Importance Evidence of gut microbiota perturbations has accumulated for multiple psychiatric disorders, with microbiota signatures proposed as potential biomarkers. However, no attempts have been made to evaluate the specificity of these across the range of psychiatric conditions. Objective To conduct an umbrella and updated meta-analysis of gut microbiota alterations in general adult psychiatric populations and perform a within- and between-diagnostic comparison. Data Sources Cochrane Library, PubMed, PsycINFO, and Embase were searched up to February 2, 2021, for systematic reviews, meta-analyses, and original evidence. Study Selection A total of 59 case-control studies evaluating diversity or abundance of gut microbes in adult populations with major depressive disorder, bipolar disorder, psychosis and schizophrenia, anorexia nervosa, anxiety, obsessive compulsive disorder, posttraumatic stress disorder, or attention-deficit/hyperactivity disorder were included. Data Extraction and Synthesis Between-group comparisons of relative abundance of gut microbes and beta diversity indices were extracted and summarized qualitatively. Random-effects meta-analyses on standardized mean difference (SMD) were performed for alpha diversity indices. Main Outcomes and Measures Alpha and beta diversity and relative abundance of gut microbes. Results A total of 34 studies provided data and were included in alpha diversity meta-analyses (n = 1519 patients, n = 1429 control participants). Significant decrease in microbial richness in patients compared with control participants were found (observed species SMD = -0.26; 95% CI, -0.47 to -0.06; Chao1 SMD = -0.5; 95% CI, -0.79 to -0.21); however, this was consistently decreased only in bipolar disorder when individual diagnoses were examined. There was a small decrease in phylogenetic diversity (SMD = -0.24; 95% CI, -0.47 to -0.001) and no significant differences in Shannon and Simpson indices. Differences in beta diversity were consistently observed only for major depressive disorder and psychosis and schizophrenia. Regarding relative abundance, little evidence of disorder specificity was found. Instead, a transdiagnostic pattern of microbiota signatures was found. Depleted levels of Faecalibacterium and Coprococcus and enriched levels of Eggerthella were consistently shared between major depressive disorder, bipolar disorder, psychosis and schizophrenia, and anxiety, suggesting these disorders are characterized by a reduction of anti-inflammatory butyrate-producing bacteria, while pro-inflammatory genera are enriched. The confounding associations of region and medication were also evaluated. Conclusions and Relevance This systematic review and meta-analysis found that gut microbiota perturbations were associated with a transdiagnostic pattern with a depletion of certain anti-inflammatory butyrate-producing bacteria and an enrichment of pro-inflammatory bacteria in patients with depression, bipolar disorder, schizophrenia, and anxiety.

中文翻译：

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精神疾病中肠道微生物群组成的扰动：回顾和荟萃分析。

肠道微生物群扰动的重要性已经积累了多种精神疾病的证据，微生物群特征被提议作为潜在的生物标志物。然而，尚未尝试评估这些在精神疾病范围内的特异性。目的 对一般成年精神病患者的肠道微生物群变化进行综合性和更新的荟萃分析，并进行诊断内和诊断间比较。数据源 Cochrane Library、PubMed、PsycINFO 和 Embase 已被搜索到 2021 年 2 月 2 日，以获取系统评价、荟萃分析和原始证据。研究选择 共有 59 项病例对照研究评估了患有重度抑郁症、双相情感障碍、精神病和精神分裂症、神经性厌食症、焦虑症、包括强迫症、创伤后应激障碍或注意力缺陷/多动障碍。数据提取和合成 对肠道微生物相对丰度和β多样性指数的组间比较进行了提取和定性总结。对 alpha 多样性指数进行了标准化平均差 (SMD) 的随机效应荟萃分析。主要成果和措施 Alpha 和 Beta 多样性以及肠道微生物的相对丰度。结果 共有 34 项研究提供了数据，并被纳入 alpha 多样性荟萃分析（n = 1519 名患者，n = 1429 名对照参与者）。与对照组相比，患者的微生物丰富度显着降低（观察到的物种 SMD = -0.26；95% CI，-0.47 至 -0.06；Chao1 SMD = -0.5；95% CI，-0.79 至 -0.21）；然而，当检查个别诊断时，这仅在双相情感障碍中持续下降。系统发育多样性略有下降（SMD = -0.24；95% CI，-0.47 至 -0.001），香农指数和辛普森指数没有显着差异。仅在重度抑郁症和精神病和精神分裂症中始终观察到β多样性的差异。关于相对丰度，几乎没有发现疾病特异性的证据。相反，发现了微生物群特征的跨诊断模式。在重度抑郁症、双相情感障碍、精神病和精神分裂症以及焦虑症之间，粪杆菌和粪球菌的消耗水平和埃格氏菌的富集水平一致，这表明这些疾病的特征是产生抗炎丁酸盐的细菌减少，同时富含促炎属。还评估了地区和药物的混杂关联。结论和相关性 本系统评价和荟萃分析发现，在抑郁症、双相情感障碍、精神分裂症患者中，肠道微生物群扰动与某些产生抗炎丁酸盐的细菌的消耗和促炎细菌的富集有关。 ，和焦虑。