The University of South Florida, USA.
The University of Kansas, USA.
J Psychiatr Res. 2017 Dec;95:9-18. doi: 10.1016/j.jpsychires.2017.07.019. Epub 2017 Jul 22.
Previous research suggested that folate levels play an important role in the etiology and course of depression. However, the literature has been inconsistent with regard to differences in folate level between individuals with and without depression. The present meta-analysis synthesized the results of previous studies to examine whether individuals with depression had lower levels of folate than individuals without depression.
Meta-analytic procedures were conducted in accordance with PRISMA guidelines. Studies evaluating folate levels in individuals with and without depression via red blood cell folate, serum folate, or dietary intake of folate methods were identified via PsycINFO and PubMed. Random-effects meta-analysis was conducted using Hedge's g, and moderation analysis was used for both folate measurement method and population type. Study heterogeneity was assessed with I and publication bias was qualitatively assessed via funnel plot and quantitatively assessed with the trim-and-fill method and Begg's adjusted rank test.
We found a significant, small effect size, such that individuals with depression had lower folate levels than those without depression, Hedge's g = -0.24 (95% CI = -0.31, -0.16), p < 0.001. Study heterogeneity was high (I = 84.88%), and neither folate measurement method nor population accounted for study heterogeneity.
Individuals with depression have lower serum levels of folate and dietary folate intake than individuals without depression. Given that previous literature suggested folate supplementation improved the efficacy of traditional antidepressant medications, future research on folate supplementation in depression is warranted and clinicians may wish to consider folate supplementation for patients with depression.
先前的研究表明，叶酸水平在抑郁症的病因和病程中起着重要作用。然而，关于抑郁症患者和非抑郁症患者之间叶酸水平的差异，文献一直存在不一致。本荟萃分析综合了以往研究的结果，以检验抑郁症患者的叶酸水平是否低于非抑郁症患者。
按照 PRISMA 指南进行荟萃分析程序。通过 PsycINFO 和 PubMed 确定评估红细胞叶酸、血清叶酸或叶酸饮食摄入方法中个体是否存在抑郁症的叶酸水平的研究。使用 Hedge 的 g 进行随机效应荟萃分析，并用叶酸测量方法和人群类型进行调节分析。使用 I 评估研究异质性，并通过漏斗图定性评估发表偏倚，并使用修剪和填充方法和 Begg 的调整秩检验进行定量评估。
我们发现了一个显著的小效应量，即抑郁症患者的叶酸水平低于非抑郁症患者，Hedge 的 g=-0.24（95%CI=-0.31，-0.16），p<0.001。研究异质性很高（I=84.88%），叶酸测量方法和人群均不能解释研究异质性。
抑郁症患者的血清叶酸水平和叶酸饮食摄入量低于非抑郁症患者。鉴于先前的文献表明叶酸补充剂提高了传统抗抑郁药物的疗效，因此有必要对抑郁症患者的叶酸补充进行进一步的研究，临床医生可能希望考虑为抑郁症患者补充叶酸。
