Tural Ümit, Alioğlu Firdevs
Turk Psikiyatri Derg. 2019 Summer;30(2):99-108.
The objective of this study is to perform a systematic review and meta-analysis on whether patients with panic disorder (PD) and their healthy first-degree relatives have an increased sensitivity to carbon dioxide inhalation test compared to healthy controls (HC) or patients with psychiatric disorders other than panic disorder.
The databases of PubMed, EMBASE and PsycNET were searched using Boolean operators "panic AND carbon dioxide" and "panic AND CO2". Selected research articles were classified according to the carbon dioxide concentrations used in testing and the clinical characteristics of the samples. The assumption of heterogeneity across the studies was assessed by chi square based Q and I2 statistics. Publication biases were explored by Begg-Mazumdar's and Egger's tests in addition to funnel graphics. Odds ratios representing effect size of the carbon dioxide inhalation procedure were calculated according to fixed effect and random effect models after obtaining percent weight effects of each study.
Meta-Analysis was conducted on 33 research studies that include 2114 participants totally. Participants with PD experienced significantly more frequent panic attacks (PA) compared to HC following in both 5% (OR=14.713, 95% CI 7.532 - 28.739) and 35% carbon dioxide inhalation (OR=11.507, 95% CI 7.775 - 17.031). HC who have a first-degree relative with PD experienced PA approximately 3 times more than HC who have not a first-degree relative with PD (OR=2.658, 95% CI 1.678 - 4.212) following carbon dioxide inhalation test. Participants with PD experienced significantly more frequent PA than the patients with other psychiatric disorders following the carbon dioxide inhalation test (OR = 3.524, 95% CI 1.945 - 6.384).
There is an increased sensitivity of carbon dioxide inhalation in patients with PD and their healthy first-degree relatives. The role and possible mechanisms of carbon dioxide in etiology and physiopathology of PD should be studied extensively.
本研究的目的是进行一项系统评价和荟萃分析，以探讨惊恐障碍（PD）患者及其健康的一级亲属与健康对照（HC）或除惊恐障碍外的其他精神障碍患者相比，对二氧化碳吸入试验的敏感性是否增加。
使用布尔运算符“panic AND carbon dioxide”和“panic AND CO2”检索PubMed、EMBASE和PsycNET数据库。根据测试中使用的二氧化碳浓度和样本的临床特征对选定的研究文章进行分类。通过基于卡方的Q和I2统计量评估各研究间异质性的假设。除漏斗图外，还通过Begg-Mazumdar检验和Egger检验探索发表偏倚。在获得每项研究的加权百分比效应后，根据固定效应模型和随机效应模型计算代表二氧化碳吸入程序效应大小的比值比。
对33项研究进行了荟萃分析，共纳入2114名参与者。与HC相比，PD患者在吸入5%（比值比=14.713，95%可信区间7.532 - 28.739）和35%二氧化碳后惊恐发作（PA）频率显著更高（比值比=11.507，95%可信区间7.775 - 17.031）。在二氧化碳吸入试验后，有PD一级亲属的HC发生PA的次数比没有PD一级亲属的HC多约3倍（比值比=2.658，95%可信区间1.678 - 4.212）。与其他精神障碍患者相比，PD患者在二氧化碳吸入试验后惊恐发作频率显著更高（比值比 = 3.524，95%可信区间1.945 - 6.384）。
PD患者及其健康的一级亲属对二氧化碳吸入的敏感性增加。应广泛研究二氧化碳在PD病因学和生理病理学中的作用及可能机制。
