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自闭症谱系障碍个体的疼痛敏感性异常:来自元分析的证据

本站小编 Free考研考试/2022-01-01

张文芸, 李晓云, 姚俊杰, 叶倩, 彭微微()
深圳大学心理学院, 深圳 518060
收稿日期:2020-09-21发布日期:2021-04-25
通讯作者:彭微微E-mail:ww.peng0923@gmail.com

基金资助:国家自然科学基金(31871127);广东省普通高校特色创新类项目(2019KTSCX149);深圳市基础研究自由探索项目(JCYJ20190808154413592)

Abnormalities in pain sensitivity among individuals with autism spectrum disorder: Evidence from meta-analysis

ZHANG Wenyun, LI Xiaoyun, YAO Junjie, YE Qian, PENG Weiwei()
School of Psychology, Shenzhen University, Shenzhen 518060, China
Received:2020-09-21Published:2021-04-25
Contact:PENG Weiwei E-mail:ww.peng0923@gmail.com






摘要/Abstract


摘要: 本研究采用元分析方法, 以疼痛阈限、疼痛诱发生理反应和疼痛评分为结果变量, 考察了自闭症谱系障碍个体(Autism Spectrum Disorder, ASD)的疼痛敏感性异常, 以期为ASD的诊断和干预提供参考。元分析共纳入16项研究(总样本量N = 822)。对于疼痛阈限, ASD组和对照组无显著差异, 但受到疼痛模态等变量的调节作用, 如ASD组的压力疼痛阈限显著低于对照组。对于疼痛诱发生理反应, ASD组对现实医疗疼痛的生理反应强于对照组。然而, ASD组和对照组在疼痛评分上无显著差异。将来研究应结合多模态疼痛刺激和多维度疼痛评估, 系统考察ASD个体的疼痛敏感性及其与临床核心症状之间的联系。



图1文献检索过程及纳入与排除流程图
图1文献检索过程及纳入与排除流程图


表1纳入元分析的研究的相关信息(16篇)
研究 ASD组样本量
及年龄(岁)
对照组样本量
及年龄(岁)
刺激模态 刺激位置 疼痛测量
指标
地区 主要结果
Fan et al. 2014 n = 24
年龄:18.4 ± 2.8
n = 21
年龄:19.3 ± 3.4
压力疼痛 左右手(食指背侧
近端指骨)
疼痛阈限 亚洲 ASD低疼痛阈限,
高疼痛敏感性↑
Chen et al.
2017
n = 37
年龄:18.2 ± 5.2
n = 34
年龄:19.3 ± 4.6
压力疼痛 左右手(食指背侧
近端指骨)
疼痛阈限 亚洲 ASD低疼痛阈限,
高疼痛敏感性↑
Riquelme et al. 2016 n = 27
年龄:6.3 ± 3.2
n = 30
年龄:6.5 ± 3.4
压力疼痛 脸、手背和手掌 疼痛阈限 欧洲 ASD低疼痛阈限,
高疼痛敏感性↑
Chien et al.
2017
n = 31
年龄:20.5 ± 5.2
n = 22
年龄:21.4 ± 2.6
热痛 腿(外侧) 疼痛评分 亚洲 无显著差异?
Failla et al.
2018
n = 15
年龄:27.5 ± 10.3
n = 16
年龄:30.1 ± 10.9
热痛 腿(外侧) 疼痛阈限
疼痛评分
美洲 无显著差异?
Dubois et al. 2020 n = 19
年龄:31.5 ± 8.5
n = 19
年龄:31.6 ± 8.4
热痛 手臂 疼痛评分 欧洲 无显著差异?
Cascio et al. 2008 n = 8
年龄:29.3 ± 10.5
n = 8
年龄:29.0 ± 9.7
冷痛
热痛
前臂
手掌
疼痛阈限 美洲 ASD低疼痛阈限,
高疼痛敏感性↑
Duerden et al. 2015 n = 20
年龄:14.6 ± 1.9
n = 55
年龄:15.7 ± 1.1
冷痛
热痛
前臂 疼痛阈限 美洲 无显著差异?
Bird et al.
2010
n = 18
年龄:34.6 ± 13.3
n = 18
年龄:35 ± 12.8
电刺激疼痛 手背 疼痛阈限 欧洲 无显著差异?
Thaler et al. 2018 n = 16
年龄:25.5 ± 5.4
n = 16
年龄:24.5 ± 2.7
电刺激疼痛 手背 疼痛阈限
疼痛评分
欧洲 无显著差异?
李晋 等, 2015 n = 70
年龄:2~8
n = 71
年龄:2~8
电刺激疼痛 前臂 疼痛阈限 亚洲 ASD高疼痛阈限,
低疼痛敏感性↓
Yasuda et al. 2016 n = 15
年龄:25.8 ± 9.2
n = 15
年龄:26.3 ± 7.5
冷痛
热痛
电刺激疼痛
前臂 疼痛阈限
耐受阈限
疼痛评分
亚洲 疼痛阈限和耐受阈限:
无显著差异?
疼痛评分:
ASD低疼痛评分↓
Fründtet al. 2017 n = 13
年龄:31.7 ± 8.2
n = 13
年龄:32.1 ± 7.1
冷痛
热痛
压力疼痛
机械疼痛
左右手背 疼痛阈限 欧洲 无显著差异?
Vaughan et al. 2019 n = 13
年龄:27.2 ± 9.2
n = 13
年龄:27.1 ± 8.1
冷痛
热痛
冷水压痛
机械疼痛
压力疼痛
手掌(压痛)
手部(冷水压痛)
手、脚和脸均值
(其他剩余模态)
疼痛阈限
耐受阈限
(冷压痛)
美洲 无显著差异?
Tordjman et al. 2009 n = 63
年龄:11.7 ± 4.5
n = 11
年龄:12.7 ± 5.9
静脉穿刺 手臂 生理反应
(心率)
欧洲 ASD生理反应强烈↑,
心率变化大
Rattaz et al.
2013
n = 35
年龄:4.8
n = 36
年龄:3.7
静脉穿刺 手臂 生理反应
(心率)
欧洲 ASD生理反应强烈↑,
心率变化大
李晋 等, 2015 n = 68
年龄:2~8
n = 64
年龄:2~8
静脉穿刺 手臂 生理反应
(心率)
亚洲 ASD生理反应强烈↑,
心率变化大

表1纳入元分析的研究的相关信息(16篇)
研究 ASD组样本量
及年龄(岁)
对照组样本量
及年龄(岁)
刺激模态 刺激位置 疼痛测量
指标
地区 主要结果
Fan et al. 2014 n = 24
年龄:18.4 ± 2.8
n = 21
年龄:19.3 ± 3.4
压力疼痛 左右手(食指背侧
近端指骨)
疼痛阈限 亚洲 ASD低疼痛阈限,
高疼痛敏感性↑
Chen et al.
2017
n = 37
年龄:18.2 ± 5.2
n = 34
年龄:19.3 ± 4.6
压力疼痛 左右手(食指背侧
近端指骨)
疼痛阈限 亚洲 ASD低疼痛阈限,
高疼痛敏感性↑
Riquelme et al. 2016 n = 27
年龄:6.3 ± 3.2
n = 30
年龄:6.5 ± 3.4
压力疼痛 脸、手背和手掌 疼痛阈限 欧洲 ASD低疼痛阈限,
高疼痛敏感性↑
Chien et al.
2017
n = 31
年龄:20.5 ± 5.2
n = 22
年龄:21.4 ± 2.6
热痛 腿(外侧) 疼痛评分 亚洲 无显著差异?
Failla et al.
2018
n = 15
年龄:27.5 ± 10.3
n = 16
年龄:30.1 ± 10.9
热痛 腿(外侧) 疼痛阈限
疼痛评分
美洲 无显著差异?
Dubois et al. 2020 n = 19
年龄:31.5 ± 8.5
n = 19
年龄:31.6 ± 8.4
热痛 手臂 疼痛评分 欧洲 无显著差异?
Cascio et al. 2008 n = 8
年龄:29.3 ± 10.5
n = 8
年龄:29.0 ± 9.7
冷痛
热痛
前臂
手掌
疼痛阈限 美洲 ASD低疼痛阈限,
高疼痛敏感性↑
Duerden et al. 2015 n = 20
年龄:14.6 ± 1.9
n = 55
年龄:15.7 ± 1.1
冷痛
热痛
前臂 疼痛阈限 美洲 无显著差异?
Bird et al.
2010
n = 18
年龄:34.6 ± 13.3
n = 18
年龄:35 ± 12.8
电刺激疼痛 手背 疼痛阈限 欧洲 无显著差异?
Thaler et al. 2018 n = 16
年龄:25.5 ± 5.4
n = 16
年龄:24.5 ± 2.7
电刺激疼痛 手背 疼痛阈限
疼痛评分
欧洲 无显著差异?
李晋 等, 2015 n = 70
年龄:2~8
n = 71
年龄:2~8
电刺激疼痛 前臂 疼痛阈限 亚洲 ASD高疼痛阈限,
低疼痛敏感性↓
Yasuda et al. 2016 n = 15
年龄:25.8 ± 9.2
n = 15
年龄:26.3 ± 7.5
冷痛
热痛
电刺激疼痛
前臂 疼痛阈限
耐受阈限
疼痛评分
亚洲 疼痛阈限和耐受阈限:
无显著差异?
疼痛评分:
ASD低疼痛评分↓
Fründtet al. 2017 n = 13
年龄:31.7 ± 8.2
n = 13
年龄:32.1 ± 7.1
冷痛
热痛
压力疼痛
机械疼痛
左右手背 疼痛阈限 欧洲 无显著差异?
Vaughan et al. 2019 n = 13
年龄:27.2 ± 9.2
n = 13
年龄:27.1 ± 8.1
冷痛
热痛
冷水压痛
机械疼痛
压力疼痛
手掌(压痛)
手部(冷水压痛)
手、脚和脸均值
(其他剩余模态)
疼痛阈限
耐受阈限
(冷压痛)
美洲 无显著差异?
Tordjman et al. 2009 n = 63
年龄:11.7 ± 4.5
n = 11
年龄:12.7 ± 5.9
静脉穿刺 手臂 生理反应
(心率)
欧洲 ASD生理反应强烈↑,
心率变化大
Rattaz et al.
2013
n = 35
年龄:4.8
n = 36
年龄:3.7
静脉穿刺 手臂 生理反应
(心率)
欧洲 ASD生理反应强烈↑,
心率变化大
李晋 等, 2015 n = 68
年龄:2~8
n = 64
年龄:2~8
静脉穿刺 手臂 生理反应
(心率)
亚洲 ASD生理反应强烈↑,
心率变化大



图2疼痛阈限森林图
图2疼痛阈限森林图



图3疼痛评分森林图
图3疼痛评分森林图



图4疼痛诱发生理反应森林图
图4疼痛诱发生理反应森林图


表2ASD疼痛耐受阈限文章相关信息
研究 样本量 刺激模态 ASD 个体 普通个体 p
Yasuda et al. 2016 15 vs 15 接触式冷痛 2.50 ± 7.22 ℃ 3.74 ± 11.24 ℃ 0.66
接触式热痛 46.12 ± 2.23 ℃ 46.35 ± 3.16 ℃ 0.66
电刺激疼痛 104.48 ± 52.23 μA 92.86 ± 55.99 μA 0.47
Vaughan et al. 2019 13 vs 13 冷压痛 37.28 ± 45.49 s 28.24 ± 17.87 s 0.51

表2ASD疼痛耐受阈限文章相关信息
研究 样本量 刺激模态 ASD 个体 普通个体 p
Yasuda et al. 2016 15 vs 15 接触式冷痛 2.50 ± 7.22 ℃ 3.74 ± 11.24 ℃ 0.66
接触式热痛 46.12 ± 2.23 ℃ 46.35 ± 3.16 ℃ 0.66
电刺激疼痛 104.48 ± 52.23 μA 92.86 ± 55.99 μA 0.47
Vaughan et al. 2019 13 vs 13 冷压痛 37.28 ± 45.49 s 28.24 ± 17.87 s 0.51


表3调节变量随机模型分析
调节变量 同质性分析 类别 独立样本 效应值及95%置信区间 双侧检验
p
QB df p 点估计 下限 上限
刺激模态 10.90 4 p< 0.05 冷痛 6 0.17 -0.16 0.51 0.31
热痛 6 -0.05 -0.58 0.49 0.86
压力痛 5 1.62 0.46 2.77 0.006
机械痛 2 -0.43 -0.98 0.12 0.13
电刺激疼痛 4 -0.27 -1.37 0.82 0.63
刺激位置 3.46 3 0.33 手部 10 0.41 -0.24 1.06 0.22
手臂 6 0.78 -0.34 2.2 0.43
腿部 1 0.22 -0.98 0.42 0.54
多部位均值 6 0.93 -0.49 0.93 0.15
ASD组样本量 79.26 3 p< 0.001 n ≤ 10 2 1.54 0.72 2.36 p< 0.001
10 < n≤ 20 16 -0.04 -0.24 0.15 0.65
20 < n≤ 50 4 1.86 0.39 3.33 0.01
n> 50 1 -1.61 -1.99 -1.23 p< 0.001
被试群体 6.90 3 0.08 儿童 2 0.81 -3.94 5.55 0.74
青少年 2 -0.28 -0.64 0.09 0.14
青少年与成人 6 0.89 0.06 1.72 0.04
成人 13 0.07 -0.26 0.40 0.66
地区 0.44 2 0.80 亚洲 6 0.57 -0.81 1.96 0.42
美洲 10 0.14 -0.25 0.53 0.48
欧洲 7 0.33 -0.58 1.23 0.48

表3调节变量随机模型分析
调节变量 同质性分析 类别 独立样本 效应值及95%置信区间 双侧检验
p
QB df p 点估计 下限 上限
刺激模态 10.90 4 p< 0.05 冷痛 6 0.17 -0.16 0.51 0.31
热痛 6 -0.05 -0.58 0.49 0.86
压力痛 5 1.62 0.46 2.77 0.006
机械痛 2 -0.43 -0.98 0.12 0.13
电刺激疼痛 4 -0.27 -1.37 0.82 0.63
刺激位置 3.46 3 0.33 手部 10 0.41 -0.24 1.06 0.22
手臂 6 0.78 -0.34 2.2 0.43
腿部 1 0.22 -0.98 0.42 0.54
多部位均值 6 0.93 -0.49 0.93 0.15
ASD组样本量 79.26 3 p< 0.001 n ≤ 10 2 1.54 0.72 2.36 p< 0.001
10 < n≤ 20 16 -0.04 -0.24 0.15 0.65
20 < n≤ 50 4 1.86 0.39 3.33 0.01
n> 50 1 -1.61 -1.99 -1.23 p< 0.001
被试群体 6.90 3 0.08 儿童 2 0.81 -3.94 5.55 0.74
青少年 2 -0.28 -0.64 0.09 0.14
青少年与成人 6 0.89 0.06 1.72 0.04
成人 13 0.07 -0.26 0.40 0.66
地区 0.44 2 0.80 亚洲 6 0.57 -0.81 1.96 0.42
美洲 10 0.14 -0.25 0.53 0.48
欧洲 7 0.33 -0.58 1.23 0.48







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