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:
2021-04-25Contact:
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/表 7
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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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, | 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. | 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. | 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. | 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. | 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. | 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, | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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. | 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, | 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. | 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. | 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. | 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. | 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. | 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, | 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. | 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. | 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. | 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. | 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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