Acta Psychiatrica Scandinavica:精神分裂症的发生率及产前和婴儿暴露于病毒感染性疾病的影响

2021-05-16 MedSci原创 MedSci原创

芬兰1956年至1989年出生的人精神分裂症的发病率有所下降,而紧张性精神分裂症的下降可能部分归因于脊髓灰质炎的根除。重要的是随着时间的推移跟踪精神分裂症的发病率,并寻找可能影响变化的因素。

全世界精神分裂症的终生累积发病率约为1%。对于精神分裂症的发病率是否在发生变化,存在着相互矛盾的证据,一些研究显示出了下降的趋势,一项研究报告说在之前的下降之后出现了上升的趋势,另一项研究指出近年来发病率在增加,特别是在较年轻的年龄组中。从1990年到2017年,全球年龄标准化的精神分裂症发病率有所下降,但在趋势上有很大的地方差异。产前和儿童早期的病毒感染在精神分裂症病因中的作用也有争议。

Antti Tanskanen等研究调查了芬兰1956 - 1989年出生队列中精神分裂症的累积发病率,不同年龄类别的精神分裂症风险和精神分裂症的紧张性亚型。其次,研究了在产前或婴儿期暴露于小儿麻痹症和麻疹病例是否与精神分裂症或紧张症亚型的累积发病率相关。

 精神分裂症患者是根据医院出院登记簿确定的。通过1972年至2014年的随访,计算了4个年龄组1956年至1989年的精神分裂症累计发病率。小儿麻痹症和麻疹的年发病率来自全国登记。用线性模型分析了对数转化脊髓灰质炎、麻疹发病率和精神分裂症,特别是紧张性精神分裂症发病率之间的关系。

在25岁、30岁、35岁和40岁时确诊的每1000例活产儿中精神分裂症的累计发病率。Log2:同年小儿麻痹症和麻疹患者的人数,说明流行病的程度。蓝色条表示40岁、35岁和30岁以下的出生年份。

在25岁、30岁、35岁和40岁时确诊的每1000例活产儿中紧张性精神分裂症的累计发病率。Log2:同年小儿麻痹症和麻疹患者的人数,说明流行病的程度。蓝色条显示的是40岁、35岁和30岁之前的出生年份。

 这项研究的发现表明,在20世纪50年代至70年代出生的芬兰人群中,精神分裂症的累积发病率显著下降。从1956年到1974年,40岁的精神分裂症发病率下降了近23%。这一趋势主要是因为青年发病精神分裂症的发病率在下降,在研究期间,25岁的累积发病率下降了41%。在20世纪50年代后期出生的人群中,25岁之前精神分裂症的累积发病率是40岁之前累积发病率的50%。相比之下,在出生20年后出生的队列中,25岁之前发病的精神分裂症比例下降到40%,这表明青年发病精神分裂症的累计发病率比一般精神分裂症下降得更快。结果还显示,不同出生年龄和不同年龄组的发病率都达到了峰值。从1977年到1980年,30岁之前的精神分裂症累计发病率突然增加,之后呈下降趋势。这与上世纪90年代首次入学人数增加的研究结果一致。以每年的活产数为分母;因此,与基于风险年的计算相比,儿童死亡率的下降趋势削弱了该研究结果的下降趋势。

综上所述,1956-1989年出生的个体中精神分裂症的累积发病率下降了23%(从每1000个活产13例下降到10)。这种下降在16-25岁的精神分裂症患者中最为显著(−41%)。三十年来,紧张性精神分裂症的发病率下降了90%,而且在出生年份脊髓灰质炎的年发病率和紧张性精神分裂症的发病率之间有显著的相关性。芬兰1956年至1989年出生的人精神分裂症的发病率有所下降,而紧张性精神分裂症的下降可能部分归因于脊髓灰质炎的根除。重要的是随着时间的推移跟踪精神分裂症的发病率,并寻找可能影响变化的因素。

原文出处

Tanskanen, A., Taipale, H., Cannon, M., Cotter, D. and Tiihonen, J. (2021), Incidence of schizophrenia and influence of prenatal and infant exposure to viral infectious diseases. Acta Psychiatr. Scand., 143: 487-494. https://doi.org/10.1111/acps.13295

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    2021-09-19 windight
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    2021-05-18 qilu_qi

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