儿童孤独症谱系障碍的环境危险因素研究

Environmental risk factors for autism spectrum disorders in children

摘要:

目的 了解与儿童孤独症谱系障碍(ASD)发病相关的可能环境危险因素。方法 采用病例对照研究的方法,选择诊断为ASD的男童81例、全面发育迟缓(GDD)男童74例及健康体检男童163例作为研究对象,采用自制儿童养育环境调查表记录一般人口学资料、家庭社会经济情况、父母生活习惯及环境接触、母亲孕期健康状况、儿童出生时情况、生后养育环境等资料,运用多因素logistic回归分析法调查ASD和GDD发生的环境危险因素。结果 多因素logistic回归分析显示母亲职业毒物接触、孕期疾病及被动吸烟史、儿童出生地点、出生后第2年户外活动、与同龄儿童交流机会等6项环境危险因素与儿童ASD患病有显著相关性(OR值分别为20.675、3.559、2.422、2.646、23.820、5.081,P<0.05),其中孕期被动吸烟、与同龄儿童交流机会及第2年户外活动3项环境危险因素也与GDD的患病有显著相关性(P<0.05)。结论 母亲职业毒物接触、孕期疾病及儿童出生地点级别低可能是与ASD特异关联的危险因素,而孕期被动吸烟、与同龄儿童交流机会及第2年户外活动少是儿童ASD的非特异性环境危险因素,提示ASD的发生发展可能受基因与环境因素交互作用的影响。

Abstract:

Objective To investigate the environmental risk factors for autism spectrum disorders (ASD) in children. Methods In this case-control study, 81 boys with ASD, 74 boys with global developmental delay (GDD), and 163 healthy boys were enrolled. A self-designed nurturing environment questionnaire was used to record general demographic data, family social-economic status, parents' living habits and environmental exposure, maternal health status during pregnancy, birth situations, and rearing environment after birth. Multivariate logistic regression was used to identify environmental risk factors for ASD and GDD. Results Multivariate logistic regression analysis showed that six environmental risk factors such as maternal occupational toxicant exposure, diseases during pregnancy and a history of passive smoking, children's birth places, the frequency of outdoor activities in the second year after birth, and the opportunities to communicate with other age-matched children were significantly associated with the incidence of ASD (OR=20.67, 3.559, 2.422, 2.646, 23.820, and 5.081, respectively; P<0.05). Among the above six risk factors, passive smoking during pregnancy, the opportunities to communicate with their peers, and the frequency of outdoor activities in the second year after birth were also significantly associated with the incidence of GDD (P<0.05). Conclusions Maternal occupational toxicant exposure, diseases during pregnancy, and low level of children's birth places may be the specific risk factors associated with ASD, and passive smoking during pregnancy, fewer opportunities to communicate with their peers, and fewer outdoor activities in the second year after birth are non-specific risk factors for ASD, indicating that the development of ASD may be influenced by both genes and environmental factors.