注意缺陷多动障碍患儿智商的影响因素分析

Association study of intelligence of attention deficit hyperactivity disorder children in China

目的:探讨5-羟色胺(5-HT)系统5-HT2A受体基因(HTR2A)-1438A/G、儿茶酚-O-甲基转移酶(COMT)基因Val158Met、单胺氧化酶A(MAOA)30 bp-VNTR多态及父母受教育程度等多因素对儿童注意缺陷多动障碍(ADHD)智商的影响。方法:对485例汉族ADHD患儿进行韦氏智商评定和HTR2A-1438A/G、COMT基因Val158Met和MAOA基因30 bp-VNTR多态性的检测,比较各基因型组间智商的差异,同时对影响智力的相关因素进行多元线性回归分析。结果:患儿经过C-WISC测试后,MAOA基因两组基因型FIQ上的差异趋于有统计学意义,低活性组(男3R,女3R3R)的得分高于高活性组(男4R,女3R4R/4R4R)[(102.6±12.4)vs(100.3±11.7),P=0.078];COMT基因两组基因型FIQ上的差异有统计学意义,高活性组(ValVal)的得分明显高于中低活性组(ValMet和MetMet)[(103.5±13.6)vs(100.5±11.5),P=0.036];HTR2A3组基因型FIQ和VIQ的差异有统计学意义;经两两比较,GG基因型组的得分分别明显高于GA和AA组[FIQ:(106.9±10.7)vs(100.7±12.3)vs(101.7±12.9),P=0.003;VIQ:(110.1±10.6)vs(103.5±12.1)vs(105.1±13.2),P=0.001];父母的受教育程度与患儿的FIQ、VIQ及PIQ均相关。经多因素分析,保留在FIQ和VIQ模型中的自变量有2个:HTR2A基因型和母亲受教育程度;保留在PIQ模型中的自变量有1个,即HTR2A基因型。结论:提示5-HT系统的HTR2A基因-1438A/G多态以及母亲的受教育程度是中国汉族ADHD患儿智商的影响因素。

Objective ：To investigate the association of 5-HT2A receptor gene （HTR2A） -1438A/G, Cat- echol-O-methyltransferase （COMT） gene Val158Met, Monoamine oxidase A （ MAOA ） gene 30 bp-VN- TR（MAOA-uVNTR） polymorphisms, and the educational attainment level of the parents with the intelli- gence of attention deficit hyperactivity disorder （ADHD） in China. Methods： A total of 485 DSM-IV ADHD children of Chinese Han descent were included, both complete IQ evaluation, HTR2A-1438A/G, COMT gene Val158Met, and MAOA-uVNTR genotyping results were obtained. The quantitative traits of psychometric IQ were calculated by using the Chinese Wechsler Intelligence Scale for Children （C-WISC）. The multifactor linear regression analysis was used to test the associated factors on intelligence. Results： Analyses revealed that ADHD children with low enzymatic activity （3R for males, 3R3R for females） of MAOA-uVNTR performed better on Full Scale IQ （FIQ） than did patients with high enzymatic activity （4R for males, 3R4R/4R4R for females） [ （ 102.6 ± 12. 4） vs （ 100. 3 ±11.7）, P = 0. 0781. The patients with high-enzymatic activity （ValVal） of COMT gene Val158Met performed significantly bet- ter on FIQ than did patients with mid-low enzymatic activity （ValMet and MetMet） [ （103.5 ± 13.6） vs （ 100.5 ± 11.5） , P = 0. 036 ]. ADHD children with GG genotype of HTR2A-1438A/G performed signi- ficantly better on some aspects of C-WISC test （Full Scale IQ and Verbal Scale IQ） than did children with GA and AA genotypes[ FIQ ： （ 106.9± 10. 7） vs （ 100.7 ± 12. 3） vs （ 101.7 ± 12.9）, P =0. 003 ; VIQ： （110. 1±10.6） vs （103.5±12. 1） vs （105.1±13.2）, P=O. OOl]. The educational attainment level of the parents was associated with all the aspects of C-WISC test （Full Scale IQ, Verbal Scale IQ, and Performance Scale IQ）. The multiple linear regression analysis showed that the genotype of HTR2A- 1438A/G had significant correlation with FIQ, VIQ and PIQ; while the educational attainment level of the mother had significant correlation with FIQ and VIQ. Conclusion： The HTR2A-1438A/G polymorphism and the educational attainment level of the mother were associated with the intelligence of ADHD children in China.