Korkmaz Şükrü Alperen, Kızgın Sadice
Department of Psychiatry, Çanakkale Onsekiz Mart University, Çanakkale, Turkey.
Department of Psychiatry, Ankara Bilkent City Hospital, Ankara, Turkey.
Curr Med Res Opin. 2023 Oct;39(10):1383-1390. doi: 10.1080/03007995.2023.2260302. Epub 2023 Oct 10.
Recent studies show that inflammation is related to the pathogenesis of acute mania of bipolar disorder. Neutrophil/high-density lipoprotein (HDL) ratio (NHR), lymphocyte/HDL ratio (LHR), monocyte/HDL ratio (MHR) and platelet/HDL ratio (PHR) have recently been investigated as novel markers of inflammation. In addition, the atherogenic index of plasma (AIP) and atherogenic coefficient (AC) are the leading atherogenic indices. The study aimed to investigate these inflammation and atherogenic index markers in acute mania of bipolar disorder. Another aim was to determine whether there is a relationship between these markers and disease severity and psychotic symptoms.
A total of 109 BD-M and 101 (HC) were enrolled in the study. The differences in NHR, LHR, MHR, PHR, AIP and AC and their association with illness severity and psychotic symptoms were analyzed after adjusting for age, sex, total cholesterol level, body-mass index and smoking status. Then, a receiver operating characteristic (ROC) curve and linear discriminant analysis (LDA) were used to analyze these parameters' diagnostic potential. Moreover, the Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale for use in bipolar illness-Severity subscale (CGI-BP-S) were used to assess the severity of clinical symptoms.
We found higher levels of NHR, MHR, PHR and AIP, but not LHR and AC, after adjusting confounding factors in patients with BD-M compared to HCs. In logistic regression analysis, higher levels of MHR and NHR were associated with BD-M. MHR, NHR and PHR were predictors for differentiating the BD-M group from the HC group. However, the severity of the illness or the psychotic feature of the manic episode did not significantly affect the parameters. In the ROC curve analysis of BD-M, the indicators with an area under the curve (AUC) higher than 0.6 were the MHR, NHR, PHR and LHR.
These results provide information about the role of inflammation in the pathophysiology of BD-M. Even after controlling for confounding factors, MHR, NHR, PHR and AIP are potential biomarkers for BD-M. Moreover, the increase in AIP may explain the co-morbidity between BD and cardiovascular diseases. However, the severity of the illness or the psychotic feature of the manic episode did not significantly affect the levels of inflammation ratios used in our study. Due to the low cost and widespread use of lipid metabolism and related inflammation rates, it may be beneficial to know the MHR, NHR, PHR and AIP levels in BD-M patients.
近期研究表明，炎症与双相情感障碍急性躁狂发作的发病机制有关。中性粒细胞/高密度脂蛋白（HDL）比值（NHR）、淋巴细胞/HDL比值（LHR）、单核细胞/HDL比值（MHR）和血小板/HDL比值（PHR）最近被作为炎症的新型标志物进行研究。此外，血浆致动脉粥样硬化指数（AIP）和致动脉粥样硬化系数（AC）是主要的致动脉粥样硬化指标。本研究旨在调查双相情感障碍急性躁狂发作中的这些炎症和致动脉粥样硬化指数标志物。另一个目的是确定这些标志物与疾病严重程度及精神病性症状之间是否存在关联。
本研究共纳入109例双相情感障碍躁狂发作患者（BD - M）和101例健康对照者（HC）。在对年龄、性别、总胆固醇水平、体重指数和吸烟状况进行校正后，分析NHR、LHR、MHR、PHR、AIP和AC的差异及其与疾病严重程度和精神病性症状的关联。然后，使用受试者工作特征（ROC）曲线和线性判别分析（LDA）来分析这些参数的诊断潜力。此外，使用青年躁狂评定量表（YMRS）和双相情感障碍临床总体印象量表严重程度分量表（CGI - BP - S）来评估临床症状的严重程度。
我们发现，在对混杂因素进行校正后，与健康对照者相比，双相情感障碍躁狂发作患者的NHR、MHR、PHR和AIP水平较高，但LHR和AC水平未升高。在逻辑回归分析中，较高的MHR和NHR水平与双相情感障碍躁狂发作相关。MHR、NHR和PHR是区分双相情感障碍躁狂发作组和健康对照组的预测指标。然而，疾病的严重程度或躁狂发作的精神病性特征并未显著影响这些参数。在双相情感障碍躁狂发作患者的ROC曲线分析中，曲线下面积（AUC）高于0.6的指标为MHR、NHR、PHR和LHR。
这些结果提供了关于炎症在双相情感障碍躁狂发作病理生理学中作用的信息。即使在控制了混杂因素之后，MHR、NHR、PHR和AIP仍是双相情感障碍躁狂发作的潜在生物标志物。此外，AIP的升高可能解释了双相情感障碍与心血管疾病的共病现象。然而，疾病的严重程度或躁狂发作的精神病性特征并未显著影响我们研究中所使用的炎症比值水平。由于脂质代谢及相关炎症率检测成本低且应用广泛，了解双相情感障碍躁狂发作患者的MHR、NHR、PHR和AIP水平可能会有所帮助。
