Institute of Psychiatry, King's College London, London, UK.
Acta Psychiatr Scand. 2011 Feb;123(2):98-106. doi: 10.1111/j.1600-0447.2010.01623.x. Epub 2010 Oct 20.
We aimed to systematically evaluate the empirical evidence for the commonly held view that the reduced reproductive output in patients with schizophrenia is compensated for by an increased fitness in unaffected relatives. Secondary aims were to quantify the magnitude of the fertility disadvantage and the apparent gender difference in fertility of patients with schizophrenia.
We carried out a systematic review and meta-analysis of studies investigating the fertility of patients with schizophrenia, their siblings, their parents and the general population.
Patients with schizophrenia had reduced fertility compared with the general population, [Fertility Ratio (FR)=0.39 (95% Confidence Interval (CI)=0.35-0.44)]. Siblings of patients with schizophrenia had somewhat fewer offspring than the general population (FR=0.96, 95% CI=0.93-1.00). Parents of patients with schizophrenia had fertility similar to the general population (FR=1.17, 95% CI=0.94-1.46). Men had a greater impairment in fertility than women, both in patients (FR=0.54, 95% CI=0.50-0.57) and in their unaffected siblings (FR=0.81, 95% CI=0.71-0.92).
Compensatory fitness advantage in siblings and parents cannot explain the maintenance of schizophrenia in the population. Alternative explanations include mutation-selection balance and the role of quantitative traits.
我们旨在系统评估一个普遍观点的经验证据，即精神分裂症患者生育能力降低的情况可以通过未受影响亲属的生育力提高来得到补偿。次要目的是量化精神分裂症患者生育力受损的严重程度以及明显的性别差异。
我们对研究精神分裂症患者、他们的兄弟姐妹、父母和一般人群生育力的研究进行了系统回顾和荟萃分析。
与一般人群相比，精神分裂症患者的生育能力降低，[生育比率（FR）=0.39（95%置信区间（CI）=0.35-0.44）]。精神分裂症患者的兄弟姐妹所生育的后代比一般人群略少（FR=0.96，95%CI=0.93-1.00）。精神分裂症患者的父母的生育能力与一般人群相似（FR=1.17，95%CI=0.94-1.46）。男性的生育能力受损程度大于女性，无论是在患者中（FR=0.54，95%CI=0.50-0.57）还是在未受影响的兄弟姐妹中（FR=0.81，95%CI=0.71-0.92）。
同胞和父母的适应性健康优势不能解释精神分裂症在人群中的维持。替代解释包括突变-选择平衡和数量性状的作用。
