中国0～6岁儿童孤独症谱系障碍患病率的meta分析

目的:了解中国0～6岁儿童孤独症谱系障碍(autism spectrum disorders,ASD)流行现状及趋势.方法:在Pubmed、Web of Science、Scopus、中国期刊全文数据库(CNKI)、万方数据库、维普数据库(VIP)和中国生物医学文献数据库(CBM)检索于2017年2月25日之前发表的关于中国0～6岁儿童孤独症谱系障碍及其亚型患病率研究的文献,按照设定的纳入和诊断标准进行筛选.采用随机效应模型合并不同时期和不同性别儿童患病率数据,并根据数据来源、年龄、筛查和诊断工具、文献质量进行亚组分析.结果:共有9篇ASD患病率文献和20篇孤独症(au-tism or autistic disorder,AD)患病率文献纳入研究.2006-2010年和2011-2015年0～6岁儿童AD合并患病率分别为1.74‰(95％ CI:1.12‰ ～ 2.69‰)和1.80‰(95％ CI:1.33‰ ～ 2.43‰),差异无统计学意义(P =0.898),但均显著高于1996-2005年合并患病率0.94‰(95％ CI:0.67‰～ 1.33‰) (P =0.031;P=0.005).0～6岁儿童ASD合并患病率在2006-2010年和2011-2015年分别为3.52‰(95％ CI:1.48‰ ～ 8.34‰)和3.48‰(95％ CI:1.77‰ ～6.84‰),差异未见统计学意义(P=0.983).不同性别ASD和AD患病率在不同时期差异均无统计学意义.合并得到2006-2015年0～6岁儿童ASD和AD患病率分别为3.51‰(95％ CI:2.15‰～5.74‰)和1.77‰(95％ CI:1.40‰～ 2.24‰),男女患病率比分别为2.59:1和3.63:1.亚组分析提示月龄和文献质量与ASD或AD合并患病率相关.结论:2006-2015年中国0～6岁儿童ASD和AD患病率均保持稳定,相比2005年以前是否呈上升趋势难以定论.建议开展全国代表性儿童早期ASD和AD现况调查与监测,准确估计ASD及AD流行现状和趋势.

Prevalence of autism spectrum disorders in children aged 0-6 years in China: a meta-analysis

Objective:To estimate the prevalence and trend of autism spectrum disorders (ASD) in children aged 0-6 years in China.Methods:Systematic literature searches were conducted in PubMed,Web of Science,Scopus,China National Knowledge Infrastructure (CNKI),Chinese Biomedical Literature Database (CBM),Wanfang and Weipu Database (VIP),and the literatures published before February 25,2017 were selected according to the same criteria.Prevalence Data of three periods were abstracted,then pooled using random effect model.Subgroup analysis was done across data resource,age group,screening criteria,diagnostic criteria,and literature quality.Results:In the study,9 ASD studies and 20 autism (also known as autistic disorder,AD) studies were eligible for review.The pooled prevalence of AD in children aged 0-6 years in 2006-2010 and 2011-2015 was 1.74 ‰ (95％ CI:1.12‰o-2.69‰) and 1.80‰ (95％ CI:1.33‰-2.43‰),and there was no significant difference between the two groups (P =0.898),but they were higher than 0.94‰ (95％ CI:0.67‰-1.33‰) in 1996-2005 (P =0.031;P =0.005) significantly.The pooled prevalence of ASD in children aged 0-6 years was 3.52 ‰ (95％ CI:1.48‰-8.34‰) and 3.48‰ (95％ CI:1.77‰-6.84‰) in 2006-2010 and 2011-2015,respectively,and the difference between the two periods was not significant (P =0.983).There was no significant difference between the pooled prevalence in the three periods among the boys,and girls' too.The pooled prevalence of ASD in children aged 0-6 years was 3.51‰(95％ CI:2.15‰-5.74‰) and AD was 1.77‰ (95％ CI:1.40‰-2.24‰) in 2006-2015,with prevalence ratios of boys to girls 2.59:1 and 3.63:1,respectively.The pooled prevalence of AD was lower in 0-6 years children than in other age groups and higher in high-quality studies than in low-quality studies,which was the same as ASD.Data resource,screening and diagnostic criteria were not significantly related with the pooled prevalence of AD and ASD.Conclusion:The prevalence of ASD and AD in children aged 0-6 years in China from 2006 to 2015 was stable,and there was not enough evidence to prove that it was higher than before 2005.National survey and monitoring of early childhood autism should to be conducted.