Do interventions for mood improve inflammatory biomarkers in Inflammatory Bowel Disease?: A Systematic Review and Meta-Analysis

Meta-analysis of RCTs in adults with IBD that trialled interventions that included mood (depression, anxiety, stress, distress, or poor emotional well-being) as a primary or secondary outcome. All studies had to include an inflammatory biomarker, measured pre- and post-intervention. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Five electronic databases (in MEDLINE, EMBASE, PsycINFO, Global Health (through Ovid, 2022) and Web of Science (through Clarivate 2022), from 1947 to October 2023) were searched. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMD) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401).

28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (-0.35, 95%CI:-0.48, -0.22, p<0.001) and medium effects on mood outcomes (-0.50, 95%CI:-0.73, -0.27, p<0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (-0.19, 95%CI:-0.34, -0.03, p=0.018) and C-Reactive Protein (-0.29, 95%CI: -0.47, -0.10, p=0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD≥0.2) on mood.

对成人炎症性肠病（IBD）患者的随机对照试验（RCTs）进行荟萃分析，旨在评估包括情绪（抑郁、焦虑、压力、不适或情绪不佳）作为主要或次要结局的干预措施。所有研究均须包含一种炎症生物标志物，并在干预前后进行测量。本研究遵循系统评价与荟萃分析优先报告项目（PRISMA）指南。检索了五个电子数据库（包括1947年至2023年10月期间的MEDLINE、EMBASE、PsycINFO、全球健康（通过Ovid，2022）和Web of Science（通过Clarivate，2022）），独立审阅者筛选研究、提取数据并评估方法论质量。数据被汇总以估计标准化均数差异（SMD）和95%置信区间（CI）。随机效应稳健方差估计考虑了测量多个生物标志物的研究。干预类型、情绪作为主要或次要结局以及情绪结局和IBD亚型对治疗效果的影响被视为治疗效应调节因素。当有足够的生物标志物时，进行了个体荟萃分析（预先注册PROSPERO：CRD42023389401）。共纳入符合纳入标准的研究28项，涉及1789名参与者。干预措施在生物标志物上显示出小而具有统计学意义的效应（-0.35，95%CI：-0.48，-0.22，p<0.001）以及在情绪结局上显示出中等效应（-0.50，95%CI：-0.73，-0.27，p<0.001），没有实质性异质性和发表偏倚的证据。个体分析显示，改善粪便钙卫蛋白（-0.19，95%CI：-0.34，-0.03，p=0.018）和C反应蛋白（-0.29，95%CI：-0.47，-0.10，p=0.002）的小效应。心理治疗干预措施的效果大小大于运动或抗抑郁药（相比），并且当情绪上有效应（SMD≥0.2）时。