儿童孤独症谱系障碍的环境危险因素研究

发布时间：2018-05-08 13:49

本文选题：孤独症谱系障碍 + 危险因素　；参考：《浙江大学》2016年硕士论文

【摘要】：研究背景：儿童孤独症谱系障碍(autism spectrum disorder, ASD)是一种童年早期起病的神经发育障碍性疾病,主要特点为在多种场合下表现的社会-情感交互反应、非语言的交流行为和对人际关系的发展、维持和理解的障碍以及固定刻板的行为模式或兴趣。近20年来ASD的患病率明显增加,严重影响了儿童的身心健康和人口素质,从而引起社会和研究界的普遍关注和重视。因为ASD病因的不确定性,目前尚缺乏针对ASD核心症状的有效药物,主要的治疗措施是康复训练和特殊教育。大量研究表明,儿童ASD可能是易感基因、神经生化、免疫激活、围生期疾病和环境因素共同交互作用的结果,但其具体病因及发病机制仍不是非常清楚[2]。深入了解与儿童ASD发病相关的可能环境危险因素,对于该病的预防和早期的干预具有积极作用。研究目的：了解与儿童孤独症谱系障碍发病相关的可能环境危险因素,为儿童ASD的早期预防及病因学研究提供依据。研究对象与方法：采用病例对照研究的方法,对诊断为ASD的男童81例、全面发育迟缓(Global Developmental Delay, GDD)男童74例及健康体检(Typical development, TD)男童163例,采用自制孕-围产期-出生后养育环境调查表调查儿童一般人口学情况、家庭基本情况、父母生活习惯及居住环境、母亲孕期健康情况、环境暴露、儿童出生时情况、生后养育及生活环境等资料,并进行分析比较。统计学：计量资料用均数±标准差(x±s)表示,计数资料以例数和百分率表示。多组间计量资料的比较采用单因素方差分析；计数资料的比较采用卡方检验,组间两两比较采用卡方分割法。采用非条件多因素logistic回归模型分析ASD发生的环境危险因素。P0.05为差异有统计学意义。寻找与ASD发病相关的可能环境危险因素。研究结果：1.以正常对照组作为参照,母亲职业毒物接触、孕期疾病及被动吸烟史、儿童出生在县区级以下医院或家中、出生后第2年户外活动少、与同龄儿交流机会少与ASD相关,其OR值依次为20.675、3.559、2.422、2.646、23.820、5.081(P0.05)。2.与GDD组儿童比较,ASD组儿童父亲文盲或半文盲较少(P0.01)。3.以正常对照组作为参照,父亲受教育程度低、母亲孕期被动吸烟及孕期阴道感染或出血史、胎儿脐带异常、新生儿期疾病史、儿童6个月内人工喂养和混合喂养、儿童第2年内户外活动少及与同龄儿交流机会少与GDD相关(P0.05)。结论：母亲职业毒物接触、孕期疾病、孕期被动吸烟及低级别分娩地点、儿童与同龄儿交流机会少及第2年户外活动少均可能是与ASD相关的环境危险因素；其中,母亲职业毒物接触、孕期疾病及低级别分娩地点可能与ASD特异关联,而孕期被动吸烟、儿童与同龄儿交流机会少及第2年户外活动少可能与儿童ASD非特异关联,提示ASD可能是易感基因受多种环境危险因素的作用而发生发展。
[Abstract]:Background: autism in children with autism spectrum disorder (spectrum) is a neurodevelopmental disorder from early childhood, characterized by social-emotional interaction in a variety of settings. Nonverbal communication and the development of relationships, barriers to maintenance and understanding, and fixed patterns of behavior or interest. In the past 20 years, the prevalence of ASD has increased significantly, which has seriously affected the physical and mental health of children and the quality of the population. Because of the uncertainty of the etiology of ASD, there is a lack of effective drugs for the core symptoms of ASD. The main treatment measures are rehabilitation training and special education. A large number of studies have shown that ASD in children may be the result of the interaction of susceptibility genes, neurobiochemistry, immune activation, perinatal diseases and environmental factors, but its specific etiology and pathogenesis are still not very clear [2]. Further understanding of the possible environmental risk factors associated with the onset of ASD in children plays a positive role in the prevention and early intervention of the disease. Objective: to investigate the possible environmental risk factors associated with autism spectrum disorders in children and to provide evidence for early prevention and etiology of childhood ASD. Subjects and methods: a case-control study was conducted in 81 boys diagnosed with ASD, 74 boys with global stunting and 163 boys with type development. Self-made questionnaire on pregnancy perinatal and postnatal rearing environment was used to investigate the general demography of children, basic family situation, parents' living habits and living environment, maternal health during pregnancy, environmental exposure, and the situation of the child at birth. The data of postnatal rearing and living environment were analyzed and compared. Statistics: the measurement data were expressed as mean 卤standard deviation x 卤s, and the counting data were expressed as cases and percentages. Single factor analysis of variance was used for comparison of measurement data among groups, chi-square test was used for comparison of counting data, and chi-square method was used for comparison between two groups. The non-conditional multivariate logistic regression model was used to analyze the environmental risk factors of ASD. To explore the possible environmental risk factors associated with the onset of ASD. The result of the study was: 1. Taking the normal control group as reference, the mother exposed to occupational poisons, pregnancy sickness and history of passive smoking, children born in hospitals or homes below county level, less outdoor activities in the second year after birth, and less chance of communicating with children of the same age were associated with ASD. The OR value was 20.675U 3.559U 2.422U 2.646n 23.820U 5.081g P0.05N 路2.The OR value was 20.675U 3.559U 2.422U 2.646U 23.820g 5.081g. Compared with the children of GDD group, the number of illiterate or semi-illiterate father in ASD group was lower than that in GDD group (P 0.01). 3. Compared with the normal control group, the father had a low level of education, the mother had a history of passive smoking during pregnancy, a history of vaginal infection or bleeding during pregnancy, abnormal umbilical cord of the fetus, a history of neonatal disease, and children were fed with artificial and mixed feeding within 6 months. Less outdoor activities and less communication with children of the same age in the second year were associated with GDD (P 0.05). Conclusion: occupational toxic exposure of mother, diseases during pregnancy, passive smoking during pregnancy and low level delivery sites, less chances of communication between children and children of the same age and less outdoor activities in 2 years may be the environmental risk factors associated with ASD. Maternal exposure to occupational poisons, diseases during pregnancy and low birth sites may be specifically associated with ASD, while passive smoking during pregnancy, less chance of communication with children of the same age, and less outdoor activity in 2 years may be associated with non-specific association with ASD in children. The results suggest that ASD may be a susceptible gene affected by many environmental risk factors.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R749.94

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