双相障碍患者的甲状腺激素水平：系统评价和荟萃分析。
Thyroid hormone levels in patients with bipolar disorder: a systematic review and meta-analysis.
机构信息
The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, China.
出版信息
BMC Endocr Disord. 2024 Nov 18;24(1):248. doi: 10.1186/s12902-024-01776-1.
PURPOSE
To investigate the difference in blood (serum/plasma) thyroid hormone (TH) levels, including thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3), in bipolar disorder (BD) during different mood episodes (depression and mania) compared with healthy control (HC) and between manic episodes (BD-M) and depressive episodes (BD-D).
METHODS
As of September 1, 2024, the electronic databases PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, China Science and Technology Journal Database, Wanfang Database, and Clinical Trials. Gov were systematically searched with no language limitations. Standardized mean differences (SMD) with 95% confidence interval (CI) were summarized using a random effects model. The chi-squared-based Q test and the I test assessed the size of heterogeneity.
RESULTS
The 21 studies included a total of 3696 participants, Of the 2942 BD patients, 1583 were in depressive episodes 1359 were in manic episodes. The status of measuring blood TH levels included 2 studies in plasma and 19 in serum. Combined with the results of the sensitivity analyses, we obtained the following relatively reliable results: serum T3 (SMD: -0.63, 95%CI: -1.09 to -0.17) and FT3 (SMD: -0.42, 95%CI: -0.83 to -0.00) levels decreased significantly in BD-D compared to HC; serum T3 (SMD: -0.91, 95%CI: -1.49 to -0.32) levels decreased significantly and serum FT4 (SMD: 0.37, 95%CI: 0.14 to 0.60) levels increased significantly in BD-M than in HC; serum T3 (SMD: 0.87, 95%CI: 0.24 to 1.49) and FT3 (SMD: 0.27, 95%CI: 0.13 to 0.42) levels demonstrated a significant elevation in BD-M compared to BD-D. In the group of euthyroidism, apart from serum FT4 (SMD: 0.21, 95%CI: -0.15 to 0.58) levels showed no significant difference between BD-M and HC, other results above remained consistent.
CONCLUSION
Serum T3 and FT3 levels decreased significantly in BD-D compared to HC. Serum T3 levels decreased significantly and serum FT4 levels increased significantly in BD-M compared to HC. Serum T3 and FT3 levels increased significantly in BD-M than in BD-D. The temporality of changes in TH levels and BD progression demands further longitudinal studies to illustrate.
TRIAL REGISTRATION
Number and date of registration for prospectively registered trials No. CRD42022378530.
目的
比较双相情感障碍（BD）不同心境发作（抑郁和躁狂）与健康对照组（HC）以及躁狂发作（BD-M）与抑郁发作（BD-D）之间的血（血清/血浆）甲状腺激素（TH）水平，包括促甲状腺激素（TSH）、甲状腺素（T4）、三碘甲状腺原氨酸（T3）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）的差异。
方法
截至 2024 年 9 月 1 日，系统检索了 PubMed、Embase、Cochrane 图书馆、Web of Science、中国国家知识基础设施、中国生物医学文献数据库、中国科技期刊数据库、万方数据库和 ClinicalTrials.gov 等电子数据库，无语言限制。使用随机效应模型总结标准化均数差（SMD）及其 95%置信区间（CI）。基于卡方的 Q 检验和 I 检验评估异质性的大小。
结果
21 项研究共纳入 3696 名参与者，2942 名 BD 患者中，1583 名处于抑郁发作期，1359 名处于躁狂发作期。血液 TH 水平测量状态包括 2 项血浆研究和 19 项血清研究。结合敏感性分析的结果，我们得到了以下相对可靠的结果：与 HC 相比，BD-D 患者血清 T3（SMD：-0.63，95%CI：-1.09 至-0.17）和 FT3（SMD：-0.42，95%CI：-0.83 至-0.00）水平显著降低；与 HC 相比，BD-M 患者血清 T3（SMD：-0.91，95%CI：-1.49 至-0.32）水平显著降低，血清 FT4（SMD：0.37，95%CI：0.14 至 0.60）水平显著升高；与 BD-D 相比，BD-M 患者血清 T3（SMD：0.87，95%CI：0.24 至 1.49）和 FT3（SMD：0.27，95%CI：0.13 至 0.42）水平显著升高。在甲状腺功能正常组中，除血清 FT4（SMD：0.21，95%CI：-0.15 至 0.58）水平在 BD-M 与 HC 之间无显著差异外，其他结果与上述结果一致。
结论
与 HC 相比，BD-D 患者血清 T3 和 FT3 水平显著降低。与 HC 相比，BD-M 患者血清 T3 水平显著降低，血清 FT4 水平显著升高。与 BD-D 相比，BD-M 患者血清 T3 和 FT3 水平显著升高。TH 水平的变化与 BD 进展的时间关系需要进一步的纵向研究来阐明。
试验注册
前瞻性注册试验的注册号和日期：No. CRD42022378530。
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