儿童孤独症围孕期危险因素的1∶1配对病例对照研究

Periconceptional Risk Factors for Childhood Autism:A 1∶1 Matched Case-control Study

目的探讨儿童孤独症的围孕期危险因素。方法采用1∶1配比的病例对照研究方法,选取国内多家医疗保健机构确诊的181例1~5岁孤独症患儿及与其地区、年龄、性别相匹配的181例健康儿童分别作为病例组和对照组。采用自行设计的《儿童行为及相关因素调查表》对儿童的主要监护人进行妊娠期相关因素的回顾性调查。利用SPSS18.0统计软件进行条件Logistic回归分析,计算优势比（OR）和95%置信区间（CI）。结果儿童孤独症与早产（OR=6.92,95%CI=1.80~26.67）、经产妇（OR=2.29,95%CI=1.14~4.58）、孕前/孕早期补充叶酸（OR=0.07,95%CI=0.01~0.41）、孕早期精神刺激（OR=16.16,95%CI=3.37~77.45）、孕早期患病（OR=9.74,95%CI=1.77~53.52）、孕中期产检异常（OR=6.00,95%CI=1.03~34.80）和孕晚期住院安胎（OR=3.15,95%CI=1.36~7.29）等存在相关性。结论母亲围孕期叶酸补充、精神刺激、患病、住院安胎等因素可在一定程度上影响儿童孤独症发生的风险。

Objective To explore the periconceptional risk factors for childhood autism.Methods A 1∶1 matched casecontrol study method was used.A total of 181 children who were diagnosed as having autism in health care institutes in China and at age of 1to 5were recruited in the study and designated as case group.The same number of age-,region-,and sex-matched children served as control group.The main guardians of these children were interviewed for the related factors during pregnancy by using a self-designed questionnaire（Child Behavior and Related Factor Rating Scale）.Conditional logistic regression analysis was conducted by using SPSS 18.0software,and the hazard ratio（OR）and 95% confidence interval（CI）were obtained.Results Childhood autism was associated with preterm birth（OR=6.92,95%CI=1.80-26.67）,multiparous women（OR=2.29,95%CI=1.14-4.58）,folic acid supplementation in pre-pregnancy or early pregnancy（OR=0.07,95%CI=0.01-0.41）,mental stimulation in early pregnancy（OR=16.16,95%CI=3.37-77.45）,developing diseases in early pregnancy（OR=9.74,95%CI=1.77-53.52）,abnormal prenatal examination results during the second trimester（OR=6.00,95%CI=1.03-34.80）and tocolysis in the late pregnancy（OR=3.15,95%CI=1.36-7.29）.Conclusion Factors including folic acid supplementation in pre-pregnancy or early pregnancy,mental stimulation in early pregnancy,developing diseases in early pregnancy,and tocolysis in late pregnancy may increase the risk of developing childhood autism to some extent.