decreased after resolution of an index manic episode (-0.36, -0.66 to -0.05; p = 0.022) and slightly decreased after resolution of an index depressive episode (-0.18, -0.30 to -0.07; p = 0.002).Interpretation CRP concentrations are increased in bipolar disorder regardless of mood state, but are higher during mania than in depression and euthymia, suggesting an increased inflammatory burden in mania.