Tianjin Mental Health Institute, Tianjin Anding Hospital, Tianjin, China; University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands; University of Groningen, Research School Behavioral and Cognitive Neurosciences (BCN), Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands.
J Affect Disord. 2019 Oct 1;257:640-649. doi: 10.1016/j.jad.2019.07.045. Epub 2019 Jul 5.
A substantial percentage of depressed patients do not respond satisfactorily to conventional antidepressant treatment. This treatment resistant depression (TRD) may be partly related to inflammatory processes in the central nervous system. Accordingly, peripheral inflammatory markers might serve to predict treatment response with novel but still experimental forms of antidepressant treatment.
A literature search on treatment of TRD and inflammatory markers was performed using the PubMed/Medline database on November 8th 2018, and 95 articles were retrieved initially, which were subsequently screened and selected only when the inclusion and exclusion criteria were met.
Ten studies were recruited. In five studies higher baseline interleukin-6 (IL-6) or C-reactive protein (CRP)/high-sensitivity-CRP (hsCRP) in blood predicted better response to medication with anti-inflammatory characteristics, such as ketamine and infliximab. One study found that higher IL-6 predicted worse response to antidepressant treatment in patients with TRD. No evidence was found for the predictive value of other inflammatory markers (e.g., Tumor Necrosis Factor-α, Interferon-γ).
The number of available studies was limited; included studies showed considerable methodological variation and used different definitions for TRD.
The inflammatory markers IL-6 and CRP/hsCRP could hold promise as markers for the prediction of treatment response in TRD. Clearly, this field of research is still far from mature but it could pave the way for novel and efficacious treatments for at least the inflammatory type of TRD with more well-designed studies and more convincing results.
相当一部分抑郁症患者对传统抗抑郁治疗反应不佳。这种治疗抵抗性抑郁症（TRD）可能部分与中枢神经系统的炎症过程有关。因此，外周炎症标志物可能有助于预测新型但仍处于实验阶段的抗抑郁治疗的反应。
使用 2018 年 11 月 8 日的 PubMed/Medline 数据库对 TRD 和炎症标志物的治疗进行了文献检索，最初检索到 95 篇文章，随后仅在符合纳入和排除标准的情况下进行筛选和选择。
共纳入 10 项研究。在 5 项研究中，较高的基线白细胞介素 6（IL-6）或 C 反应蛋白（CRP）/高敏 C 反应蛋白（hsCRP）水平预示着对具有抗炎特性的药物（如氯胺酮和英夫利昔单抗）反应更好。一项研究发现，IL-6 水平较高预示着 TRD 患者对抗抑郁治疗的反应较差。没有证据表明其他炎症标志物（如肿瘤坏死因子-α、干扰素-γ）具有预测价值。
可用研究数量有限；纳入的研究显示出相当大的方法学差异，并使用不同的 TRD 定义。
炎症标志物 IL-6 和 CRP/hsCRP 可能有望成为预测 TRD 治疗反应的标志物。显然，该研究领域仍远未成熟，但它可以为至少具有炎症型 TRD 的新型有效治疗方法铺平道路，需要更多设计良好的研究和更有说服力的结果。
