Rømer Troels Boldt, Sengeløv Henrik, Christensen Rune Haubo Bojesen, Benros Michael Eriksen
Copenhagen Research Center for Biological and Precision Psychiatry, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Biol Psychiatry Glob Open Sci. 2024 Aug 26;4(6):100389. doi: 10.1016/j.bpsgos.2024.100389. eCollection 2024 Nov.
Immunological mechanisms have been implicated in the development of mental disorders, and interestingly, case reports have suggested that hematopoietic stem cell transplantation (HSCT) can both transmit and cure psychotic disorders by replacing immune progenitor cells.
Using Danish registers, we followed patients who received HSCT from donors with a psychiatric diagnosis or psychotropic medication use. We assessed risk of incident mental disorders or psychotropic medication use compared with recipients with unaffected donors. We identified 464 donor-recipient pairs (51.3% male recipients). All donor-recipient pairs were related.
Receiving HSCT from a donor with a psychiatric history was not significantly associated with incident psychiatric diagnoses (hazard rate ratio [HRR] 2.79, 95% CI, 0.83-9.39; = .098) or incident use of psychotropics (HRR 1.43, 95% CI, 0.91-2.24; = .118). Subgroup analysis showed an increased risk of antipsychotic use, which remained significant after adjusting for confounders (HRR 4.73, 95% CI, 1.26-17.78; = .021); however, this was based on a small number of cases. For depression and antidepressant use, data were available to perform a meta-analysis of our and one additional study, which showed no significant difference (HRR 1.24, 95%, CI 0.66-2.35).
Receiving HSCT from a donor with a psychiatric history did not affect risk of mental disorders. An increased risk of antipsychotic use was observed only in subgroup analyses; however, the exploratory nature of the study, the limited sample size, and family relationship between donors and recipients do not allow for causal conclusions, and external replication studies are warranted.
免疫机制与精神障碍的发生有关，有趣的是，病例报告表明造血干细胞移植（HSCT）可通过替换免疫祖细胞来传播和治愈精神障碍。
利用丹麦的登记资料，我们追踪了接受来自有精神疾病诊断或使用精神药物的供体的造血干细胞移植的患者。我们评估了与接受未受影响供体的受者相比，发生精神障碍或使用精神药物的风险。我们确定了464对供体-受者对（男性受者占51.3%）。所有供体-受者对均有亲属关系。
接受来自有精神病史供体的造血干细胞移植与精神疾病诊断（风险率比[HRR]2.79，95%可信区间，0.83 - 9.39；P = 0.098）或精神药物的使用（HRR 1.43，95%可信区间，0.91 - 2.24；P = 0.118）无显著相关性。亚组分析显示抗精神病药物使用风险增加，在调整混杂因素后仍具有显著性（HRR 4.73，95%可信区间，1.26 - 17.78；P = 0.021）；然而，这是基于少数病例。对于抑郁症和抗抑郁药物的使用，有数据可对我们的研究和另一项研究进行荟萃分析，结果显示无显著差异（HRR 1.24，95%，可信区间0.66 - 2.35）。
接受来自有精神病史供体的造血干细胞移植不影响精神障碍风险。仅在亚组分析中观察到抗精神病药物使用风险增加；然而，该研究的探索性质、样本量有限以及供体与受者之间的亲属关系不允许得出因果结论，因此需要外部重复研究。
