Маркеры системного воспаления при несуицидальном самоповреждающем поведении: обзор предметного поля

Обоснование: несуицидальные самоповреждения (НССП) — широко распространенный, особенно среди подростков, феномен, являющийся значимым предиктором суицида. Суицидальное поведение ассоциировано с активацией системного иммуновоспалительного ответа. Роль системного воспаления при НССП изучена в меньшей степени, а результаты проведенных исследований не систематизированы.

Цель обзора предметного поля: обобщить результаты исследований маркеров системного воспаления (МСВ) при НССП, ответив на вопросы: 1) существует ли связь МСВ с НССП? 2) зависит ли эта связь от клинических, социально-демографических, медико-биологических и фармакогенных факторов? 3) оценивалась ли прогностическая ценность МСВ при НССП?

Материал и методы: в обзор предметного поля включали только оригинальные исследования МСВ у лиц с НССП, результаты которых были опубликованы до 31 марта 2025 г. Поиск релевантных источников проводили в базах данных MEDLINE и eLibrary.

Результаты: из 427 публикаций отобрано 6 исследований (5 кросс-секционных и 1 лонгитюдное), отвечавших критериям соответствия. Анализ их результатов выявил: 1) повышенные уровни МСВ при НССП как у подростков, так и у взрослых пациентов (преимущественно с расстройствами аффективного спектра) по сравнению с пациентами без НССП и со здоровыми испытуемыми (4 исследования); 2) наличие единичных данных о влиянии на уровень МСВ таких факторов как жестокое обращение в детстве (1 исследование), суицидные попытки в анамнезе (1 исследование), тяжесть депрессии (1 исследование), паттерны ЭЭГ-активности (1 исследование); 3) связь повышенного уровня интерлейкина-6 у подростков с НССП с увеличением частоты самоповреждений в течение последующих 3 месяцев (1 исследование).

Заключение: результаты обзора убедительно подтверждают связь НССП с изменениями профиля МСВ, отражающими активацию системного воспаления. Однако малое число исследований, их гетерогенность и преобладание кросс-секционного дизайна не позволяют однозначно оценить специфичность выявленных ассоциаций, причинно-следственные связи, влияние модифицирующих факторов и клиническую применимость МСВ как биомаркеров риска или прогноза НССП, что требует проведения исследований более высокого методологического качества.

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