本文選題：孤獨癥譜系障礙 + 危險因素　； 參考：《浙江大學》2016年碩士論文

【摘要】：研究背景：兒童孤獨癥譜系障礙(autism spectrum disorder, ASD)是一種童年早期起病的神經發(fā)育障礙性疾病,主要特點為在多種場合下表現的社會-情感交互反應、非語言的交流行為和對人際關系的發(fā)展、維持和理解的障礙以及固定刻板的行為模式或興趣。近20年來ASD的患病率明顯增加,嚴重影響了兒童的身心健康和人口素質,從而引起社會和研究界的普遍關注和重視。因為ASD病因的不確定性,目前尚缺乏針對ASD核心癥狀的有效藥物,主要的治療措施是康復訓練和特殊教育。大量研究表明,兒童ASD可能是易感基因、神經生化、免疫激活、圍生期疾病和環(huán)境因素共同交互作用的結果,但其具體病因及發(fā)病機制仍不是非常清楚[2]。深入了解與兒童ASD發(fā)病相關的可能環(huán)境危險因素,對于該病的預防和早期的干預具有積極作用。研究目的：了解與兒童孤獨癥譜系障礙發(fā)病相關的可能環(huán)境危險因素,為兒童ASD的早期預防及病因學研究提供依據。研究對象與方法：采用病例對照研究的方法,對診斷為ASD的男童81例、全面發(fā)育遲緩(Global Developmental Delay, GDD)男童74例及健康體檢(Typical development, TD)男童163例,采用自制孕-圍產期-出生后養(yǎng)育環(huán)境調查表調查兒童一般人口學情況、家庭基本情況、父母生活習慣及居住環(huán)境、母親孕期健康情況、環(huán)境暴露、兒童出生時情況、生后養(yǎng)育及生活環(huán)境等資料,并進行分析比較。統(tǒng)計學：計量資料用均數±標準差(x±s)表示,計數資料以例數和百分率表示。多組間計量資料的比較采用單因素方差分析；計數資料的比較采用卡方檢驗,組間兩兩比較采用卡方分割法。采用非條件多因素logistic回歸模型分析ASD發(fā)生的環(huán)境危險因素。P0.05為差異有統(tǒng)計學意義。尋找與ASD發(fā)病相關的可能環(huán)境危險因素。研究結果：1.以正常對照組作為參照,母親職業(yè)毒物接觸、孕期疾病及被動吸煙史、兒童出生在縣區(qū)級以下醫(yī)院或家中、出生后第2年戶外活動少、與同齡兒交流機會少與ASD相關,其OR值依次為20.675、3.559、2.422、2.646、23.820、5.081(P0.05)。2.與GDD組兒童比較,ASD組兒童父親文盲或半文盲較少(P0.01)。3.以正常對照組作為參照,父親受教育程度低、母親孕期被動吸煙及孕期陰道感染或出血史、胎兒臍帶異常、新生兒期疾病史、兒童6個月內人工喂養(yǎng)和混合喂養(yǎng)、兒童第2年內戶外活動少及與同齡兒交流機會少與GDD相關(P0.05)。結論：母親職業(yè)毒物接觸、孕期疾病、孕期被動吸煙及低級別分娩地點、兒童與同齡兒交流機會少及第2年戶外活動少均可能是與ASD相關的環(huán)境危險因素；其中,母親職業(yè)毒物接觸、孕期疾病及低級別分娩地點可能與ASD特異關聯,而孕期被動吸煙、兒童與同齡兒交流機會少及第2年戶外活動少可能與兒童ASD非特異關聯,提示ASD可能是易感基因受多種環(huán)境危險因素的作用而發(fā)生發(fā)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 鹵standard deviation x 鹵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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R749.94

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