中国儿童孤独症谱系障碍患病率的系统综述(英文)

Prevalence of autism spectrum disorders among children in China:a systematic review

背景中国孤独症和孤独症谱系障碍(autism spectrum disorders,ASD)的患病率缺乏可靠的估计。目的运用Meta分析综合评价中国18岁以下人群孤独症和ASD患病情况,并分析其在性别、民族、城乡等不同因素间的差异。方法检索中国知识资源总库、中国科技期刊数据库、万方数据检索系统、中国生物医学文摘数据库、PubMed和Web of Science等数据库,收集关于中国孤独症谱系障碍患病率的文献,按照预先制定的纳入及排除标准筛选相关研究。采用R-2.1 5.2软件对资料进行统计学分析。结果共纳入24项研究,其中5项来自香港和台湾的注册研究(涉及14,570,369名儿童),19项来自大陆以人群为基础的筛查和诊断研究(合并样本量为771,413名儿童)。港台注册研究报道的孤独症年患病率为1.8～424.6/10,000。中国大陆的18项研究(剔除一个患病率最低的全国性研究)报道孤独症患病率为2.8～30.4/10,000,合并后孤独症患病率为12.8/10,000(95%CI,9.4～17.5)。5项研究报道ASD(患病率为7.3～75.3/10,000)合并后患病率24.5/10,000(95%CI,10.4～57.4)。不同性别、居住地点、发表时间和抽样来源之间报道的患病率存在明显差异。结论港台注册研究报道的孤独症患病率存着巨大差异(达200倍),大陆以人群为基础的筛查诊断研究报道的患病率存在较大差异(10～15倍),凸显迫切需要建立标准的方法来估计孤独症和ASD的患病率。只有方法学质量得到改善,才有可能为这些不常见但严重致残的疾病提供循证的防治策略。

Background： There are no reliable estimates of the prevalences of autism and autism spectrum disorders （ASD） in China. Objective： Combine results across studies to estimate the prevalences of autism and ASD among Chinese children under the age of 18, and assess variations in the prevalences with respect to gender, ethnicity, and urban versus rural residence. Methods： Based on pre-defined inclusion and exclusion criteria, studies were identified by searching the following databases： Chinese National Knowledge Infrastructure, Chongqing VlP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, Pubmed, and Web of Science. Statistical analysis was conducted using R-2.15.2 software. Results： The 24 studies meeting inclusion criteria included 5 registry studies from Taiwan and Hong Kong （covering a total of 14 570 369 children） and 19 community-based screening and diagnostic studies from China's Mainland （with a combined sample of 771 413 children）. The annually reported prevalence of autism in the registry studies ranged from 1.8 to 424.6 per 10 000. A meta-analysis of 18 of the studies from China's Mainland （excluding a large nationwide study with the lowest prevalence of autism） with a range in rates from 2.8 to 30.4 per 10 000 generated an estimated pooled prevalence of autism of 12.8 per 10 000 （95%CI, 9.4 to 17.5）. The pooled prevalence of ASD estimated from 5 of these studies （which had a range in rates from 7.3 to 75.3 per 10000） was 24.5 per 10000 （95%CI, 10.4 to 57.4）. The reported prevalence of autism varied substantially by gender, location of residence, date of publication, and source of the sample. Conclusion： The huge difference between the rates for autism reported from registry systems in Hong Kong and Taiwan （a 200-fold difference） and the large differences in rates reported from community-based screening studies in China's Mainland （a 10- to 15-fold difference） highlight the urgent need for establishing standardized methods for estimating the prevalences of autism and ASD. Until these methodological improvements have been made, it will not be possible to develop evidence-based prevention and treatment strategies for the management of these uncommon but seriously disabling conditions.