Bartoli Francesco, Crocamo Cristina, Mazza Mario Gennaro, Clerici Massimo, Carrà Giuseppe
Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.
J Psychiatr Res. 2016 Oct;81:133-9. doi: 10.1016/j.jpsychires.2016.07.007. Epub 2016 Jul 9.
Previous research has hypothesised increased uric acid levels, possibly because of an amplified purinergic metabolism and a reduced adenosine activity, in subjects with bipolar disorder. This systematic review and meta-analysis aimed at estimating if individuals with bipolar disorder had uric acid levels higher than both healthy controls and subjects with major depression (trait marker hypothesis). It also tested if uric acid levels could differ in different phases of bipolar disorder (state marker hypothesis). Meta-analyses were carried out generating pooled standardized mean differences (SMDs), using random-effects models. Heterogeneity between studies was estimated using the I(2) index. Relevant sensitivity and meta-regression analyses were conducted. We searched main Electronic Databases, identifying twelve studies that met our inclusion criteria. Meta-analyses showed increased uric acid levels in individuals with bipolar disorder as compared with both healthy controls (SMD = 0.65, p < 0.001, I(2) = 82.9%) and those with major depression (SMD = 0.46, p < 0.001; I(2) = 68.7%). However, meta-regression analyses confirmed this association only as compared with healthy controls. Finally, though uric acid levels were higher in manic/mixed phases as compared with depressive ones (SMD = 0.34; p = 0.04, I(2) = 58.8%), a sensitivity analysis did not confirm the association. In sum, our meta-analysis shows that subjects with bipolar disorder have uric acid levels higher than healthy controls. The potential role of factors that might clarify the nature of this association deserves additional research.
先前的研究推测，双相情感障碍患者的尿酸水平升高，可能是由于嘌呤能代谢增强和腺苷活性降低。本系统评价和荟萃分析旨在评估双相情感障碍患者的尿酸水平是否高于健康对照者和重度抑郁症患者（特质标记假说）。它还检验了双相情感障碍不同阶段的尿酸水平是否存在差异（状态标记假说）。采用随机效应模型进行荟萃分析，生成合并标准化均数差（SMD）。使用I²指数估计研究间的异质性。进行了相关的敏感性分析和荟萃回归分析。我们检索了主要电子数据库，确定了12项符合纳入标准的研究。荟萃分析显示，与健康对照者（SMD = 0.65，p < 0.001，I² = 82.9%）和重度抑郁症患者相比，双相情感障碍患者的尿酸水平升高（SMD = 0.46，p < 0.001；I² = 68.7%）。然而，荟萃回归分析仅证实了与健康对照者相比的这种关联。最后，尽管躁狂/混合相的尿酸水平高于抑郁相（SMD = 0.34；p = 0.04，I² = 58.8%），但敏感性分析并未证实这种关联。总之，我们的荟萃分析表明，双相情感障碍患者的尿酸水平高于健康对照者。可能阐明这种关联本质的因素的潜在作用值得进一步研究。
