Tourette综合征发生的危险因素分析

Risk factors for Tourette syndrome

摘要:

目的：研究Tourette综合征（TS）发生的主要危险因素。方法：运用遗传流行病学病例对照研究，对门诊80例TS患儿用Li-Mantel-Gart法估算分离比，并对其一、二级亲属用Falconer回归方法估算遗传度。同时，分别对该80例TS患儿和80例以其他疾病于门诊就诊的对照患儿应用家庭环境量表和自制一般情况调查表收集资料，再用单因素和多因素方法对资料进行分析。结果：TS分离比是0.1176，一级亲属遗传度为（49.7±2.6）%，二级亲属遗传度为（21.5±3.4）%，一、二级亲属加权平均遗传度为（39.5±2.1）%。TS组的独立性、娱乐性、组织性等因子的评分明显低于对照组，而矛盾性和控制性等因子评分则明显高于对照组，两组间差异均具有统计学意义（P<0.01）。单因素分析显示TS发生的相关危险因素为TS阳性家族史、家庭教育类型、孕母吸烟、家庭矛盾性、父母文化程度低、家庭控制性、出生时缺氧。多因素logistic回归分析发现TS阳性家族史、家庭矛盾性、家庭教育类型、父母文化程度低、孕母吸烟等是TS发生的主要危险因素。结论：TS的发生是遗传和环境各种因素相互作用的结果，遗传方式为多基因遗传；具有TS家族史的儿童，积极改善其生活环境是非常必要的。

Abstract:

OBJECTIVE: To identify the risk factors for Tourette syndrome (TS) in children. METHODS: Through a genetic epidemiologic case control study, segregation ratio was estimated using the method of Li-Manted-Gart in 80 children with TS. Heritability for the first- and second-degree relatives was estimated using the Falconer regression method. In addition, the 80 children and 80 controls with other diseases were evaluated using the Family Environment Scale and a self-designed questionnaire. Risk factors for TS were investigated using single factor and multifactor regression analysis. RESULTS: The segregation ratio of TS was 0.1176. Heritabilities for the first- and second-degree relatives were (49.7±2.6)% and (21.5±3.4) % respectively. The weighted mean heritability of the first-degree and second-degree relatives was (39.5±2.1)%. Significantly decreased scores were noted in independence, active-recreational orientation and organization and increased scores were noted in the conflict and control in the TS group compared with the control group (P<0.01). Single factor analysis indicated that the risk factors for TS included family history, type of home education, maternal smoking, family conflict, low level of parental education, family control and fetal anoxia. Multifactor regression analysis indicated that there were five important risk factors for TS: family history, family conflict, type of family education, low level of parental education and maternal smoking. CONCLUSIONS: Both heredity and environment are involved in the pathogenesis of TS. The mode of inheritance for TS is polygenic. Improving the living environments of children with a family history of TS is of prime importance.