Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.
PLoS One. 2021 Apr 8;16(4):e0243685. doi: 10.1371/journal.pone.0243685. eCollection 2021.
Child maltreatment (CM) is associated with mental and physical health disorders in adulthood. Some studies have identified elevated markers of systemic inflammation in adult survivors of CM, and inflammation may mediate the association between CM and later health problems. However, there are methodological inconsistencies in studies of the association between CM and systemic inflammation and findings are conflicting. We performed a systematic review to examine the association of CM with systemic inflammation in adults.
A pre-registered systematic review was performed following PRISMA guidelines. Medline, Embase, Scopus and PsychInfo were searched for studies of the association of CM with blood markers of inflammation in adults. Quality was assessed using the Crowe Critical Appraisal Tool. We had intended to perform a meta-analysis, but this was not possible due to variation in study design and reporting.
Forty-four articles met criteria for inclusion in the review. The most widely reported biomarkers were C-Reactive Protein (CRP) (n = 27), interleukin-6 (IL-6) (n = 24) and Tumour Necrosis Factor-alpha (TNF-a) (n = 17). Three studies were prospective (all relating to CRP) and the remainder were retrospective. 86% of studies were based in high income countries. In the prospective studies, CM was associated with elevated CRP in adulthood. Results of retrospective studies were conflicting. Methodological issues relating to the construct of CM, methods of analysis, and accounting for confounding or mediating variables (particularly Body Mass Index) may contribute to the uncertainty in the field.
There is some robust evidence from prospective studies that CM is associated with elevated CRP in adulthood. We have identified significant methodological inconsistencies in the literature and have proposed measures that future researchers could employ to improve consistency across studies. Further prospective, longitudinal, research using robust and comparable measures of CM with careful consideration of confounding and mediating variables is required to bring clarity to this field.
儿童虐待（CM）与成年人的精神和身体健康障碍有关。一些研究已经确定了 CM 成年幸存者中系统性炎症标志物的升高，并且炎症可能介导 CM 与后来的健康问题之间的关联。然而，CM 与系统性炎症之间关联的研究存在方法学上的不一致，并且研究结果存在冲突。我们进行了一项系统综述，以检查 CM 与成年人系统性炎症之间的关联。
根据 PRISMA 指南进行了预先注册的系统综述。检索了 Medline、Embase、Scopus 和 PsychInfo 数据库，以寻找关于 CM 与成年人血液炎症标志物关联的研究。使用 Crowe 批判性评估工具评估质量。我们原本打算进行荟萃分析，但由于研究设计和报告的差异，这是不可能的。
有 44 篇文章符合纳入综述的标准。报道最多的生物标志物是 C 反应蛋白（CRP）（n = 27）、白细胞介素 6（IL-6）（n = 24）和肿瘤坏死因子-α（TNF-a）（n = 17）。三项前瞻性研究（均与 CRP 相关）和其余回顾性研究。86%的研究基于高收入国家。在前瞻性研究中，CM 与成年后 CRP 升高有关。回顾性研究的结果存在冲突。与 CM 结构、分析方法以及对混杂或中介变量（特别是体重指数）的考虑相关的方法学问题可能导致该领域的不确定性。
有一些来自前瞻性研究的有力证据表明，CM 与成年后 CRP 升高有关。我们已经确定了文献中存在重大的方法学不一致，并提出了未来研究人员可以采用的措施，以提高研究之间的一致性。需要进一步进行前瞻性、纵向、使用稳健且可比的 CM 测量方法，并仔细考虑混杂和中介变量的研究，以阐明这一领域。
