Can bipolar disorder be viewed as a multi-system inflammatory disease?
Can bipolar disorder be viewed as a multi-system inflammatory disease?
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躁郁症可以看作是多系统炎症性疾病吗？
DOI：
10.1016/j.jad.2011.12.049
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发表时间：
2012-12-01
影响因子：
6.6
通讯作者：
Kupfer, David J.
中科院分区：
文献类型：
--
作者：
Leboyer, Marion;Soreca, Isabella;Scott, Jan;Frye, Mark;Henry, Chantal;Tamouza, Ryad;Kupfer, David J.
众所周知，双相情感障碍患者过早死亡的风险很高。心血管合并症是导致死亡率过高的主要原因，远高于自杀相关的风险。在这篇综述中，我们探讨了共病性医学疾病，强调双相情感障碍可以有效地概念化为多系统炎症性疾病的证据。我们对最近发表的所有与双相情感障碍相关的英文文章进行了系统的PubMed检索，交叉引用了以下术语：死亡率和发病率、心血管、糖尿病、肥胖、代谢综合征、炎症、自身抗体、逆转录病毒、压力、睡眠和昼夜节律。迄今收集到的证据表明，从早期阶段就存在多系统参与，因此需要主动筛查和诊断程序，以及综合治疗，以减少进展和过早死亡。探索可以解释观察到的联系的生物学途径表明，炎症背景失调可能是心血管和双相情感障碍的共同因素。将双相情感障碍视为一种多系统障碍，有助于我们将精神障碍重新定义为“大脑和身体的障碍”。目前的文献基本上缺乏纵向和机制研究，以及比较研究来探讨双相情感障碍与主要情绪障碍和精神障碍相比医疗负担的程度。也有必要根据双相情感障碍的共病发生率寻找其亚组。双相情感障碍的共病性医学疾病可能不仅被视为健康行为和精神药物的后果，而且被视为多系统疾病的早期表现。因此，医疗监测是病例评估的关键组成部分。探索炎症的常见生物学途径应该有助于发现生物标志物，最终导致创新的诊断工具、新的预防方法和个性化治疗。
Patients with bipolar disorder are known to be at high risk of premature death. Comorbid cardio-vascular diseases are a leading cause of excess mortality, well above the risk associated with suicide. In this review, we explore comorbid medical disorders, highlighting evidence that bipolar disorder can be effectively conceptualized as a multi-systemic inflammatory disease. We conducted a systematic PubMed search of all English-language articles recently published with bipolar disorder cross-referenced with the following terms: mortality and morbidity, cardio-vascular, diabetes, obesity, metabolic syndrome, inflammation, auto-antibody, retro-virus, stress, sleep and circadian rhythm. Evidence gathered so far suggests that the multi-system involvement is present from the early stages, and therefore requires proactive screening and diagnostic procedures, as well as comprehensive treatment to reduce progression and premature mortality. Exploring the biological pathways that could account for the observed link show that dysregulated inflammatory background could be a common factor underlying cardio-vascular and bipolar disorders. Viewing bipolar disorder as a multi-system disorder should help us to re-conceptualize disorders of the mind as “disorders of the brain and the body”. The current literature substantially lacks longitudinal and mechanistic studies, as well as comparison studies to explore the magnitude of the medical burden in bipolar disorder compared to major mood disorders as well as psychotic disorders. It is also necessary to look for subgroups of bipolar disorder based on their rates of comorbid disorders. Comorbid medical illnesses in bipolar disorder might be viewed not only as the consequence of health behaviors and of psychotropic medications, but rather as an early manifestation of a multi-systemic disorder. Medical monitoring is thus a critical component of case assessment. Exploring common biological pathways of inflammation should help biomarkers discovery, ultimately leading to innovative diagnostic tools, new methods of prevention and personalized treatments.
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