【原】[罂粟摘要]童年不良经历对成年后慢性疼痛和重度抑郁的影响:系统回顾和Meta分析

童年不良经历对成年后慢性疼痛和重度抑郁的影响:系统回顾和Meta分析

贵州医科大学  麻醉与心脏电生理课题

翻译:  柏雪    编辑:  严旭   审较:  曹莹

背景:不良的童年经历与多种疾病的增加有关，并对一生的身心健康产生影响。慢性疼痛通常与情绪障碍有关，如重度抑郁症(MDD);两者都与不良的童年经历有关。目前尚不清楚不良童年经历对神经发育的影响如何导致慢性疼痛、重度抑郁症或两者的易感性，以及是否存在共同的机制。我们的目的是采用系统回顾和Meta分析评估不良童年经历引起的中枢神经变化与慢性疼痛、重度抑郁症或两者均患有的相关证据。

方法：系统地搜索了电子数据库，以查找关于不良童年经历、慢性疼痛、MDD 或两者均患有的神经影像学资料。两名独立审稿人筛选标题、摘要和全文，并评估质量。提取神经影像学数据后，进行激活似然估计Meta分析以确定与这些合并症相关的重要大脑区域。

结果:2414项研究中有49项符合条件，其中43项研究了童年不良经历和重度抑郁症，6项研究了童年不良经历和慢性疼痛。没有人将不良童年经历、慢性疼痛和重度抑郁症一起调查。暴露于不良童年经历的MDD患者在额上回、舌回、海马、脑岛、壳核、颞上回、颞下回和小脑前部发现了功能和结构异常。此外，在基于研究任务的功能性 MRI 研究中，在患有重度抑郁症或慢性疼痛并且有童年不良经历暴露的患者中，扣带回、顶下小叶和楔前叶的脑功能异常被确定。

结论：我们发现，与没有不良童年经历的成年人相比，不良童年经历暴露可能导致患有重度抑郁症或慢性疼痛的成年人发生不同的大脑功能和结构改变。

原始文献来源  ：

Antoniou G,Lambourg E,Steele JD, et al.The effect of adverse childhood experiences on chronic pain and major depression in adulthood: a systematic review and meta-analysis[J].Br J Anaesth,2023.

英文原文：

The effect of adverse childhood experiences on chronic pain and major depression in adulthood: a systematic review and meta-analysis

Abstract 

Background: Adverse childhood experiences have been linked to increased multimorbidity, with physical and mental health consequences throughout life. Chronic pain is often associated with mood disorders, such as major depressive disorder (MDD); both have been linked to adverse childhood experiences. It is unclear how the effect of adverse childhood experiences on neural processing impacts on vulnerability to chronic pain, MDD, or both, and whether there are shared mechanisms. We aimed to assess evidence for central neural changes associated with adverse childhood experiences in subjects with chronic pain, MDD, or both using systematic review and meta-analysis.

Methods: Electronic databases were systematically searched for neuroimaging studies of adverse childhood experiences, with chronic pain, MDD, or both. Two independent reviewers screened title, abstracts, and full text, and assessed quality.

After extraction of neuroimaging data, activation likelihood estimate meta-analysis was performed to identify significant brain regions associated with these comorbidities.

Results: Forty-nine of 2414 studies were eligible, of which 43 investigated adverse childhood experiences and MDD and six investigated adverse childhood experiences and chronic pain. None investigated adverse childhood experiences, chronic pain, and MDD together. Functional and structural brain abnormalities were identified in the superior frontal, lingual gyrus, hippocampus, insula, putamen, superior temporal, inferior temporal gyrus, and anterior cerebellum in patients with MDD exposed to adverse childhood experiences. In addition, brain function abnormalities were identified for patients with MDD or chronic pain and exposure to adverse childhood experiences in the cingulate gyrus, inferior parietal lobule, and precuneus in task-based functional MRI studies.

Conclusions: We found that adverse childhood experiences exposure can result in different functional and structural brain alterations in adults with MDD or chronic pain compared with those without adverse childhood experiences.