天津市婴幼儿孤独症患病率与危险因素

Prevalence and risk factors of infantile autism in Tianjin

目的:探讨天津市婴幼儿孤独症的患病率及相关危险因素,为今后孤独症病因研究提供线索。方法:应用巢式病例对照研究方法,按分层整群抽样的原则随机抽取天津市7 904名1.5～3岁的儿童进行孤独症筛查,对412名筛查阳性儿童进行追踪,年龄满3岁时进行孤独症确诊;每个病例按相同性别月龄匹配4例对照,因素调查表分为四部分,每部分分别进行单因素及多因素条件Logistic回归。结果:22例确诊为孤独症,天津市婴幼儿孤独症患病率及其95%的可信区间为27.83/万(16.22/万～39.44/万),男性孤独症患病率是女性的4倍(P<0.05)。单因素分析时发现孤独症的危险因素总共有8个,各部分多因素分析显示主要危险因素为:父亲有害职业史、母亲人工流产史、被动吸烟、妊娠浮肿、妊娠呕吐、新生儿黄疸。结论:孤独症不应再被认为是极罕见病,环境因素与孤独症发病有一定关系。

Objective：To investigate the prevalence and related risk factors of infantile autism in Tianjin,in order to provide clues to etiology of autistic disorder.Methods：Using nested case-control study,7 904 children aged 1.5 to 3 were screened for autistic disorder by cluster random sampling method,412 screening-positive children entered the cohort and were diagnosed when they were 3 years old.4 healthy children were selected to match 1 case,with the same age and sex.The screen and diagnostic questionnaire used in this survey included checklist for Autism in Toddlers（CHAT）,Childhood Autism Rating Scale（CARS）,factor questionnaire and so on.There were four parts in factor questionnaire.Single variable and multivariate conditional logistic regression analysis were used to analyze risk factors in each parts.Results：22 children were diagnosed with autism,the prevalence of infant autism was 27.83/10 000 in Tianjin,95% confidence interval was 16.22/10 000 to 39.44/10 000.There were significant differences in autism prevalence between boys and girls（χ2=8.016,P0.05）.The prevalence of infant autism in boys was 4 times that of girls.8 risk factors were found in single variable conditional logistic regression analysis.After multivariate analysis,the risk factors of autistic disorder were parental occupational exposure history,induced abortion history,passive smoking,edema of pregnancy,vomiting of pregnancy,neonatal jaundice.Conclusion：Autistic disorder should not be considered as an extremely rare disorder,and environmental factors relate with the cause of autism disorder.