孤独症的危险因素探讨

【作者】 张雅丽；

【导师】 牛小媛；

【作者基本信息】 山西医科大学 ， 神经病学， 2007， 硕士

【摘要】 目的：孤独症是神经科临床常见病，但其病因及发病机制不清。研究表明，孤独症的危险因素可能涉及遗传学、母亲孕产期并发症、患者生长期的重大疾病、家庭情况等，但这些危险因素的作用目前并未明确。本试验通过对孤独症人群的研究，探讨孤独症的危险因素及其在孤独症发病中的地位。方法：本课题采用回顾性病例对照研究。选取在某两个训练机构中的孤独症儿章138名(全部符合美国DSM-Ⅳ诊断标准)，与年龄、性别相匹配的138名身体健康、智力正常的儿章进行对照研究。研究内容主要包括母亲孕产期并发症(母亲先兆流产、孕早期感冒、孕期X线照射、孕期服药、是否正常孕周、助产、剖宫产、缺氧窒息)、患者生长期重大疾病(癫痫、高热惊厥、外伤)、家庭情况(父母的文化程度、父母的性格)、遗传史等危险因素。研究方式采用问卷调查的方法。统计方法采用t检验，x~2检验和非条件多因素Logistic回归分析，采用SPSS13．0统计软件进行数据处理。结果：统计结果显示，父母的文化程度(父x~2=18．17，P<0．01，OR=3．07；母x~2=7．67，P<0．01，OR=2．02)、母亲先兆流产(x~2=16．66，P<0．01，OR=6．77)、孕早期感冒(x~2=11．50，P<0．01，OR=3．43)、是否正常孕周(x~2=4．13，P<0．05，OR=2．01)、缺氧窒息(x~2=4．57，P<0．05，OR=2．18)、高热惊厥(x~2=12．13，P<0．01，OR=2．90)、遗传史(x~2=6．06，P<0．05，OR=10．70)和母亲性格内向(x~2=4．00，P<0．05，OR=1．97)有统计学意义；而孕期服药、孕期X线照射、助产、剖宫产、癫痫、脑外伤和父亲性格等无统计学意义。非条件多因素回归分析结果显示，以上有统计学意义的各危险因素中，对孤独症发病的贡献值从大到小依次为遗传史、先兆流产、孕早期感冒、父亲的文化程度、产期异常、母亲的性格内向。结论：本调查发现，母亲孕产期并发症、患者生长期重大疾病、家庭情况、遗传史等均可能是孤独症的危险因素，尤其是遗传史及母亲的先兆流产与孤独症发病的关系最为密切。控制以上危险因素可能有助于预防和降低孤独症的发生率。更多还原

【Abstract】 Objective: Autism is a serious neurodevelopmental disorder with a highly heterogeneous pathogenesis and its causes remain largely unknown. Both genetic and environmental factors are likely to contribute etiologically. However, it is difficult to determine how much these risk factors contributed to the pathogenesis of autism. The aim of the present study was to estimate the possible associations between autism and its risk factors in a large case-control analysis.Method: A retrospective case-control analysis was performed in 2 special autism schools in Qindao city. 138 children with autism (who meet DSM-Ⅳcriteria) and 138 randomly selected control children for this study from the normal school matched to the sex and age. We included genetic or environmental insults or epigenetic factors such as potential prenatal, perinatal, neonatal, developmental and family risk factors. We analyze the data by t-test、x~2 test and unconditional logistic regression models.Results: There were significant association between autism and culture level of parents (father:x~2=l8.17, P<0.01, OR=3.07; mother:x~2 =7.67, P<0.01, OR=2.02), threatened abortion( x~2= 16.66 ,P<0.01,OR=6.77), influenza(x~2 =11.50 , P<0.01,OR=3.43), pregnant week(x~2 =4.13 , P<0.05, OR=2.01).neonate suffocates (x~2=4.57 , P<0.05, OR=2.18), convulsions (x~2=12.13 , P<0.01, OR=2.90), hereditary disease history (x~2 =6.06 , P<0.05, OR= 10.70), mothers’ character (x~2 =4.00, P<0.05, OR=1.97). No statistically significant group differences were detected in term of the other factors. These factors according to their contributive values were hereditary disease history, threatened abortion, fathers’ culture level, abnormal pregnant week, mothers’ character, respectively.Conclusion: These data suggested that the unfavorable events in pregnant, delivery, the neonatal and developmental phase increase the incidence of autism. We should take some effective to control these risk factors.更多还原