感染和炎症在精神分裂症中的作用:证据综述

IF 1.5 Q3 PSYCHIATRY Middle East Current Psychiatry Pub Date : 2024-02-02 DOI:10.1186/s43045-024-00397-7
Gellan K. Ahmed, Haidi Karam-Allah Ramadan, Khaled Elbeh, Nourelhoda A. Haridy
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引用次数: 0

摘要

精神分裂症是一种严重的精神疾病,影响着全球约 1%的人口。虽然其确切病因尚不清楚,但新出现的证据表明,感染和炎症可能会导致一部分人发病。本综述全面总结了将感染、免疫系统功能紊乱和精神分裂症风险联系在一起的证据。一些基于人群的研究表明,需要住院治疗的产前或儿童期严重感染与日后精神分裂症诊断风险的增加有关,尤其是在有遗传倾向的个体中。中枢神经系统感染和全身感染似乎都会带来风险。特定的病原体包括弓形虫、疱疹病毒、衣原体等。自身免疫性疾病也与精神分裂症易感性的增加有关,这可能是由于血脑屏障的破坏使得大脑反应性抗体得以进入。最近的 2019 年冠状病毒病(COVID-19)大流行提出了 SARS-CoV-2 作为新发精神病风险因素的问题。感染与精神分裂症的关联机制可能涉及炎症、细胞因子、小胶质细胞活化和色氨酸/犬尿氨酸通路调节。针对炎症的治疗对精神分裂症有一定疗效,这进一步支持了炎症假说。虽然流行病学和机理方面的证据很充分,但要最终确定免疫功能失调与精神分裂症之间的确切联系机制,还需要进一步的研究。有证据表明,免疫系统异常可能与遗传和环境因素相互作用,在部分患者的精神分裂症病理生理学中起着一定的作用。需要开展更多的研究来更清楚地了解这些联系,这可能有助于未来的预防和针对特定疾病亚型的个性化治疗方法。
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The role of infections and inflammation in schizophrenia: review of the evidence
Schizophrenia is a severe mental illness affecting approximately 1% of the population worldwide. While its exact causes remain unknown, emerging evidence suggests that infections and inflammation may contribute to disease development in a subset of individuals. This review comprehensively summarizes the evidence linking infections, immune system dysfunction, and schizophrenia risk. Several population-based studies have linked serious prenatal or childhood infections requiring hospitalization to increased risk of later schizophrenia diagnosis, especially in individuals with genetic predisposition. Both central nervous system infections and systemic infections appear to confer risk. Specific pathogens including Toxoplasma gondii, herpesviruses, Chlamydophila, and more have been implicated. Autoimmune diseases are also associated with increased schizophrenia susceptibility, possibly due to blood-brain barrier disruption allowing brain-reactive antibodies access. The recent Coronavirus disease 2019 (COVID-19) pandemic raises questions about SARS-CoV-2 as a risk factor for new-onset psychosis. The mechanisms underlying the infection-schizophrenia link likely involve inflammation, cytokines, microglial activation, and tryptophan/kynurenine pathway modulation. Treatments targeting inflammation showed some efficacy in schizophrenia, further supporting an inflammation hypothesis. While the epidemiological and mechanistic evidence is substantial, further research is needed to conclusively determine the exact mechanisms linking immune dysfunction to schizophrenia requires further study. The evidence suggests immune system abnormalities likely play a role, perhaps by interacting with genetic and environmental factors, in instigating schizophrenia pathophysiology in a subset of patients. More research is needed to understand these connections more clearly which may aid future prevention and personalized treatment approaches tailored to specific illness subtypes.
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来源期刊
Middle East Current Psychiatry
Middle East Current Psychiatry Medicine-Psychiatry and Mental Health
CiteScore
3.00
自引率
0.00%
发文量
89
审稿时长
9 weeks
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