双相障碍不同心境发作的激素和炎症特征：一项大规模临床研究。
Hormonal and inflammatory signatures of different mood episodes in bipolar disorder: a large-scale clinical study.
机构信息
Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China.
Beijing SmindU Medical Science & Technology Co., Ltd, Beijing, 100020, China.
出版信息
BMC Psychiatry. 2023 Jun 20;23(1):449. doi: 10.1186/s12888-023-04846-1.
BACKGROUND
Bipolar disorder (BD) is characterized by intensive mood fluctuations. While hormones imbalance plays important role in the mood swings, it is unknown whether peripheral hormones profiles could differentiate the manic and depressive mood episodes in BD. In this study, we investigated the changes of various hormones and inflammatory markers across distinct mood episodes of BD in a large clinical study to provide mood episode-specific peripheral biomarkers for BD.
METHODS
A total of 8332 BD patients (n = 2679 depressive episode; n = 5653 manic episode) were included. All patients were in acute state of mood episodes and need hospitalization. A panel of blood tests were performed for levels of sex hormones (serum levels of testosterone, estradiol, and progesterone), stress hormones (adrenocorticotropic hormone and cortisol), and an inflammation marker (C-reactive protein, CRP). A receiver operating characteristic (ROC) curve was used to analyze the discriminatory potential of the biomarkers for mood episodes.
RESULTS
In overall comparison between mood episodes, the BD patients expressed higher levels of testosterone, estradiol, progesterone, and CRP (P < 0.001) and lower adrenocorticotropic hormone (ACTH) level (P < 0.001) during manic episode. The episode-specific changes of testosterone, ACTH, and CRP levels remained between the two groups (P < 0.001) after correction for the confounding factors including age, sex, BMI, occupation, marital status, tobacco use, alcohol consumption, psychotic symptoms, and age at onset. Furthermore, we found a sex- and age-specific impact of combined biomarkers in mood episodes in male BD patients aged ≥ 45 years (AUC = 0.70, 95% CI, 0.634-0.747), not in females.
CONCLUSIONS
While both hormone and inflammatory change is independently associated with mood episodes, we found that the combination of sex hormones, stress hormones and CRP could be more effective to differentiate the manic and depressive episode. The biological signatures of mood episodes in BD patients may be sex- and age-specific. Our findings not only provide mood episode-related biological markers, but also better support for targeted intervention in BD treatments.
背景
双相情感障碍（BD）的特征是情绪波动剧烈。尽管激素失衡在情绪波动中起着重要作用，但外周激素谱是否能区分 BD 的躁狂和抑郁发作尚不清楚。在这项研究中，我们在一项大型临床研究中调查了 BD 不同情绪发作时各种激素和炎症标志物的变化，为 BD 提供情绪发作特异性的外周生物标志物。
方法
共纳入 8332 例 BD 患者（n=2679 例抑郁发作；n=5653 例躁狂发作）。所有患者均处于情绪发作的急性期，需要住院治疗。进行了一组血液检查，以检测性激素（血清睾酮、雌二醇和孕酮水平）、应激激素（促肾上腺皮质激素和皮质醇）和炎症标志物（C 反应蛋白，CRP）的水平。使用受试者工作特征（ROC）曲线分析生物标志物对情绪发作的鉴别潜力。
结果
在情绪发作的总体比较中，BD 患者在躁狂发作时表现出更高的睾酮、雌二醇、孕酮和 CRP 水平（P<0.001）和更低的促肾上腺皮质激素（ACTH）水平（P<0.001）。在校正年龄、性别、BMI、职业、婚姻状况、吸烟、饮酒、精神病症状和发病年龄等混杂因素后，两组之间仍存在睾酮、ACTH 和 CRP 水平的发作特异性变化（P<0.001）。此外，我们发现，在年龄≥45 岁的男性 BD 患者中，性激素、应激激素和 CRP 的联合生物标志物对情绪发作具有性别和年龄特异性影响（AUC=0.70，95%CI，0.634-0.747），而在女性中则不然。
结论
尽管激素和炎症变化都与情绪发作独立相关，但我们发现，性激素、应激激素和 CRP 的组合可以更有效地区分躁狂和抑郁发作。BD 患者情绪发作的生物学特征可能具有性别和年龄特异性。我们的发现不仅提供了与情绪发作相关的生物学标志物，而且为 BD 治疗的靶向干预提供了更好的支持。
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