自杀未遂危险因素的配对病例对照研究

A paired case-control study on related factors to attempted suicide

目的了解汉族人群自杀未遂的环境危险因素、儿茶酚胺氧位甲基转移酶(COMT)158/108基因多态性与自杀未遂有无关联。方法采用配对的病例对照研究,对205例自杀未遂者(男性89例、女性116例)与相应对照(与病例同性别、年龄相差3岁以内、同地区)进行COMT158/108基因型测定、环境因素与自杀未遂的关系研究。结果病例组与对照组在COMT基因型、基因频率上差别无统计学意义;多因素条件logistic回归模型分析显示,COMT158/108Val/Val、文化程度低、吸烟、情感冲突、精神障碍、抑郁皆为自杀未遂的危险因素,OR值分别为2.43(95%CI:1.10～5.40)、5.70(95%CI:1.88～17.27)、3.54(95%CI:1.02～12.36)、10.96(95%CI:4.74～25.34)、6.35(95%CI:1.68～24.05)、11.30(95%CI:4.58～27.89);且因素间无相乘模型一级交互作用。结论研究表明,文化程度低、吸烟、情感冲突、精神障碍、抑郁为自杀未遂的危险因素;支持COMT158/108Val/Val为自杀未遂的易感基因型。并提示基因图谱上116bp片段可能与COMT高活性相关。

Objective To understand the environmental risk factors on attempted suicide, and to study the interaction between factors as gene polymorphism of catechol-O-methyltransferase( COMT ) associated to attempted suicide. Methods Paired case-control study of 205 suicide attempters(89 male,116 female) and molecular biological techniques were used to study the relation between gene polymorphism of COMT , environmental factors and the rate of attempted suicide. Controls were paired with cases according to the same gender, similar age(no more than 3 years) and in the same district. Results There were no significant differences in gene types and gene frequency between case and control groups. Multivariate conditional logistic regression model analysis showed that COMT Val/Val 158/108, low education level, cigarette smoking, emotional conflicts, psychologic disorders and depression were risk factors of attempted suicide with OR values as 2.43 (95% CI : 1.10- 5.40 ), 5.70 (95% CI : 1.88- 17.27 ), 3.54 (95% CI : 1.02- 12.36 ), 10.96 (95% CI : 4.74- 25.34 ), 6.35 (95% CI : 1.68- 24.05 ) and 11.30 (95% CI : 4.58- 27.89 ) respectively. There was no first level interaction between any two risk factors. Conclusion The study supported that low education level, cigarette smoking, affective conflicts, psychiatric disorders, depression were risk factors of attempted suicide and COMT Val/Val 158/108 was suspected to be a susceptible gene type of attempted suicide but needs further study. The study also suggested that 116 bp in gene atlas be possibly correlated to high activity of COMT .