背景:垂体前叶激素的作用-即促肾上腺皮质激素(ACTH),促黄体生成和促卵泡激素(LH和FSH),生长激素(GH),催乳素(PRL),和促甲状腺激素(TSH)-在早期精神分裂症和精神病中不清楚。因此,我们对ACTH的血液浓度进行了系统评价和荟萃分析,LH和FSH,GH,PRL,与健康对照相比,首次发作精神病(FEP)的未服药患者的TSH和TSH。
方法:我们搜索了Embase,MEDLINE,和PsycInfo的文章索引到2022年9月。对数据质量进行了评价。进行了随机效应荟萃分析,生成汇总标准化平均差(SMD)。使用I2统计量估计研究之间的异质性。进行敏感性和荟萃回归分析。
结果:纳入26项研究。药物幼稚的人患有FEP,与健康的受试者相比,血液中ACTH浓度较高(k=7;N=548;SMD=0.62;95CI:0.29至0.94;p<0.001;I2=60.9%)和PRL(k=17;N=1757;SMD=0.85;95CI:0.56至1.14;p<0.001;I2=85.5%);TSH水平较低(k=6;N=634=0.54;Ip=元回归没有显示年龄的任何调节作用(p=0.78),性别(p=0.21),或症状严重程度(p=0.87)对药物初始FEP中PRL浓度的影响。现有数据不足以对FSH进行荟萃分析,LH,和GH。
结论:未服用药物的FEP患者ACTH发生了改变,PRL,和TSH血液浓度,支持以下假设:垂体前叶激素分泌异常可能与精神分裂症和精神病的发作有关。需要进一步的研究来阐明垂体激素在FEP中的作用。
The role of anterior pituitary hormones - i.e., adrenocorticotropic hormone (ACTH), luteinizing and follicle stimulating hormones (LH and FSH), growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone (TSH) - in early schizophrenia and psychoses unclear. We thus performed a systematic
review and meta-analysis on the blood concentrations of ACTH, LH and FSH, GH, PRL, and TSH in drug-naïve people with first-episode psychosis (FEP) as compared with healthy controls.
We searched Embase, MEDLINE, and PsycInfo for articles indexed until September 2022. Data quality was appraised. Random-effects meta-analyses were carried out, generating pooled standardized mean differences (SMDs). Between-study heterogeneity was estimated using the I2 statistic. Sensitivity and meta-regression analyses were performed.
Twenty-six studies were included. Drug-naïve people with FEP, compared to healthy subjects, had higher blood concentrations of ACTH (k = 7; N = 548; SMD = 0.62; 95%CI: 0.29 to 0.94; p < 0.001; I2 = 60.9%) and PRL (k = 17; N = 1757; SMD = 0.85; 95%CI: 0.56 to 1.14; p < 0.001; I2 = 85.5%) as well as lower levels of TSH (k = 6; N = 677; SMD = -0.34; 95%CI: -0.54 to -0.14; p = 0.001; I2 = 29.1%). Meta-regressions did not show any moderating effect of age (p = 0.78), sex (p = 0.21), or symptom severity (p = 0.87) on PRL concentrations in drug-naïve FEP. Available data were not sufficient to perform meta-analyses on FSH, LH, and GH.
Drug-naïve people with FEP have altered ACTH, PRL, and TSH blood concentrations, supporting the hypothesis that an abnormal anterior pituitary hormone secretion may be involved in the onset of schizophrenia and psychoses. Further research is needed to elucidate the role of pituitary hormones in FEP.