University of New South Wales Research Unit for Schizophrenia Epidemiology, School of Psychiatry, Sydney, Australia.
Biol Psychiatry. 2012 Nov 1;72(9):775-84. doi: 10.1016/j.biopsych.2012.04.020. Epub 2012 May 22.
Volume reduction in insular cortex may constitute an important neuropathology in schizophrenia. We provide the first meta-analysis of studies that conducted region-of-interest analyses of the magnitude of effect and pattern of insula volume reduction in schizophrenia compared with healthy control subjects.
Included studies examined insula volume in schizophrenia relative to healthy control subjects. Studies were located via electronic database searches and hand searching. Study selection, data extraction, and quality assessment were completed by two independent reviewers. Hedge's g effect sizes were calculated using Comprehensive Meta-Analysis (v.2) to quantify volumetric differences between people with and without schizophrenia, accounting for moderating influences of age, sex, illness duration, medication, whole brain volume, and potential differences in hemispheric and anatomical subregions.
Random-effects analysis showed reductions of bilateral insula (n = 945, g = -.446, 95% confidence interval -.639 to -.252, p = .00001), with moderate heterogeneity apparent (I² = 76%). This effect was consistent across left and right insula and not influenced by illness stage or sex. Additional analyses revealed larger reductions of anterior (n = 605, g = -.643, p < 0.001; I² = 52%) than of posterior insula (n = 453, g = -.321, p = .028; I² = 55%). Meta-regression analyses did not identify any significant predictors of reduced insula volume.
This meta-analysis indicates medium-sized reduction of insula volume in schizophrenia, of greatest magnitude in the anterior subregion. Cellular distinctions across anterior and posterior insula may contribute to understanding the neuropathology and functional significance of the observed volumetric differences.
脑岛皮层体积减少可能构成精神分裂症的重要神经病理学。我们提供了第一项元分析，该分析对与健康对照组相比，精神分裂症患者脑岛体积减少的效应幅度和模式进行了基于感兴趣区的分析。
纳入的研究检查了精神分裂症患者的脑岛体积与健康对照组相比的情况。通过电子数据库搜索和手工搜索来定位研究。由两名独立的审查员完成研究选择、数据提取和质量评估。使用 Comprehensive Meta-Analysis（v.2）计算 Hedge's g 效应大小，以量化有和无精神分裂症的个体之间的体积差异，同时考虑年龄、性别、疾病持续时间、药物、全脑体积以及半球和解剖亚区的潜在差异的调节影响。
随机效应分析显示双侧脑岛（n = 945，g = -.446，95%置信区间 -.639 至 -.252，p =.00001）体积减少，明显存在中度异质性（I² = 76%）。这种效应在左侧和右侧脑岛之间是一致的，不受疾病阶段或性别影响。进一步的分析表明，前脑岛（n = 605，g = -.643，p < 0.001；I² = 52%）比后脑岛（n = 453，g = -.321，p =.028；I² = 55%）的体积减少更大。元回归分析未发现脑岛体积减少的任何显著预测因子。
这项元分析表明精神分裂症患者脑岛体积中等程度减少，前区减少幅度最大。前脑岛和后脑岛之间的细胞差异可能有助于理解观察到的体积差异的神经病理学和功能意义。
