Department of Translational Psychiatry, Moscow Research Institute of Psychiatry, The Branch of V. Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation.
Department of Fundamental and Applied Neurobiology, V. Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation.
Neuropsychobiology. 2022;81(1):1-18. doi: 10.1159/000515930. Epub 2021 May 17.
The objective of this study was to provide comprehensive evidence synthesis including all available up-to-date data about the prevalence of N-methyl D-aspartate receptor (NMDAR) antibodies (ABs) in psychotic patients in order to evaluate the clinical relevance of ABs as well as to specify potential explanations of the heterogeneity of the findings and determine areas for further research.
A literature search was conducted using the PubMed/Medline, Web of Knowledge, and Scopus databases.
Forty-seven studies and 4 systematic reviews (including 2 meta-analyses) were included in the present review. Studies that used cell-based assays (CBAs) provided heterogeneous results on AB prevalence, obviously depending on the type of detection assay and sample characteristics. Improvement of AB detection methods is necessary to determine the real prevalence of ABs across different groups of patients and healthy people. Live CBAs seem to have better sensitivity but probably poorer specificity than fixed CBAs. Moreover, some links between AB-positive status and acute symptoms are possible. A small amount of data on immunotherapy in AB-positive patients raises the possibility of its effectiveness but obviously require further research.
NMDAR ABs are definitely present in a subset of psychotic patients. NMDAR ABs might shape psychosis and underlie some symptoms, and immunotherapy might be regarded as a treatment option for patients failing to respond to other therapies.
本研究旨在提供全面的证据综合，包括关于精神病患者中 N-甲基-D-天冬氨酸受体 (NMDAR) 抗体 (AB) 流行率的所有最新数据，以评估 AB 的临床相关性，并明确发现异质性的潜在解释，并确定进一步研究的领域。
使用 PubMed/Medline、Web of Knowledge 和 Scopus 数据库进行文献检索。
本综述纳入了 47 项研究和 2 项系统评价（包括 2 项荟萃分析）。使用基于细胞的检测 (CBA) 的研究提供了 AB 流行率的异质结果，这显然取决于检测检测方法和样本特征的类型。需要改进 AB 检测方法，以确定不同患者组和健康人群中 ABs 的真实流行率。活 CBA 似乎比固定 CBA 具有更好的敏感性，但特异性可能较差。此外，AB 阳性状态与急性症状之间可能存在一些联系。少量关于 AB 阳性患者免疫治疗的数据表明其有效性，但显然需要进一步研究。
NMDAR AB 确实存在于一部分精神病患者中。NMDAR AB 可能塑造精神病并构成一些症状，免疫疗法可能被视为对其他治疗反应不佳的患者的治疗选择。
