Xiong Tao, Chen Hongju, Luo Rong, Mu Dezhi
Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 17, Section Three, Ren Min Nan Lu Avenue, Chengdu, Sichuan, China, 610041.
Cochrane Database Syst Rev. 2016 Oct 13;10(10):CD010922. doi: 10.1002/14651858.CD010922.pub2.
The rising prevalence of autism spectrum disorder (ASD) has increased the need for evidence-based treatments to lessen the impact of symptoms. Presently, no therapies are available to effectively treat individuals with all of the symptoms of this disorder. It has been suggested that hyperbaric oxygen therapy may alleviate the biochemical dysfunction and clinical symptoms of ASD.
To determine whether treatment with hyperbaric oxygen:1. improves core symptoms of ASD, including social communication problems and stereotypical and repetitive behaviors;2. improves noncore symptoms of ASD, such as challenging behaviors;3. improves comorbid states, such as depression and anxiety; and4. causes adverse effects.
On 10 December 2015, we searched CENTRAL, Ovid MEDLINE, Embase, and 15 other databases, four of which were Chinese language databases. We also searched multiple trial and research registers.
We selected randomized controlled trials (RCTs) and quasi-RCTs of any dose, duration, and frequency for hyperbaric oxygen therapy compared with no treatment or sham treatment for children and adults with ASD.
We used standard methodological procedures expected by The Cochrane Collaboration, in that three review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence by using the GRADE approach.
We included one trial with a total of 60 children with a diagnosis of ASD who randomly received hyperbaric oxygen therapy or a sham treatment. Using GRADE criteria, we rated the quality of the evidence as low because of the small sample size and wide confidence intervals (CIs). Other problems included selection bias and short duration or follow-up.Overall, study authors reported no improvement in social interaction and communication, behavioral problems, communication and linguistic abilities, or cognitive function. With regard to the safety of hyperbaric oxygen therapy (adverse events), they reported minor-grade ear barotrauma events. Investigators found significant differences between groups in total number of side effect events (Peto odds ratio (OR) 3.87, 95% CI 1.53 to 9.82) and in the number of children who experienced side effects (Peto OR 4.40, 95% CI 1.33 to 14.48).
AUTHORS' CONCLUSIONS: To date, there is no evidence that hyperbaric oxygen therapy improves core symptoms and associated symptoms of ASD. It is important to note that adverse effects (minor-grade ear barotrauma events) can occur. Given the absence of evidence of effectiveness and the limited biological plausibility and possible adverse effects, the need for future RCTs of hyperbaric oxygen therapy must be carefully considered.
自闭症谱系障碍（ASD）患病率的上升增加了对循证治疗的需求，以减轻症状的影响。目前，尚无有效治疗该疾病所有症状患者的疗法。有人提出高压氧疗法可能缓解ASD的生化功能障碍和临床症状。
确定高压氧治疗是否：1. 改善ASD的核心症状，包括社交沟通问题以及刻板和重复行为；2. 改善ASD的非核心症状，如具有挑战性的行为；3. 改善共病状态，如抑郁和焦虑；4. 导致不良反应。
2015年12月10日，我们检索了Cochrane系统评价数据库、Ovid MEDLINE、Embase以及其他15个数据库，其中4个为中文数据库。我们还检索了多个试验和研究注册库。
我们纳入了将高压氧疗法与未治疗或假治疗进行比较的随机对照试验（RCT）和半随机对照试验，试验对象为患有ASD的儿童和成人，涉及任何剂量、疗程和频率。
我们采用了Cochrane协作网期望的标准方法程序，由三位综述作者独立选择研究、评估其偏倚风险并提取相关数据。我们还采用GRADE方法评估证据质量。
我们纳入了一项试验，共有60名诊断为ASD的儿童，他们被随机分配接受高压氧治疗或假治疗。根据GRADE标准，由于样本量小和置信区间宽，我们将证据质量评为低。其他问题包括选择偏倚以及随访时间短。总体而言，研究作者报告社交互动与沟通、行为问题、沟通与语言能力或认知功能均无改善。关于高压氧治疗的安全性（不良事件），他们报告了轻度耳气压伤事件。研究人员发现两组在副作用事件总数（Peto比值比（OR）3.87，95%置信区间1.53至9.82）以及出现副作用的儿童数量（Peto OR 4.40，95%置信区间1.33至14.48）方面存在显著差异。
迄今为止，尚无证据表明高压氧疗法能改善ASD的核心症状及相关症状。需要注意的是，可能会出现不良反应（轻度耳气压伤事件）。鉴于缺乏有效性证据、生物学合理性有限以及可能存在的不良反应，必须谨慎考虑未来进行高压氧疗法RCT的必要性。
