Importance Questions of whether and how cortical thickness (CTh) alterations differ over the course of schizophrenia (SCZ) have yet to be resolved. Objective To characterize CTh alterations across illness stages in SCZ. Data Sources PubMed, Embase, Web of Science, and Science Direct were screened for CTh studies published before June 15, 2021. Study Selection Original studies comparing whole-brain CTh alterations from healthy controls in individuals at clinical high-risk (CHR), first episode of psychosis (FEP), and long-term illness stages of SCZ were included. Data Extraction and Synthesis This preregistered systematic review and meta-analysis followed PRISMA reporting guidelines. Separate and pooled meta-analyses were performed using seed-based d mapping. Meta-regression analyses were conducted. Main Outcomes and Measures Cortical thickness differences from healthy control individuals across illness stages. Results Ten studies comprising 859 individuals with CHR (mean [SD] age, 21.02 [2.66] years; male, 573 [66.7%]), 12 studies including 671 individuals with FEP (mean [SD] age, 22.87 [3.99] years; male, 439 [65.4%]), and 10 studies comprising 579 individuals with long-term SCZ (mean [SD] age, 41.58 [6.95] years; male, 396 [68.4%]) were included. Compared with healthy control individuals, individuals with CHR showed cortical thinning in bilateral medial prefrontal cortex (z = -1.01; P < .001). Individuals with FEP showed cortical thinning in right lateral superior temporal cortex (z = -1.34; P < .001), right anterior cingulate cortex (z = -1.44; P < .001), and right insula (z = -1.14; P = .002). Individuals with long-term SCZ demonstrated CTh reductions in right insula (z = -3.25; P < .001), right inferior frontal cortex (z = -2.19; P < .001), and left (z = -2.37; P < .001) and right (z = -1.94; P = .002) temporal pole. There were no significant CTh differences between CHR and FEP. Individuals with long-term SCZ showed greater cortical thinning in right insula (z = -2.58; P < .001), right inferior frontal cortex (z = -2.32; P < .001), left lateral temporal cortex (z = -1.91; P = .002), and right temporal pole (z = -1.82; P = .002) than individuals with FEP. Combining all studies on SCZ, accelerated age-related CTh reductions were found in bilateral lateral middle temporal cortex and right pars orbitalis in inferior frontal cortex. Conclusions and Relevance The absence of significant differences between FEP and CHR noted in this systematic review and meta-analysis suggests that the onset of psychosis was not associated with robust CTh reduction. The greater cortical thinning in long-term SCZ compared with FEP with accelerated age-related reduction in CTh suggests progressive neuroanatomic alterations following illness onset. Caution in interpretation is needed because heterogeneity in samples and antipsychotic treatment may confound these results.

中文翻译：

---

精神分裂症病程不同阶段的皮质厚度异常：系统评价和荟萃分析。


皮质厚度 (CTh) 变化在精神分裂症 (SCZ) 病程中是否存在差异以及如何变化的问题尚未得到解决。目的 描述 SCZ 不同疾病阶段的 CTh 变化特征。数据来源 PubMed、Embase、Web of Science 和 Science Direct 筛选了 2021 年 6 月 15 日之前发表的 CTh 研究。研究选择 原始研究比较了临床高危 (CHR) 个体与健康对照的全脑 CTh 改变，首先包括精神病发作 (FEP) 和 SCZ 的长期疾病阶段。数据提取和综合这项预先注册的系统评价和荟萃分析遵循 PRISMA 报告指南。使用基于种子的 d 映射进行单独和汇总荟萃分析。进行了元回归分析。主要结果和措施 不同疾病阶段的皮质厚度与健康对照个体的差异。结果 10 项研究包括 859 名 CHR 患者（平均 [SD] 年龄，21.02 [2.66] 岁；男性，573 名 [66.7%]），12 项研究包括 671 名 FEP 患者（平均 [SD] 年龄，22.87 [3.99] 岁；男性，573 名 [66.7%]）。包括 439 名男性 [65.4%]）和 10 项研究，其中包括 579 名长期 SCZ 个体（平均 [SD] 年龄，41.58 [6.95] 岁；男性，396 名 [68.4%]）。与健康对照个体相比，患有 CHR 的个体双侧内侧前额叶皮层皮质变薄 (z = -1.01; P < .001)。患有 FEP 的个体显示右侧上颞叶皮质 (z = -1.34; P < .001)、右前扣带皮层 (z = -1.44; P < .001) 和右侧岛叶 (z = -1.14) 的皮质变薄P = .002)。长期 SCZ 的个体表现出右侧岛叶 (z = -3.25; P < .001)、右额下皮质 (z = -2.19; P < .001) 的 CTh 减少。001) 和左 (z = -2.37; P < .001) 和右 (z = -1.94; P = .002) 颞极。 CHR 和 FEP 之间没有显着的 CTh 差异。长期 SCZ 个体的右侧岛叶 (z = -2.58; P < .001)、右额下皮质 (z = -2.32; P < .001)、左侧颞叶皮质 (z = -1.91；P = .002) 和右颞极 (z = -1.82；P = .002) 高于 FEP 个体。综合所有关于 SCZ 的研究，发现双侧外侧颞中叶皮层和下额叶皮层的右眼眶部加速了与年龄相关的 CTh 减少。结论和相关性 本系统评价和荟萃分析中指出，FEP 和 CHR 之间不存在显着差异，这表明精神病的发作与 CTh 的强劲减少无关。与 FEP 相比，长期 SCZ 的皮质变薄程度更大，并且 CTh 与年龄相关加速减少，这表明疾病发作后神经解剖学发生了进行性改变。解释时需要谨慎，因为样本和抗精神病药物治疗的异质性可能会混淆这些结果。