Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
Prog Neuropsychopharmacol Biol Psychiatry. 2017 Oct 3;79(Pt B):90-95. doi: 10.1016/j.pnpbp.2017.06.008. Epub 2017 Jun 13.
Evidence suggests an association between low lipid levels and suicidality in subjects with severe mental disorders. This is the first systematic review and meta-analysis aimed at exploring differences in lipid profile between suicide attempters and non-attempters with bipolar disorder. We included observational studies providing comparative cross-sectional data on total cholesterol, LDL-cholesterol and triglycerides levels. We searched main Electronic Databases, identifying 11 studies that met our inclusion criteria, including also unpublished data. Meta-analyses based on random-effects models were carried out, generating pooled standardized mean differences (SMDs). Heterogeneity among studies was estimated using the I index. The meta-analyses included data on lipid profile from 11 studies based on 288 subjects with and 754 without suicide attempt, respectively. No differences in total cholesterol (SMD: -0.10; 95%CI: -0.30 to 0.10; p=0.34), LDL-cholesterol (SMD: -0.26; 95%CI: -0.65 to 0.13; p=0.19), and triglycerides (SMD: -0.06; 95%CI: -0.31 to 0.19; p=0.63) were detected. Heterogeneity across studies was low-moderate and no risk of publication bias was found. Subgroup analyses showed no differences on effect size across different study characteristics, including different time-frames of suicide attempt, except for small sample size. Therefore, the evidence for an association between serum lipid profile and suicidality in bipolar disorder cannot be claimed. More research is needed to better understand the mechanisms underlying suicidal behaviours in bipolar patients, exploring further peripheral biomarkers as this may help clinicians screen and prevent suicidality.
有证据表明，严重精神障碍患者的血脂水平低与自杀意念有关。这是第一项旨在探索双相情感障碍患者自杀未遂者和非自杀未遂者血脂特征差异的系统评价和荟萃分析。我们纳入了提供总胆固醇、LDL-胆固醇和甘油三酯水平比较横断面数据的观察性研究。我们在主要电子数据库中进行了搜索，确定了 11 项符合我们纳入标准的研究，其中还包括未发表的数据。基于随机效应模型进行了荟萃分析，生成了汇总标准化均数差值（SMD）。使用 I 指数估计研究间的异质性。荟萃分析包括来自 11 项研究的数据，这些研究基于分别有自杀未遂和无自杀未遂的 288 名和 754 名患者。总胆固醇（SMD：-0.10；95%CI：-0.30 至 0.10；p=0.34）、LDL-胆固醇（SMD：-0.26；95%CI：-0.65 至 0.13；p=0.19）和甘油三酯（SMD：-0.06；95%CI：-0.31 至 0.19；p=0.63）无差异。研究间异质性为低-中度，未发现发表偏倚的风险。亚组分析显示，在不同的研究特征（包括自杀未遂的不同时间框架）下，效应大小没有差异，除了样本量较小。因此，不能声称双相情感障碍患者的血清脂质谱与自杀意念之间存在关联。需要更多的研究来更好地了解双相情感障碍患者自杀行为的潜在机制，探索进一步的外周生物标志物，因为这可能有助于临床医生筛查和预防自杀意念。
