Plasma L-Tryptophan Concentration in Major Depressive Disorder: New Data and Meta-Analysis
Plasma L-Tryptophan Concentration in Major Depressive Disorder: New Data and Meta-Analysis
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DOI：
10.4088/jcp.13r08908
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发表时间：
2014-09-01
影响因子：
5.3
通讯作者：
Kunugi, Hiroshi
中科院分区：
文献类型：
--
作者：
Ogawa, Shintaro;Fujii, Takashi;Kunugi, Hiroshi
目的：色氨酸是人体必需的氨基酸，是5-羟色胺的前体，主要通过犬尿氨酸途径代谢。5-羟色胺和犬尿氨酸都与重度抑郁症（MDD）的病理生理学有关。然而，血浆色氨酸浓度在MDD患者并没有明确地被报告为减少，这促使我们进行荟萃分析，对以前的研究和我们自己的data.Data Sources：我们搜索PubMed数据库的病例对照研究发表到2013年8月31日，使用搜索词血浆和色氨酸和MDD的同义词。对术语氨基酸而不是色氨酸进行了额外检索。我们从2011年3月至2012年7月招募了66名MDD患者（DSM-IV）和82名对照者。大多数患者接受了药物治疗（N = 53）。总血浆色氨酸浓度测定的液相色谱/质谱method.Study选择：我们仔细检查了160项研究的资格。选择用英语撰写并记录患者和对照血浆色氨酸值的原始文章。数据提取：我们在荟萃分析中纳入了文献中的24项研究和我们自己的数据，共涉及744名患者和793名对照。还提取了未用药患者（N = 156）及其对照受试者（N = 203）的数据。结果：在我们的病例对照研究中，MDD患者血浆色氨酸水平的平均值（SD）显著低于对照组，而对照组的平均值（SD）显著低于对照组（53.9 [10.9] vs 57.2 [11.3] μ mol/L; P = .03）。调整发表偏倚后的荟萃分析显示，MDD患者显著减少，效应量适中（Hedges g，-0.45）。然而，对未用药受试者的分析产生了较大的影响（Hedges g，-0.84; P = .00015）。我们发现一个弱关联抑郁症的严重程度在荟萃回归分析（P = 0.049）。结论：这项荟萃分析提供了令人信服的证据，降低血浆色氨酸水平的MDD患者，特别是在未用药的患者。
Objective: Tryptophan, an essential amino acid, is the precursor to serotonin and is metabolized mainly by the kynurenine pathway. Both serotonin and kynurenine have been implicated in the pathophysiology of major depressive disorder (MDD). However, plasma tryptophan concentration in patients with MDD has not unequivocally been reported to be decreased, which prompted us to perform a meta-analysis on previous studies and our own data.Data Sources: We searched the PubMed database for case-control studies published until August 31, 2013, using the search terms plasma AND tryptophan AND synonyms for MDD. An additional search was performed for the term amino acid instead of tryptophan. We obtained our own data in 66 patients with MDD (DSM-IV) and 82 controls who were recruited from March 2011 to July 2012. The majority of the patients were medicated (N = 53). Total plasma tryptophan concentrations were measured by the liquid chromatography/mass spectrometry method.Study Selection: We scrutinized 160 studies for eligibility. Original articles that were written in English and documented plasma tryptophan values in patients and controls were selected.Data Extraction: We included 24 studies from the literature and our own data in the meta-analysis, which involved a total of 744 patients and 793 controls. Data on unmedicated patients (N = 156) and their comparison subjects (N = 203) were also extracted. To see the possible correlation between tryptophan concentrations and depression severity, meta-regression analysis was performed for 10 studies with the Hamilton Depression Rating Scale 17-item version score.Results: In our case-control study, mean (SD) plasma tryptophan level was significantly decreased in the MDD patients versus the controls (53.9 [10.9] vs 57.2 [11.3] mu mol/L; P = .03). The meta-analysis after adjusting for publication bias showed a significant decrease in patients with MDD with a modest effect size (Hedges g, -0.45). However, analysis on unmedicated subjects yielded a large effect (Hedges g, -0.84; P = .00015). We found a weak association with depression severity in the meta-regression analysis (P = .049).Conclusions: This meta-analysis provides convincing evidence for reduced plasma tryptophan levels in patients with MDD, particularly in unmedicated patients.