School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, University of New South Wales, Sydney, 2052, Australia.
Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, 2031, Australia.
Mol Autism. 2024 Jan 17;15(1):4. doi: 10.1186/s13229-023-00575-0.
BACKGROUND: Gastrointestinal symptoms and inflammatory gastrointestinal diseases exist at higher rates in the autistic population. It is not clear however whether autism is associated with elevated gastrointestinal inflammation as studies examining non-invasive faecal biomarkers report conflicting findings. To understand the research landscape and identify gaps, we performed a systematic review and meta-analysis of studies measuring non-invasive markers of gastrointestinal inflammation in autistic and non-autistic samples. Our examination focused on faecal biomarkers as sampling is non-invasive and these markers are a direct reflection of inflammatory processes in the gastrointestinal tract. METHODS: We extracted data from case-control studies examining faecal markers of gastrointestinal inflammation. We searched PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, Web of Science Core Collection and Epistemonikos and forward and backwards citations of included studies published up to April 14, 2023 (PROSPERO CRD42022369279). RESULTS: There were few studies examining faecal markers of gastrointestinal inflammation in the autistic population, and many established markers have not been studied. Meta-analyses of studies examining calprotectin (n = 9) and lactoferrin (n = 3) were carried out. A total of 508 autistic children and adolescents and 397 non-autistic children and adolescents were included in the meta-analysis of calprotectin studies which found no significant group differences (ROM: 1.30 [0.91, 1.86]). Estimated differences in calprotectin were lower in studies with siblings and studies which did not exclude non-autistic controls with gastrointestinal symptoms. A total of 139 autistic participants and 75 non-autistic controls were included in the meta-analysis of lactoferrin studies which found no significant group differences (ROM: 1.27 [0.79, 2.04]). LIMITATIONS: All studies included in this systematic review and meta-analysis examined children and adolescents. Many studies included non-autistic controls with gastrointestinal symptoms which limit the validity of their findings. The majority of studies of gastrointestinal inflammation focused on children under 12 with few studies including adolescent participants. Most studies that included participants aged four or under did not account for the impact of age on calprotectin levels. Future studies should screen for relevant confounders, include larger samples and explore gastrointestinal inflammation in autistic adolescents and adults. CONCLUSIONS: There is no evidence to suggest higher levels of gastrointestinal inflammation as measured by calprotectin and lactoferrin are present in autistic children and adolescents at the population level. Preliminary evidence suggests however that higher calprotectin levels may be present in a subset of autistic participants, who may be clinically characterised by more severe gastrointestinal symptoms and higher levels of autistic traits.
背景:胃肠道症状和炎症性胃肠道疾病在自闭症人群中的发生率更高。然而,自闭症是否与胃肠道炎症升高有关尚不清楚,因为研究非侵入性粪便生物标志物的研究报告结果相互矛盾。为了了解研究现状并确定差距,我们对测量自闭症和非自闭症样本中胃肠道炎症的非侵入性标志物的研究进行了系统回顾和荟萃分析。我们的检查重点是粪便生物标志物,因为采样是非侵入性的,这些标志物直接反映了胃肠道的炎症过程。
方法:我们从检查胃肠道炎症粪便标志物的病例对照研究中提取数据。我们检索了 PubMed、Embase、Cochrane 中心、CINAHL、PsycINFO、Web of Science 核心合集和 Epistemonikos,并对截至 2023 年 4 月 14 日发表的纳入研究的参考文献进行了检索(PROSPERO CRD42022369279)。
结果:研究自闭症人群中胃肠道炎症的粪便标志物的研究很少,并且许多已建立的标志物尚未研究。对检查钙卫蛋白(n=9)和乳铁蛋白(n=3)的研究进行了荟萃分析。荟萃分析纳入了 508 名自闭症儿童和青少年和 397 名非自闭症儿童和青少年的研究,发现组间无显著差异(ROM:1.30 [0.91,1.86])。在有兄弟姐妹的研究和不排除有胃肠道症状的非自闭症对照的研究中,钙卫蛋白的估计差异较低。荟萃分析纳入了 139 名自闭症参与者和 75 名非自闭症对照组的研究,发现组间无显著差异(ROM:1.27 [0.79,2.04])。
局限性:本系统评价和荟萃分析中纳入的所有研究均检查了儿童和青少年。许多纳入的非自闭症对照有胃肠道症状,这限制了其研究结果的有效性。大多数胃肠道炎症研究都集中在 12 岁以下的儿童,很少有研究包括青少年参与者。大多数纳入 4 岁以下参与者的研究没有考虑年龄对钙卫蛋白水平的影响。未来的研究应筛查相关混杂因素,纳入更大的样本,并探索自闭症青少年和成年人的胃肠道炎症。
结论:没有证据表明自闭症儿童和青少年的胃肠道炎症水平(通过钙卫蛋白和乳铁蛋白测量)在人群水平上更高。然而,初步证据表明,在自闭症参与者的亚组中,可能存在更高的钙卫蛋白水平,这些参与者可能具有更严重的胃肠道症状和更高水平的自闭症特征。
Cochrane Database Syst Rev. 2022-2-1
Ann Clin Biochem. 2009-9-9
Aliment Pharmacol Ther. 2008-11-15
J Pediatr Gastroenterol Nutr. 2016-5
Front Immunol. 2025-8-20
J Pediatr Gastroenterol Nutr. 2022-3-1