University Hospital Virgen del Rocio-IBIS, Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain.
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Psychol Med. 2021 Oct;51(14):2307-2320. doi: 10.1017/S0033291721002853. Epub 2021 Sep 8.
It is unclear what the prevalence of metabolic syndrome (MetS) in drug-naïve first-episode of psychosis (FEP) is, as previous meta-analyses were conducted in minimally exposed or drug-naïve FEP patients with psychotic disorder at any stage of the disease; thus, a meta-analysis examining MetS in naïve FEP compared with the general population is needed.
Studies on individuals with FEP defined as drug-naïve (0 days exposure to antipsychotics) were included to conduct a systematic review. A meta-analysis of proportions for the prevalence of MetS in antipsychotic-naïve patients was performed. Prevalence estimates and 95% CI were calculated using a random-effect model. Subgroup analyses and meta-regressions to identify sources and the amount of heterogeneity were also conducted.
The search yielded 4143 articles. After the removal of duplicates, 2473 abstracts and titles were screened. At the full-text stage, 112 were screened, 18 articles were included in a systematic review and 13 articles in the main statistical analysis. The prevalence of MetS in naïve (0 days) FEP is 13.2% (95% CI 8.7-19.0). Ethnicity accounted for 3% of the heterogeneity between studies, and diagnostic criteria used for MetS accounted for 7%. When compared with controls matched by sex and age, the odds ratio is 2.52 (95% CI 1.29-5.07; p = 0.007).
Our findings of increased rates of MetS in naïve FEP patients suggest that we are underestimating cardiovascular risk in this population, especially in those of non-Caucasian origin. Our findings support that altered metabolic parameters in FEPs are not exclusively due to antipsychotic treatments.
目前尚不清楚未经药物治疗的首发精神分裂症（FEP）患者中代谢综合征（MetS）的患病率是多少，因为之前的荟萃分析是在处于疾病任何阶段的精神分裂症患者中进行的，这些患者接触抗精神病药物的程度最低或尚未接触过抗精神病药物；因此，需要对未经药物治疗的 FEP 患者与普通人群进行 Meta 分析以评估 MetS。
纳入研究的纳入标准为 FEP 患者定义为未经药物治疗（接触抗精神病药物 0 天），以进行系统评价。采用随机效应模型对未经抗精神病药物治疗的患者 MetS 患病率进行比例 Meta 分析。采用 Meta 分析计算患病率估计值和 95%CI。还进行了亚组分析和荟萃回归以确定异质性的来源和程度。
搜索结果得到 4143 篇文章。去除重复项后，筛选了 2473 篇摘要和标题。在全文筛选阶段，筛选了 112 篇文章，其中 18 篇文章进行了系统评价，13 篇文章进行了主要的统计分析。未经治疗（0 天）的 FEP 患者 MetS 的患病率为 13.2%（95%CI 8.7-19.0）。种族差异占研究之间异质性的 3%，代谢综合征使用的诊断标准占 7%。与性别和年龄相匹配的对照组相比，比值比为 2.52（95%CI 1.29-5.07；p = 0.007）。
我们发现未经治疗的 FEP 患者中 MetS 发生率增加，这表明我们低估了该人群的心血管风险，尤其是在非高加索人群中。我们的研究结果支持这样一种观点，即 FEP 中代谢参数的改变不仅仅是由于抗精神病药物治疗所致。
