孤独症谱系障碍的早期危险因素  

A case-control study of early risk factors of autism spectrum disorder

作　　者：高磊[1] 苏媛媛[1] 戴炜[1] 韩钰[1] 邓艳梅[1] 张欣[1] 

机构地区：[1]天津医科大学公共卫生学院,天津300070

出　　处：《中国心理卫生杂志》2014年第6期440-444,共5页Chinese Mental Health Journal

基　　金：国家自然科学基金课题(孕期和围产期相关的遗传与环境因素与儿童孤独症关系的研究;编号81072313)

摘　　要：目的：探索孤独症谱系障碍患者从出生到18个月期间内的危险因素及与ASD相关的早期发育特征.方法：采用病例对照研究的方法,病例组为天津市各区特殊教育学校及残联附属康复机构中符合美国精神障碍诊断与统计手册（DSM-Ⅳ）孤独症谱系障碍诊断标准的193例儿童（3～18岁）,对照组为来自天津市各区生长发育调查库中与病例组性别年龄匹配的193例正常儿童.采用自编孤独症谱系障碍早期危险因素调查问卷对两组儿童的新生儿及婴儿期疾病史、营养接种状况和早期发育特征进行调查.结果：病例组中新生儿及婴儿期病史中“黄疸”（15.5％vs.5.7％）、“窒息”（10.4％vs.1.0％）、“呼吸窘迫”（2.6％vs.0）和“抽搐惊厥”（9.8％ vs.1.6％）的比例均高于正常对照组（均P〈0.05）;营养因素中“1周岁内母乳喂养”的比例低于正常对照组（47.77％ vs.76.2％,P〈0.05）;早期发育特征中“对母微笑延迟”（33.2％vs.2.6％）、“抓物延迟”（40.9％vs.2.6％）和“说短语延迟”（71.3％ vs.14.6％）的比例高于正常对照组（均P〈0.05）.Logistic回归分析显示,早期发育特征中的“对母微笑延迟”（OR=2.06）、“抓物延迟”（OR=1.81）和“说短语延迟”（OR=1.55）3项进入方程;全部因素中,“新生儿黄疸”（OR=1.63）、“新生儿窒息”（OR=2.11）、“抽搐惊厥史”（OR=1.58）、“1周岁内母乳喂养”（OR=0.36）和“对母微笑延迟”（OR=1.52）5项进入方程.结论：新生儿的窒息、黄疸及惊厥抽搐发作可能是孤独症谱系障碍的危险因素,母乳喂养可能是孤独症谱系障碍的保护因素,而“对母微笑延迟”、“抓物延迟”和“说短语延迟”的早期发育特征可能预示患孤独症谱系障碍的风险增加.Objective： To explore the possible early （from birth to 18 months old） risk factors of autism spectrum disorder （ASD） and the early developmental characteristics related to ASD. Methods： In this unconditional case-control study, the case group was composed of 193 children （aged 3 - 18 years old） from the special education schools and rehabilitation institutions affiliated to Federation of Disabled of Tianjin who were diagnosed as ASD ac- cording to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV）. Totally 193 gen- der-and age-matched normal children from the database of survey of growth in Tianjin were selected as controls. All 386 children were assessed with the self-made questionnaires of early risk factors for ASD to investigate the neo- natal and infantile diseases history, nutrition and vaccine of neonatal and infantile period and early developmental characteristics of ASD. Results： Among the history of infantile diseases, the rates of ＂neonatal jaundice＂ （ 15.5% vs. 5.7% ）, ＂neonatal asphyxia＂ （ 10.4% vs. 1.0% ）, ＂infantile convulsion history＂ （ 2. 6% vs. 0） and ＂transient respiratory distress＂ （9.8 % vs. 1.6% ） were higher in the case group than in the control group （Ps 〈 0. 05）. Among the nutrition factors, the rate of ＂ breast-feeding mode＂ was lower in the case group than in the control group （47. 8% vs. 76, 2%, P 〈0. 05）. The rates of ＂delayed social smile towards mother＂ （33.2% vs. 2. 6% ）, ＂delayed grabbing＂ （40. 9% vs. 2. 6% ） and ＂delayed phrases speaking＂ （71.3% vs. 14. 6% ） in early developmental char- acteristics were higher in the case group than in the control group. Logistic regression analysis showed that among early developmental characteristics factors, ＂delayed social smile towards mother＂ （OR = 2. 06）, ＂delayed grabbing＂ （OR = 1.81） and ＂delayed phrases speaking＂（ OR = 1.55） were entered into the equation. Among all the related factors, t

关 键 词：孤独症谱系障碍 早期危险因素 病例对照研究 

分 类 号：R749.94[医药卫生—神经病学与精神病学]