Chen Mengyi, Jiang Qi, Zhang Lei
Department of Geriatrics, Shanghai Pudong New District Mental Health Center, Shanghai, China. Email:
Department of Geriatrics, Shanghai Pudong New District Mental Health Center, Shanghai, China.
Ann Palliat Med. 2021 Jan;10(1):350-361. doi: 10.21037/apm-20-2293. Epub 2021 Jan 11.
At the end of the last century, genome-wide association studies revealed a significant genetic association between bipolar disorder and autoimmune diseases. Subsequently, the theory of immune pathogenesis of bipolar disorder gradually formed, and the research on autoimmune diseases and bipolar comorbidities began to extend to other diseases, but their correlation is still controversial. To explore the differences in the prevalence of bipolar disorder in patients with autoimmune disease and normal healthy people through meta-analysis, and to examine the relationship between bipolar disorder and autoimmune disease by reviewing the relevant literature.
The Cochrane, PubMed, and Embase databases were searched by computer from the date of inception of the database to July 2020. The main topics of the search were based on common autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, psoriasis, multiple sclerosis, ulcerative colitis, Crohn's disease, ankylosing spondylitis, pemphigus, and Sjogren's syndrome. The databases were comprehensively searched for controlled studies regarding the prevalence of bipolar disorder in patients with autoimmune diseases. Review Manager 5.3 software was used for meta-analysis.
In total, 10 cohort and case control studies were included. From these, 16 control groups were extracted based on nine autoimmune diseases. The meta-analysis demonstrated that the incidence of bipolar disorder was significantly increased in patients with autoimmune disease compared to patients without autoimmune disease, [mean difference (MD) =1.54, 95% confidence interval (CI): 1.28-1.86, P<0.00001]. Also, in the meta-analysis based on five cross-sectional analyses (in which a total of five control groups were extracted based on five autoimmune diseases), the high comorbidity rate of autoimmune diseases and bipolar disorder was verified (MD =2.23, 95% CI: 1.62-3.07, P<0.00001).
The prevalence of bipolar disorder is markedly higher in patients with autoimmune disease. Yet, more basic research is needed to verify the special significance of immune mechanisms in bipolar disorder.
上世纪末，全基因组关联研究揭示了双相情感障碍与自身免疫性疾病之间存在显著的遗传关联。随后，双相情感障碍的免疫发病机制理论逐渐形成，对自身免疫性疾病与双相情感障碍共病的研究开始扩展到其他疾病，但其相关性仍存在争议。通过荟萃分析探讨自身免疫性疾病患者与正常健康人群中双相情感障碍患病率的差异，并通过回顾相关文献研究双相情感障碍与自身免疫性疾病之间的关系。
通过计算机检索Cochrane、PubMed和Embase数据库，检索时间从数据库建立之日至2020年7月。检索的主要主题基于常见的自身免疫性疾病，包括系统性红斑狼疮、类风湿性关节炎、银屑病、多发性硬化症、溃疡性结肠炎、克罗恩病、强直性脊柱炎、天疱疮和干燥综合征。全面检索数据库中关于自身免疫性疾病患者双相情感障碍患病率的对照研究。使用Review Manager 5.3软件进行荟萃分析。
共纳入10项队列研究和病例对照研究。从中，基于9种自身免疫性疾病提取了16个对照组。荟萃分析表明，与无自身免疫性疾病的患者相比，自身免疫性疾病患者双相情感障碍的发病率显著升高，[平均差（MD）=1.54，95%置信区间（CI）：1.28 - 1.86，P<0.00001]。此外，在基于五项横断面分析的荟萃分析中（其中基于五种自身免疫性疾病共提取了五个对照组），验证了自身免疫性疾病与双相情感障碍的高共病率（MD =2.23，95% CI：1.62 - 3.07，P<0.00001）。
自身免疫性疾病患者中双相情感障碍的患病率明显更高。然而，需要更多的基础研究来验证免疫机制在双相情感障碍中的特殊意义。
