Department of Psychiatry, La Conception University Hospital, 13005 Marseille, France; EA 3279 - EA 3279: CEReSS, Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France.
Department of Psychiatry, La Conception University Hospital, 13005 Marseille, France; SHU Adult Psychiatry, Sainte Marguerite University Hospital, 13274 Marseille, France.
Prog Neuropsychopharmacol Biol Psychiatry. 2020 Mar 8;97:109800. doi: 10.1016/j.pnpbp.2019.109800. Epub 2019 Oct 30.
C-reactive protein (CRP) is a general marker of peripheral inflammation and has been shown to be a good marker of neuroinflammation. CRP has been found to be elevated in patients with mood disorders (especially unipolar disorders (UD) and in schizophrenia (SZ)) but also to be lowered by antidepressants.
The objectives were (i) to determine the prevalence of major depression, antidepressant prescription and remission under antidepressant in a stabilized population of SZ and UD patients consulting in a daily hospital, and (ii) to determine if CRP was a marker of major depression and remission under antidepressant in these SZ and UD populations.
Abnormal CRP was defined by a CRP blood level ≥ 3 mg/L. Depressive symptoms were assessed by the Calgary Depression Rating Scale score. The clinicians were blinded of the CRP status of the patient.
411 patients were included (272 SZ and 139 UD). 171 (41.6%) were diagnosed with current major depression (74 (27.2%) for SZ and 97 (69.8%) for UD). 86 SZ (31.6%) and 119 UD (85.6%) were treated by antidepressant. Only 28/74 (37.8%) of the SZ subjects with major depression were administered antidepressants vs. 87/97 (89.7%) for UD. The non-remission rate under antidepressant was 28/86(32.6%) for SZ and 87/119 (73.1%) for UD. Overall, 105 (40.1%) of SZ and 39 (28.1%) of UD patients were found to have abnormal CRP blood levels. Abnormal CRP levels were significantly associated with increased MDD and more strongly with increased rates of non-remission under antidepressants in SZ patients, independently of age, gender, psychotic symptomatology, functioning, tobacco smoking and metabolic syndrome. This result was not replicated in UD patients, which suggests that CRP may be a specific marker of major depression and remission under antidepressant in SZ patients.
The development of biomarkers in psychiatry may orientate specific etiologic therapies in patients with mental disorders. The present findings suggest that major depression is frequent in SZ patients and that increased CRP levels are associated with non-remission under antidepressants in this population. Anti-inflammatory strategies may be particularly useful in this specific population.
C-反应蛋白（CRP）是外周炎症的一般标志物，已被证明是神经炎症的良好标志物。研究发现，情绪障碍患者（尤其是单相障碍（UD）和精神分裂症（SZ）患者）的 CRP 水平升高，但抗抑郁药也可降低 CRP 水平。
本研究旨在（i）确定在每日医院就诊的 SZ 和 UD 稳定患者人群中，重度抑郁症、抗抑郁药处方和抗抑郁药治疗缓解的患病率；（ii）确定 CRP 是否是这些 SZ 和 UD 人群中重度抑郁症和抗抑郁药治疗缓解的标志物。
CRP 血液水平≥3mg/L 定义为 CRP 异常。抑郁症状通过卡尔加里抑郁评定量表（CDRS）评分进行评估。临床医生对患者的 CRP 状况不知情。
共纳入 411 例患者（272 例 SZ 和 139 例 UD）。171 例（41.6%）被诊断为当前患有重度抑郁症（74 例 SZ[27.2%]和 97 例 UD[69.8%]）。86 例 SZ（31.6%）和 119 例 UD（85.6%）接受了抗抑郁药治疗。仅 28/74（37.8%）例 SZ 重度抑郁症患者接受了抗抑郁药治疗，而 UD 患者则有 87/97（89.7%）接受了抗抑郁药治疗。SZ 中抗抑郁药治疗缓解率为 28/86（32.6%），UD 中为 87/119（73.1%）。总体而言，SZ 中有 105（40.1%）例和 UD 中有 39（28.1%）例患者 CRP 血液水平异常。CRP 水平异常与 MDD 发生率增加显著相关，与 SZ 患者抗抑郁药治疗缓解率降低的相关性更强，独立于年龄、性别、精神病症状、功能、吸烟和代谢综合征。这一结果在 UD 患者中未得到复制，这表明 CRP 可能是 SZ 患者重度抑郁症和抗抑郁药治疗缓解的特异性标志物。
精神病学中生物标志物的发展可能为精神障碍患者的特定病因治疗提供指导。本研究结果表明，SZ 患者中重度抑郁症较为常见，且 CRP 水平升高与该人群中抗抑郁药治疗缓解率降低有关。抗炎策略在该特定人群中可能特别有用。
