精神病性障碍中的皮质醇与认知：系统综述与多水平荟萃分析。
完整摘要 · 中文译文
新出现的证据表明，下丘脑-垂体-肾上腺（HPA）轴失调，尤其是皮质醇失调，可能导致精神病性障碍中常见的认知缺陷。我们开展了首个关于精神病中皮质醇与认知之间关联的合并系统综述和定量综合。十二项研究符合纳入标准（940名参与者；74.68%为病例；39.57%为女性；平均年龄=31.83岁）。其中，九项研究（822名参与者；71.04%为病例；35.96%为女性；平均年龄=32.72岁）为三项三级meta分析提供了数据，这些分析考察了基础皮质醇与复合认知、注意、工作记忆和处理速度（AWP）、执行功能（EF）以及言语学习和记忆（VM）之间的关联。皮质醇采样时间显著调节了皮质醇与EF之间的关系（F=10.98，p=.004），午后/傍晚皮质醇与EF之间呈现出显著的负相关（r=-0.27，95%CI[-0.42，-0.12]，p=.01）。未观察到其他稳健的皮质醇-认知关联。然而，敏感性分析显示，在排除一项有影响力的研究后，晨间皮质醇与AWP之间存在负相关。这些发现不支持精神病中基础皮质醇与认知功能之间存在普遍关联。相反，它们提示皮质醇-认知关系可能既具有域特异性，也具有采样时间特异性，其中最强的证据将午后/傍晚皮质醇升高与较差的执行功能联系起来。进一步研究使用更精确的评估 需要对皮质醇动态进行（更充分的）评估，以阐明下丘脑-垂体-肾上腺（HPA）轴失调在跨精神病性障碍的认知损害中的作用。
完整摘要 · 英文原文
Emerging evidence suggests that dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, particularly cortisol, may contribute to the cognitive deficits commonly observed in psychotic disorders. We conducted the first combined systematic review and quantitative synthesis of associations between cortisol and cognition in psychosis. Twelve studies met inclusion criteria (940 participants; 74.68% cases; 39.57% female; mean age = 31.83 years). Of these, nine studies (822 participants; 71.04% cases; 35.96% female; mean age = 32.72 years) contributed data to three-level meta-analyses examining associations between basal cortisol and composite cognition, attention, working memory and processing speed (AWP), executive functioning (EF), and verbal learning and memory (VM). Cortisol sampling time significantly moderated the relationship between cortisol and EF (F = 10.98, p = .004), with a significant negative association emerging between afternoon/evening cortisol and EF (r = -0.27, 95% CI [-0.42, -0.12], p = .01). No other robust cortisol-cognition associations were observed. However, sensitivity analyses revealed a negative association between morning cortisol and AWP following exclusion of an influential study. These findings do not support a general association between basal cortisol and cognitive functioning in psychosis. Instead, they suggest that cortisol-cognition relationships may be both domain- and sampling-time-specific, with the strongest evidence linking elevated afternoon/evening cortisol to poorer executive functioning. Further research using more precise assessments of cortisol dynamics is needed to clarify the role of HPA-axis dysregulation in cognitive impairment across psychotic disorders.