Medical College of Georgia, Augusta University, Augusta, GA, United States.
Department of Psychiatry and Health Behavior, Augusta University, 997 Saint Sebastian Way, Augusta, GA, 30912, United States.
Psychoneuroendocrinology. 2019 Jun;104:269-275. doi: 10.1016/j.psyneuen.2019.03.014. Epub 2019 Mar 19.
Schizophrenia is associated with abnormal neuroimmunoendocrine function. There is evidence for hypothalamic-pituitary-adrenal (HPA) axis abnormalities in individuals with first-episode psychosis (FEP). However, some previous meta-analyses have focused on heterogeneous sample sources and patient populations. We performed a meta-analysis of baseline (i.e., one sample) blood cortisol levels in individuals with FEP and minimal exposure to antipsychotics.
Articles were identified by searching PubMed, PsycInfo, Web of Science, and Science Direct, and the reference lists of these studies.
Twenty-six studies (comprising twenty-seven samples) met the inclusion criteria. Blood cortisol levels were significantly increased in individuals with FEP compared to controls with a small-to-medium effect size (standard mean difference [SMD] = 0.37, 95% CI 0.16-0.57, p < 0.001). In meta-regression analyses, geography was a significant moderator of this association, with larger effects seen in studies conducted in Asia versus the Middle East.
We found elevated blood cortisol levels in individuals with FEP, providing additional, complementary evidence for abnormal HPA axis function in this disorder. This finding, which does not inform on mechanism, is consistent with the "neural diathesis-stress" model of psychosis. Given the immunomodulatory effects of cortisol, methodologically rigorous longitudinal studies of cortisol parameters, inflammatory markers, and psychopathology in this patient population are warranted.
精神分裂症与神经免疫内分泌功能异常有关。有证据表明，首发精神病（FEP）患者存在下丘脑-垂体-肾上腺（HPA）轴异常。然而，一些之前的荟萃分析集中在异质的样本来源和患者人群上。我们对 FEP 患者和抗精神病药物最小暴露的基线（即一个样本）血液皮质醇水平进行了荟萃分析。
通过搜索 PubMed、PsycInfo、Web of Science 和 Science Direct 以及这些研究的参考文献列表来确定文章。
符合纳入标准的有 26 项研究（包括 27 个样本）。与对照组相比，FEP 患者的血液皮质醇水平显著升高，具有小到中等的效应大小（标准均数差 [SMD] = 0.37，95%CI 0.16-0.57，p < 0.001）。在元回归分析中，地理位置是这种关联的一个显著调节因素，在亚洲进行的研究中观察到的效果大于在中东进行的研究。
我们发现 FEP 患者的血液皮质醇水平升高，为该疾病中 HPA 轴功能异常提供了额外的、补充性证据。这一发现虽然不能说明机制，但与精神病的“神经素质-应激”模型一致。鉴于皮质醇的免疫调节作用，在该患者人群中，对皮质醇参数、炎症标志物和精神病理学进行方法学严格的纵向研究是合理的。
