Bio-X Institutes, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China; Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychiatry Disorders, Shanghai Jiao Tong University, Shanghai, China.
Department of Obstetrics and Gyneocology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Schizophr Res. 2021 Apr;230:53-60. doi: 10.1016/j.schres.2021.02.009. Epub 2021 Mar 4.
Schizophrenia and affective disorders all show high heterogeneity in clinical manifestations. A lack of objective biomarkers has long been a challenge in the clinical diagnosis of these diseases. In this study, we aimed to investigate the performance of niacin skin flushing in schizophrenia and affective disorders and determine its clinical potential as an auxiliary diagnostic marker.
In this case-control study, niacin skin-flushing tests were conducted in 613 patients (including 307 schizophrenia patients, 179 bipolar disorder patients, and 127 unipolar depression patients) and 148 healthy controls (HCs) with a modified method. Differences in niacin skin-flushing responses were compared with adjustment for gender, BMI, age, nicotine dependence, alcohol consumption and educational status. A diagnostic model was established based on a bivariate cut-off.
Schizophrenia and affective disorders showed similar performance of niacin bluntness, characterized by attenuated flushing extent and reduced flushing rate. An innovative bivariate cut-off was established according to these two features, by which we could identify -patients with either schizophrenia or affective disorders from HCs with a sensitivity of 55.28%, a specificity of 83.56% and a positive predictive value of 93.66%.
The niacin-induced skin flushing was prevalently blunted in patients with schizophrenia or affective disorders, indicating a promising potential as an auxiliary diagnostic marker in risk prediction and clinical management of these disorders. Additionally, the niacin-blunted subgroup implies a common biological basis in the investigated disorders, which provokes new thoughts in elucidating the pathological mechanisms.
精神分裂症和情感障碍在临床表现上均具有高度异质性。长期以来，缺乏客观的生物标志物一直是这些疾病临床诊断的挑战。本研究旨在探讨烟酸皮肤潮红在精神分裂症和情感障碍中的表现，并确定其作为辅助诊断标志物的临床潜力。
在这项病例对照研究中，我们采用改良方法对 613 名患者（包括 307 名精神分裂症患者、179 名双相情感障碍患者和 127 名单相抑郁患者）和 148 名健康对照者（HCs）进行了烟酸皮肤潮红试验。比较了烟酸皮肤潮红反应的差异，并对性别、BMI、年龄、尼古丁依赖、饮酒和教育程度进行了调整。根据双变量截断值建立了诊断模型。
精神分裂症和情感障碍表现出相似的烟酸迟钝性，表现为潮红程度减弱和潮红率降低。根据这两个特征，我们建立了一个创新的双变量截断值，可以将精神分裂症或情感障碍患者与 HCs 区分开来，其敏感性为 55.28%，特异性为 83.56%，阳性预测值为 93.66%。
烟酸诱导的皮肤潮红在精神分裂症或情感障碍患者中普遍减弱，表明其作为这些疾病风险预测和临床管理的辅助诊断标志物具有很大的潜力。此外，烟酸迟钝亚组表明所研究的疾病存在共同的生物学基础，这为阐明其病理机制提供了新的思路。
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