Capuzzi Enrico, Bartoli Francesco, Crocamo Cristina, Clerici Massimo, Carrà Giuseppe
Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, 20900 Monza, MB, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, 20900 Monza, MB, Italy.
Neurosci Biobehav Rev. 2017 Jun;77:122-128. doi: 10.1016/j.neubiorev.2017.03.003. Epub 2017 Mar 9.
Schizophrenia is likely to be associated with immunological abnormalities. However, antipsychotics may induce immunomodulatory effects, by influencing plasma cytokines. In order to distinguish these influences, we carried out a systematic review and meta-analysis exploring the acute effect of antipsychotics on candidate cytokines plasma levels (IL-1β, IL-2, IL-6, IL-17, IFN-γ, TNF-α) among drug-naïve subjects with first episode psychosis. We searched main Electronic Databases, identifying eight studies meeting our inclusion criteria. Plasma cytokines values were used to estimate standardized mean differences. Heterogeneity across studies was evaluated using the I index and controlled in relevant sensitivity analyses. IL-2 (p=0.023) and IL-6 (p=0.012) levels showed a significant decrease after four weeks of antipsychotic treatment. Relevant sensitivity analysis confirmed these findings. IL-1β had high between-study heterogeneity. However, leaving out one study, a significant decrease after treatment was found. IL-6 and IL-2, and possibly IL-1β, could be considered state markers, decreasing after antipsychotic treatment, whilst TNF-α, IL-17, and IFN-γ might be considered trait markers. Options for novel treatments in FEP, involving cytokine-modulating agents, should be further studied.
精神分裂症可能与免疫异常有关。然而，抗精神病药物可能通过影响血浆细胞因子而产生免疫调节作用。为了区分这些影响，我们进行了一项系统评价和荟萃分析，探讨抗精神病药物对首次发作精神病的未用药受试者血浆中候选细胞因子（IL-1β、IL-2、IL-6、IL-17、IFN-γ、TNF-α）水平的急性影响。我们检索了主要电子数据库，确定了八项符合纳入标准的研究。采用血浆细胞因子值来估计标准化均值差。使用I指数评估研究间的异质性，并在相关敏感性分析中进行控制。抗精神病药物治疗四周后，IL-2（p=0.023）和IL-6（p=0.012）水平显著下降。相关敏感性分析证实了这些发现。IL-1β在研究间具有较高的异质性。然而，排除一项研究后，发现治疗后有显著下降。IL-6和IL-2，可能还有IL-1β，可被视为状态标志物，在抗精神病药物治疗后下降，而TNF-α、IL-17和IFN-γ可能被视为特质标志物。涉及细胞因子调节剂的首发精神病新型治疗方案应进一步研究。
