University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States.
University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States; Leiden University, Faculty of Social and Behavioral Sciences, Pieter de la Court Building, P.O. Box 9555, 2300 RB Leiden, The Netherlands.
Brain Behav Immun. 2018 Oct;73:85-114. doi: 10.1016/j.bbi.2018.06.016. Epub 2018 Jun 19.
One of the most common inflammatory markers examined in depression is C-reactive protein (CRP). However, the magnitude of the association between CRP and depression when controlling for potentially confounding factors such as age, sex, socio-economic status, body mass index, medication and other substance use, and medical illness, is unclear. Inconsistencies in other methodological practices, such as sample collection, assaying, and data cleaning and transformation, may contribute to variations in results. We aggregate studies that examined the association between CRP and depression in two ways. First, a systematic review summarizes how studies of CRP and depression have reported on methodological issues. Second, a tiered meta-analysis aggregates studies that have adhered to various levels of methodological rigor. Findings from the systematic review indicate a lack of protocol detail provided. The effect between depression and CRP was small, but highly significant across all stages of the meta-analysis (p < 0.01). The effect size in the most methodologically rigorous stage of the meta-analysis, which included studies controlling for age, sex, obesity, medical conditions and substance, medication, or psychosocial factors, was small (r = 0.05). There were also only 26 articles in this stage (13% of studies from the systematic review), suggesting that more studies that consistently account for these confounding factors are needed. Additionally, an a priori quality score of methodological rigor was a significant moderator in this stage of the meta-analysis. The effect size was strikingly attenuated (r = 0.005) and non-significant in studies with higher quality scores. We describe a set of recommended guidelines for future research to consider, including sample collection and assaying procedures, data cleaning and statistical methods, and control variables to assess.
在抑郁症中，最常检测到的炎症标志物之一是 C 反应蛋白（CRP）。然而，当控制年龄、性别、社会经济地位、体重指数、药物和其他物质使用以及疾病等潜在混杂因素时，CRP 与抑郁症之间的关联程度尚不清楚。其他方法学实践中的不一致，例如样本采集、检测以及数据清理和转换，可能导致结果的差异。我们以两种方式汇总了研究 CRP 与抑郁症之间关系的研究。首先，系统综述总结了 CRP 和抑郁症研究报告的方法学问题。其次，分层荟萃分析汇总了遵守各种方法学严谨程度水平的研究。系统综述的结果表明缺乏提供的方案细节。抑郁和 CRP 之间的影响虽然很小，但在荟萃分析的所有阶段都具有高度显著性（p<0.01）。荟萃分析中方法学最严谨阶段的效应大小，包括控制年龄、性别、肥胖、疾病以及物质、药物或心理社会因素的研究，很小（r=0.05）。在这个阶段，也只有 26 篇文章（系统综述中研究的 13%），这表明需要更多的研究来始终如一地考虑这些混杂因素。此外，方法学严谨性的预先质量评分是荟萃分析这一阶段的显著调节因素。在质量评分较高的研究中，效应大小明显减弱（r=0.005）且不显著。我们描述了一组未来研究应考虑的建议指南，包括样本采集和检测程序、数据清理和统计方法以及评估的控制变量。
