目的:据报道,首次发作精神病(FEP)的抗精神病药物初治患者的催乳素和皮质醇水平发生改变。然而,它已经在非常小的样本中进行了研究,组间变异性以前从未被研究过。
目的:提供催乳素的标准化平均差异(SMD)和组间变异性的估计,抗精神病药幼稚FEP(AN-FEP)患者和健康对照(HC)的皮质醇觉醒反应(CAR)和早晨皮质醇浓度。
方法:生物,KCIMEDLINE,俄罗斯科学引文索引,SciELO,科克伦,PsycINFO,WebofScience从成立到2022年2月28日进行了搜索。
方法:纳入了同行评审的队列研究,这些研究报道了ANFEP患者和HC的催乳素或皮质醇血药浓度。
方法:研究特征,从每篇文章中提取平均值和标准偏差(SD)。使用Hedgesg估计效应大小的组间差异。用变异系数比(CVR)估计组间变异性。在这两种情况下,估计值都使用随机效应荟萃分析进行汇总。使用元回归估计研究水平特征的差异。遵循PRISMA指南(编号CRD42022303555)。
方法:催乳素,与HC组相比,AN-FEP组的CAR和早晨皮质醇血液浓度。
结果:关于催乳素的14项研究(AN-FEP组N=761,HC组N=687)和12项早晨皮质醇研究(AN-FEP组N=434,包括HC组的N=528)。在AN-FEP患者中没有发现CAR的研究。男性催乳素血药浓度的平均SMD为0.88(95%CI0.57,1.20),女性为0.56(95%CI0.26,0.87)。作为一个群体,与HC相比,AN-FEP表现出更大的催乳素水平组间变异性(CVR=1.28,95%CI1.02,1.62)。早晨皮质醇浓度的SMD无显着:0.34(95%CI-0.01,0.69),并且没有检测到组间变异性显着差异:CVR=1.05(95%CI0.91,1.20)。年龄和质量的Meta回归分析无统计学意义。漏斗图没有表明发表偏倚。
结论:在AN-FEP患者中发现催乳素水平升高。AN-FEP组的组间差异更大,表明存在催乳素水平不同的患者亚组。早晨皮质醇水平未发现明显异常。需要进一步的研究来阐明催乳素浓度是否可以用作疾病生物标志物。
Alterations in prolactin and cortisol levels have been reported in antipsychotic naïve patients with first episode psychosis (FEP). However, it has been studied in very small samples, and inter-group variability has never been studied before.
To provide estimates of standardized mean differences (SMD) and inter-group variability for prolactin, cortisol awakening response (CAR) and morning cortisol concentrations in antipsychotic naïve FEP (AN-FEP) patients and healthy controls (HC).
BIOSIS, KCI, MEDLINE, Russian Science Citation Index, SciELO, Cochrane, PsycINFO, Web of Science were searched from inception to February 28, 2022.
Peer-reviewed cohort studies that reported on prolactin or cortisol blood concentrations in AN- FEP patients and HC were included.
Study characteristics, means and standard deviations (SD) were extracted from each article. Inter group differences in magnitude of effect were estimated using Hedges g. Inter-group variability was estimated with the coefficient of variation ratio (CVR). In both cases estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. PRISMA guideline was followed (No. CRD42022303555).
Prolactin, CAR and morning cortisol blood concentrations in AN-FEP group in relation to HC group.
Fourteen studies for prolactin (N = 761 for AN-FEP group, N = 687 for HC group) and twelve studies for morning cortisol (N = 434 for AN-FEP group, N = 528 for HC group) were included. No studies were found in CAR in AN-FEP patients. Mean SMD for prolactin blood concentration was 0.88 (95% CI 0.57, 1.20) for male and 0.56 (95% CI 0.26, 0.87) for female. As a group, AN-FEP presented greater inter-group variability for prolactin levels than HC (CVR=1.28, 95% CI 1.02, 1.62). SMD for morning cortisol concentrations was non-significant: 0.34 (95% CI -0.01, 0.69) and no inter-group variability significant differences were detected: CVR= 1.05 (95% CI 0.91, 1.20). Meta-regression analyses for age and quality were non-significant. Funnel plots did not suggest a publication bias.
Increased prolactin levels were found in AN-FEP patients. A greater inter-group variability in the AN-FEP group suggests the existence of patient subgroups with different prolactin levels. No significant abnormalities were found in morning cortisol levels. Further research is needed to clarify whether prolactin concentrations could be used as an illness biomarker.