Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom.
Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, United Kingdom.
JAMA Psychiatry. 2024 Nov 1;81(11):1130-1137. doi: 10.1001/jamapsychiatry.2024.2193.
Research suggests that low-grade, nonresolving inflammation may predate adult mental and physical illness. However, evidence to date is largely cross-sectional or focuses on single disorder outcomes.
To examine trajectories of inflammation as measured by C-reactive protein (CRP) levels in a large sample of children and adolescents, and to explore associations between different identified trajectories and mental and related cardiometabolic health outcomes in early adulthood.
DESIGN, SETTING, AND PARTICIPANTS: In a longitudinal cohort study using data from the large UK-based Avon Longitudinal Study of Parents and Children (ALSPAC), latent class growth analysis (LCGA) was used to explore different trajectories of inflammation, with logistic regression exploring association with mental and physical health outcomes. Participants with measurable CRP data and associated mental and cardiometabolic health outcomes recorded were included in the analysis. Data analysis was performed from May 1, 2023, to March 30, 2024.
Inflammation was assessed via CRP levels at ages 9, 15, and 17 years. LCGA was used to identify different trajectories of inflammation.
Outcomes assessed at age 24 years included psychotic disorders, depressive disorders, anxiety disorders, hypomania, and, as a measure of insulin resistance, Homeostasis Model Assessment (HOMA2) score.
A total of 6556 participants (3303 [50.4%] female) were included. Three classes of inflammation were identified: persistently low CRP levels (reference class, n = 6109); persistently raised CRP levels, peaking at age 9 years (early peak, n = 197); and persistently raised CRP levels, peaking at age 17 years (late peak, n = 250). Participants in the early peak group were associated with a higher risk of psychotic disorder (odds ratio [OR], 4.60; 95% CI, 1.81-11.70; P = .008), a higher risk of severe depression (OR, 4.37; 95% CI, 1.64-11.63; P = .02), and higher HOMA2 scores (β = 0.05; 95% CI, 0.01-0.62, P = .04) compared with participants with persistently low CRP. The late peak group was not associated with any outcomes at age 24 years.
Low-grade systemic inflammation peaking in midchildhood was associated with specific mental and cardiometabolic disorders in young adulthood. These findings suggest that low-grade persistent inflammation in early life may be an important shared common factor for mental-physical comorbidity and so could be relevant to future efforts of patient stratification and risk profiling.
研究表明，低度、非缓解性炎症可能先于成年期的精神和身体疾病。然而，迄今为止的证据主要是横断面的，或者集中在单一疾病的结果上。
在大量儿童和青少年中，使用 C 反应蛋白（CRP）水平来检测炎症的轨迹，并探讨不同确定的轨迹与成年早期的精神和相关心血管代谢健康结果之间的关系。
设计、地点和参与者：本研究是一项基于英国阿冯纵向研究父母和孩子（ALSPAC）的大型纵向队列研究，使用数据进行了潜在类别增长分析（LCGA），以探索炎症的不同轨迹，并使用逻辑回归来探讨与精神和身体健康结果的关系。包括具有可测量 CRP 数据和相关精神及心血管代谢健康结果记录的参与者。数据分析于 2023 年 5 月 1 日至 2024 年 3 月 30 日进行。
炎症通过 9、15 和 17 岁时的 CRP 水平进行评估。LCGA 用于确定炎症的不同轨迹。
24 岁时评估的结果包括精神病、抑郁症、焦虑症、轻躁狂，以及作为胰岛素抵抗的衡量标准，稳态模型评估（HOMA2）评分。
共纳入 6556 名参与者（3303 名[50.4%]为女性）。确定了三类炎症：持续低 CRP 水平（参考组，n=6109）；9 岁时 CRP 水平持续升高，达到峰值（早峰组，n=197）；17 岁时 CRP 水平持续升高，达到峰值（晚峰组，n=250）。早峰组的参与者与精神病的风险增加相关（优势比[OR]，4.60；95%置信区间[CI]，1.81-11.70；P=0.008）、严重抑郁的风险增加（OR，4.37；95%CI，1.64-11.63；P=0.02）和更高的 HOMA2 评分（β=0.05；95%CI，0.01-0.62，P=0.04），与 CRP 持续低水平的参与者相比。晚峰组与 24 岁时的任何结果均无关。
儿童中期达到峰值的低度全身性炎症与年轻成年人的特定精神和心血管代谢疾病有关。这些发现表明，生命早期低度持续的炎症可能是精神-身体共病的一个重要共同因素，因此可能与未来的患者分层和风险分析相关。
