肌萎缩侧索硬化的危险因素研究

发布时间：2018-03-13 14:40

本文选题：肌萎缩侧索硬化　切入点：危险因素　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：背景:肌萎缩侧索硬化(Amyotrophic lateral sclerosis,ALS)是一种进行性发展的神经系统变性病,主要累及上下运动神经元,疾病通常进展迅速,且缺乏有效的治疗。ALS病因尚不清楚,国内外已知的研究认为ALS的发病主要与遗传和环境因素相关,但研究结论并不一致。目前国内已有对遗传因素的初步探索,但环境因素方面的研究相对不足,因此需要进一步明确。目的:本研究旨在通过危险因素的分析,探讨不同环境因素对ALS的保护或危害作用,寻找ALS可能的病因,为今后疾病的预防和治疗提供线索。方法:本研究主要采用病例对照的研究方法。病例组来自2013-2016年期间就诊于我院的123名患者,以1:2选取239名性别、年龄相匹配的健康对照进行配对,以调查问卷的形式进行,具体包括一般情况、家族史、合并症、外伤、吸烟、饮酒、BMI(Body mass index,体重指数)、活动情况、职业等。用SPSS24.0进行统计分析和描述。两组间计数资料或等级资料比较用x2检验;logistic回归分析计算OR值和95%可信区间(95%CI),将单因素分析有显著性差异的因素纳入条件logistic回归模型进行多因素回归分析,显著水平为a=0.05。结果:ALS发病存在正相关的环境因素包括头部外伤(OR=3.397,95%[1.298,8.893],P=0.013)、饮酒(OR=1.760,95%CI[1.110,2.790],p=0.016)、吸烟(OR=3.196,95%[1.375,7.427],P=0.007)、低BMI(OR=1.124,95%CI[1.020,1.240],P=0.019)、工人农民和相关工作者(OR=2.539,95%[1.441,4.475],P=0.001,30-34岁);ALS发病存在负相关的环境因素包括高血压(OR=0.526,95%[0.313,0.883],P=0.015)、重度体育活动(OR=0.808,95%[0.711,0.918],P=0.001)、教育年限长(OR=0.183,95%[0.078,0.428],P=0.000,12年)、每天阅读20min以上(OR=0.225,95%[0.126,0.516],P=0.000,13-30岁)、退休或未被雇佣(OR=0.040,95%[0.005,0.291],P=0.000,30-34岁);神经精神系统及心脑血管疾病家族史、一般外伤、合并血脂升高、吸烟年限和吸烟量、艺术活动、从事职员或服务行业者等因素未发现与ALS的相关性。结论:头部外伤、饮酒、吸烟、低BMI、工人或农民相关工作者与ALS发病呈正相关,有可能为ALS的促发因素;高血压、重度体育活动、教育年限长、每天阅读20min以上、退休或未被雇佣与ALS发病呈负相关,有可能为ALS的保护因素。ALS发病与上述因素之间的确切因果关系,仍需进一步队列研究证实。
[Abstract]:Background: amyotrophic lateral sclerosis (Amyotrophic lateral sclerosissis) is a progressive neurodegenerative disease, mainly involving the upper and lower motor neurons. The disease usually progresses rapidly, and the etiology of ALS is not clear. Known studies at home and abroad believe that the pathogenesis of ALS is mainly related to genetic and environmental factors, but the conclusions are not consistent. At present, there have been preliminary researches on genetic factors in China, but the research on environmental factors is relatively inadequate. Therefore, further clarification is needed. Objective: the purpose of this study was to explore the protective or harmful effects of different environmental factors on ALS by analyzing the risk factors, and to find out the possible etiology of ALS. Methods: a case-control study was used in this study. The case group was from 123 patients in our hospital from 2013 to 2016, and 239 patients were selected by 1: 2. Age-matched healthy controls were matched in the form of questionnaires, including general information, family history, complications, trauma, smoking, alcohol consumption, BMI body mass indexs, body mass index (BMI), and activity. Statistical analysis and description with SPSS24.0. Count data or grade data comparison between two groups. Calculate OR value and 95% confidence interval 95% CI by using x2 test logistic regression analysis, and incorporate the factors with significant difference in univariate analysis into conditional logistic. Regression model was used for multivariate regression analysis. Results the positive environmental factors associated with the incidence of ALS were 3.39795% [1.2988.893] P0.013P, 1.760,95CI [1.110102.790] p0.016. smoking OR3.19695% [1.3757.427] PU 0.007, low BMIOR1.12495 CI [1.0201.240] P0.019.The negative correlation between workers and workers in OR2.539% [1.4411,0.004.475] was 0.526% [0.139583]. 0. 808 / 95% [0.711 / 0.918] / P ~ (0.001), 0.18395% [0.078 / 0. 428] / 0.000, 12 years / day / day, reading 20 minutes or more / day / day, 0.225% [0.1260.516] / P _ 0.000 ~ (30) years of age, 0.04095% / 0. 095% [0.0050.291] / (0.0050.291) / 30-34 years old, family history of neuropsychiatric and cardiovascular diseases. There was no correlation between general trauma, hyperlipidemia, years of smoking and smoking, artistic activities, staff or service workers. Conclusion: head injury, alcohol consumption, smoking, etc. Low BMI, workers or farmers related to the incidence of ALS positive correlation, may be the promotion factors of ALS, hypertension, severe physical activity, long years of education, reading more than 20 minutes a day, retired or not employed is negatively correlated with the incidence of ALS. The exact causal relationship between the pathogenesis of ALS and the above factors needs further cohort study to confirm.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R744.8

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