孤独症谱系障碍相关危险因素的Logistic回归分析

Logistic regression analysis on risk factors of autism spectrum disorders

目的探索孤独症谱系障碍的可能危险因素，为进一步研究该病病因学提供线索和依据。方法采用病例对照研究方法，对2014年5月至2015年1月在江西省儿童医院初次行孤独症谱系障碍诊断符合美国《精神障碍诊断和统计手册》第4版孤独症谱系障碍诊断标准的儿童（病例组）以及在该医院保健科门诊进行健康体检的儿童（对照组）进行有关孤独症谱系障碍相关危险因素调查，共68例病例组患儿（初诊孤独症谱系障碍儿童）以及77例对照组儿童（性别与病例组匹配）符合入选及排除标准。调查内容包括一般情况、出生史、喂养史、过去健康史、母亲孕前及孕期健康史和生活环境有害因素暴露史、父母职业史、家族史和相关检查结果等。调查结果采用Logistic回归分析。结果Logistic回归分析结果表明，母亲孕前2年内有过病毒感染（OR=7．97，95％CI：2．42—26．31）、职业暴露（OR=3．99，95％CI：1．27～12．52）、孕期接触挥发性有机物（OR=22．21，95％CI：2．28～216．09）、孕期住处距公路距离（OR=0．59，95％CI：0．38～0．93）及存在家族史（OR=58．50，95％CI：5．81—589．57）可能是孤独症谱系障碍的危险因素，纯母乳喂养时间（OR=0．81，95％CI：0．66～0．98）可能是孤独症谱系障碍的保护因素。结论除遗传因素外，从怀孕到出生期间子宫环境以及生长环境在孤独症谱系障碍发病过程中起重要作用。

Objective To explore the possible risk factors for autism spectrum disorders （ASD）, and to provide a basis for exploring the etiology of the disease. Methods This case - control study included 68 patients diagnosed as ASD for a first lifetime（according to the fourth edition of the American ＂Diagnostic and Statistical Manual of Mental Disorders＂ for ASD diagnosis） from May 2014 to January 2015 ,and 77 non -ASD controls （normal children, matched on gender） in Jiangxi Children＇s Hospital were selected to undergo the risk factor survey for ASD. The survey content included 10 categories ： general status, birth, feeding, the past history, mother＇s pregnancy and her health condi- tion during pregnancy and environmental exposure, parents＇ occupational exposure, family history and relevant test results. Logistic regression analysis was performed to analyze the results of the survey. Results The possible risk factors for ASD increased if mother had virus infection 2 years before pregnant （ OR = 7.97,95 % CI： 2.42 - 26.31 ） , had occupational exposure （ OR = 3.99,95 % CI：1. 27 - 12.52）, volatile organic compounds exposure during pregnancy （ OR = 22. 21,95 % CI： 2.28 - 216.09）, as well as living closely to transport passage ways during pregnancy （ OR = 0. 59,95 % CI：0. 38 - 0.93 ） or having a family heredity history （ OR = 58.50,95% CI： 5.81 - 589.57 ）. Breastfeeding （ OR = 0. 81,95% CI：0. 66 -0.98） might be a protective factor in ASD. Conclusions In addition to genetic： factors,the uterine environment from conception to birth and growth environment play an important role in the pathogenesis of ASD.