Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, Po-Jen General Hospital, Taipei, Taiwan.
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
J Affect Disord. 2012 Jan;136(1-2):110-116. doi: 10.1016/j.jad.2011.08.022. Epub 2011 Oct 1.
Weight gain and increased production of leptin may be associated with immuno-modulation and insulin resistance in bipolar disorder. The links among inflammatory markers, leptin, and insulin of bipolar patients from acute mania to full remission remain unclear.
Thirty-three healthy, bipolar I patients under 45 years of age were enrolled. We measured the circulating levels of high-sensitivity C-reactive protein (hs-CRP), anti-inflammatory mediators (interleukin-1 receptor antagonist [IL-1Ra] and soluble tumor necrosis factor receptor 1 [sTNF-R1]), leptin, and insulin during acute mania and subsequent partial and full remission. The results were compared with 33 age- and gender-matched healthy subjects.
The levels of IL-1Ra and hs-CRP of bipolar patients in both acute mania and partial remission were significantly higher than their levels of control subjects. The hs-CRP level of bipolar patients was also elevated in full remission. The elevation of IL-1Ra and hs-CRP levels in acute mania was independent of each other. They were also independent of the body mass index (BMI) and levels of leptin and insulin measurements. The levels of leptin were all positively associated with insulin levels in the normal subjects and bipolar patients in three phases. However, a significant relationship between leptin and immunoparameter was only seen in full remission with sTNF-R1 (r=0.51). Furthermore, IL-1Ra was inversely correlated with sTNF-R1 (r=-0.37, p<0.05) during partly remission, and while levels of IL-1Ra tended to normalize when patients remitted, levels of hs-CRP and sTNF-R1 showed the opposite trend.
Activated inflammation was found in acute mania, as evidenced by high levels of IL-1Ra, hs-CRP, and sTNF-R1. The production of leptin may be more tightly linked to insulin than the immunomodulators. Chronic inflammation may exist in bipolar patients and is reflected by elevations of IL-1Ra and hs-CRP levels in acute mania and persistent higher hs-CRP in full remission.
体重增加和瘦素产量增加可能与双相情感障碍的免疫调节和胰岛素抵抗有关。从急性躁狂到完全缓解的双相患者的炎症标志物、瘦素和胰岛素之间的联系尚不清楚。
纳入 33 名年龄在 45 岁以下的健康双相 I 型患者。我们在急性躁狂和随后的部分缓解和完全缓解期间测量了循环高敏 C 反应蛋白（hs-CRP）、抗炎介质（白细胞介素 1 受体拮抗剂[IL-1Ra]和可溶性肿瘤坏死因子受体 1[sTNF-R1]）、瘦素和胰岛素的水平。将结果与 33 名年龄和性别匹配的健康受试者进行比较。
双相患者在急性躁狂和部分缓解时的 IL-1Ra 和 hs-CRP 水平明显高于对照组。双相患者的 hs-CRP 水平在完全缓解时也升高。急性躁狂时 IL-1Ra 和 hs-CRP 水平的升高是相互独立的。它们也与体重指数（BMI）和瘦素和胰岛素测量水平无关。在正常受试者和三个阶段的双相患者中，瘦素水平均与胰岛素水平呈正相关。然而，只有在完全缓解时，sTNF-R1 与瘦素之间才存在显著的关系（r=0.51）。此外，在部分缓解时，IL-1Ra 与 sTNF-R1 呈负相关（r=-0.37，p<0.05），而当患者缓解时，IL-1Ra 水平趋于正常，但 hs-CRP 和 sTNF-R1 水平则呈现相反的趋势。
在急性躁狂中发现了炎症激活，表现为 IL-1Ra、hs-CRP 和 sTNF-R1 水平升高。瘦素的产生可能与胰岛素的关系比免疫调节剂更紧密。慢性炎症可能存在于双相患者中，并且在急性躁狂时 IL-1Ra 和 hs-CRP 水平升高以及完全缓解时 hs-CRP 持续升高中得到反映。
