精神分裂症风险中的性别差异：来自荟萃分析的证据。

Sex differences in the risk of schizophrenia: evidence from meta-analysis.

作者信息

Aleman Andre, Kahn René S, Selten Jean-Paul

机构信息

Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, the Netherlands.

出版信息

Arch Gen Psychiatry. 2003 Jun;60(6):565-71. doi: 10.1001/archpsyc.60.6.565.

DOI:10.1001/archpsyc.60.6.565

PMID:12796219

Abstract

BACKGROUND

Sex differences in the risk of a particular disorder can yield important clues regarding its pathogenesis. The evidence for a sex difference in the risk of schizophrenia is inconclusive. The purpose of this study was to integrate results from the published literature and to provide a quantitative index of the male-female ratio for the incidence of schizophrenia.

METHODS

The MEDLINE and PsychLIT databases were searched for English-language publications on "incidence and schizophrenia" that appeared during the period between January 1980 and September 2001. Population-based incidence studies using standard clinical diagnostic criteria were included if they reported sex-specific incidence rates. Sex-specific incidence figures were extracted directly from each study. Categorical analyses were conducted on a subset of studies that met specific methodological criteria (to minimize criterion bias, hospital bias, and age bias). Study categorization and data extraction were performed independently by 2 of us (A. A. and J.-P.S.).

RESULTS

Log risk ratio meta-analysis was conducted using a random-effects model. The incidence risk ratios for men to develop schizophrenia relative to women were 1.42 (95% confidence interval [CI], 1.30-1.56) when all studies were included in the analysis (49 effect sizes), 1.31 (95% CI, 1.13-1.51) when studies that minimized selection biases were analyzed separately (23 effect sizes), and 1.39 (95% CI, 1.15-1.68) when only high-quality studies were included (11 effect sizes). The sex difference was significantly smaller in studies with sample years before 1980 than those with sample years after 1980. No significant sex differences were reported in studies from developing countries. A final analysis, limited to studies with an age cutoff of 64 years or older (16 effect sizes), yielded a mean risk ratio of 1.32 (95% CI, 1.13-1.55).

CONCLUSION

This meta-analysis provides evidence for a sex difference in the risk of developing schizophrenia, as reported in the published literature from the last 2 decades.

摘要

背景

特定疾病风险中的性别差异可为其发病机制提供重要线索。精神分裂症风险存在性别差异的证据尚无定论。本研究旨在整合已发表文献的结果，并提供精神分裂症发病率男女性别比的定量指标。

方法

检索MEDLINE和PsychLIT数据库，查找1980年1月至2001年9月期间发表的关于“发病率与精神分裂症”的英文出版物。如果基于人群的发病率研究报告了性别特异性发病率，且使用标准临床诊断标准，则纳入研究。从每项研究中直接提取性别特异性发病率数据。对符合特定方法学标准的一部分研究进行分类分析（以尽量减少标准偏倚、医院偏倚和年龄偏倚）。研究分类和数据提取由我们两人（A.A.和J.-P.S.）独立进行。

结果

采用随机效应模型进行对数风险比荟萃分析。当所有研究纳入分析时（49个效应量），男性患精神分裂症相对于女性的发病风险比为1.42（95%置信区间[CI]，1.30 - 1.56）；当分别分析尽量减少选择偏倚的研究时（23个效应量），发病风险比为1.31（95%CI，1.13 - 1.51）；当仅纳入高质量研究时（11个效应量），发病风险比为1.39（95%CI，1.15 - 1.68）。1980年以前样本年份的研究中性别差异显著小于1980年以后样本年份的研究。发展中国家的研究未报告显著的性别差异。最后一项分析仅限于年龄截止为64岁及以上的研究（16个效应量），得出平均风险比为1.32（95%CI，1.13 - 1.55）。