父母超重/肥胖与子代孤独症谱系障碍的关系

目的 探讨母孕前父母超重/肥胖与子代孤独症谱系障碍（ASD）发生的关系。方法 选取ASD儿童36名（ASD组）及性别、年龄与之相匹配的72名正常儿童（对照组）纳入研究。采用问卷调查的方式收集母亲孕前两组儿童父母身高、体重以及母亲孕期增重等信息,采用单因素和多因素logistic回归法分析母孕前父母超重/肥胖与子代ASD的关系。结果 ASD组母孕前父亲超重/肥胖的检出率高于对照组（56% vs 32%,P=0.018）。单因素和多因素logistic回归分析均显示母孕前父亲超重/肥胖是子代发生ASD的危险因素（分别OR=2.66、2.58,P < 0.05）。结论 母孕前父亲超重/肥胖是子代罹患ASD的独立危险因素,因此在母亲妊娠前,父亲的体重指数应控制在正常范围内,以减少子代ASD的发生。     

母亲妊娠糖尿病与子代孤独症谱系障碍发生风险的关联分析

目的 探讨母亲妊娠糖尿病暴露与子代孤独症谱系障碍（autism spectrum disorder,ASD）发生的关联。方法 采用病例对照研究方法,招募221例ASD儿童与400例健康儿童纳入研究。采用问卷调查及访谈形式收集儿童一般情况、家庭社会经济学特征、母亲孕产史、母亲孕期疾病暴露等情况,采用多因素logistic回归分析探讨母亲妊娠糖尿病暴露与子代ASD发生的关联,并探讨子代性别和妊娠糖尿病暴露对子代ASD的发生是否存在交互作用。结果 ASD组母亲妊娠糖尿病患病比例显著高于对照组（16.3% vs 9.4%,P=0.014）。校正性别、胎龄情况、出生方式、产次、母亲文化程度等变量后,母亲妊娠糖尿病暴露是子代ASD发生的危险因素（OR=2.18,95%CI:1.04～4.54,P=0.038）;在校正以上变量的基础上,进一步校正孕早期复合维生素服用、孕前3个月叶酸服用和辅助生殖等变量后,结果趋势未发生改变,但未见统计学意义（OR=1.94,95%CI:0.74～5.11,P=0.183）。妊娠糖尿病暴露与子代性别对子代ASD的发生存在交互作用（P<0.001）;性别分层分析显...     

影响足月儿发生呼吸窘迫综合征相关因素的Logistic回归分析

目的探讨影响足月儿发生呼吸窘迫综合征(RDS)的危险因素。方法选择本院RDS足月儿为病例组,同期住院健康足月儿为健康对照组。对2组儿童出生体质量、胎龄、性别、分娩方式、是否多胎、是否有产时窒息和宫内窘迫、母亲是否有糖尿病、是否有脐带绕颈因素进行单因素方差分析和多因素Logistic回归分析。结果单因素方差分析结果显示,影响足月儿发生RDS的因素包括男童、剖宫产、出生体质量、母亲有糖尿病、宫内窘迫、产时窒息、脐带绕颈。多因素非条件Logistic回归分析结果提示男童、剖宫产、出生体质量、母亲有糖尿病、宫内窘迫与足月儿RDS的发生密切相关。结论男童、剖宫产、母亲有糖尿病、宫内窘迫是足月儿发生RDS的危险因素,而高出生体质量是足月儿发生RDS的保护因素。     

父亲生育年龄与儿童孤独症谱系障碍的相关性北大核心CSCD

目的探讨父亲生育年龄与子代孤独症谱系障碍(autism spectrum disorder,ASD)的相关性。方法该研究为横断面研究,选取2016年8月至2017年3月在广州、佛山、北京、武汉、杭州、重庆的6家医院儿童保健科确诊的71例ASD儿童,以及年龄、性别和母亲生育年龄与ASD儿童匹配的284例正常发育儿童为研究对象。采用自编问卷调查收集社会人口学信息、母亲孕期及分娩等情况,采用logistic回归分析探讨父亲生育年龄与子代ASD发生的相关性。结果控制社会人口学因素、母亲孕期及分娩相关因素后,logistic回归分析显示较大的父亲生育年龄与子代患ASD风险增加显著相关(OR=1.12,95%CI:1.02~1.23,P<0.05)。将父亲生育年龄分组进一步分析,显示父亲生育年龄≥40岁与子代患ASD风险增加显著相关(调整前OR=7.08,95%CI:1.77~28.32,P<0.05;调整后OR=8.50,95%CI:1.71~42.25,P<0.05)。结论父亲生育年龄过大与子代患ASD风险升高显著相关,父亲生育年龄≥40岁为子代患ASD的高危年龄段。[中国当代儿科杂志,2022,24(8):863-868]     

象征性游戏在孤独症谱系障碍早期识别诊断中的作用

目的探索孤独症谱系障碍(ASD)儿童象征性游戏能力的影响因素,及其在疾病早期识别与诊断中的应用。方法回顾2015年4月到2017年8月就诊的123例发育行为儿保科门诊儿童的临床资料,其中66例发育迟缓(GDD)儿童包括ASD伴GDD 36例、单纯GDD 30例,57例不伴GDD儿童包括ASD不伴GDD 31例、原发性语言障碍(DLD)26例。比较各组间象征性游戏能力和Gesell婴幼儿发育水平,并探究象征性游戏能力的相关因素及对疾病的区分作用。结果在GDD儿童中,ASD伴GDD组象征性游戏检查(SPT)发展月龄低于单纯GDD组,且SPT发展月龄严重落后比例高于单纯GDD组。不伴GDD儿童中,ASD不伴GDD组SPT发展月龄低于DLD组,SPT发展月龄严重落后比例也高于DLD组;差异均有统计学意义(P0.05)。在ASD儿童中,象征性游戏能力与儿童各能区的发育水平呈显著正相关(r=0.393~0.630,P0.01),与ASD症状呈显著负相关(r=-0.390~-0.387,P0.01)。二项逻辑回归分析发现,在GDD儿童中SPT发展月龄对单纯GDD和ASD伴GDD两类疾病具有区分效应(OR=0.39,95%CI:0.745~0.992,P=0.034);在不伴GDD的儿童中区分效应无显著性(P0.05)。结论象征性游戏能力在ASD儿童中落后于发育水平相当的GDD和DLD儿童,且象征性游戏能显著区分伴有GDD的ASD,可为ASD早期识别提供线索。     

维生素D与孤独症谱系障碍的关系

孤独症谱系障碍（ASD）是一种复杂的与多个遗传和环境危险因素有关的神经发育障碍。过去几年遗传和环境因素间相互作用已成为研究的热点。最近提出了维生素D缺乏可能是ASD的一个环境危险因素。维生素D在维持大脑内稳态、促进胚胎和神经发育、免疫调节（包括大脑自身的免疫系统）、抗氧化、抗凋亡、影响神经分化及基因调控方面都有独特的作用。多项研究表明ASD患儿血清中维生素D浓度相比健康儿童存在显著降低。因此,母孕期和儿童早期缺乏维生素D可能是引起ASD的环境危险因素之一。     

孤独症谱系障碍发病影响因素研究

目的通过对比分析孤独症谱系障碍(ASD)儿童和正常儿童的健康影响因素差异,进一步探索儿童ASD的发病因素,为ASD防治提供参考依据。方法采用1∶1病例对照研究回顾性调查2014年5月至2015年5月辽宁省锦州市妇婴医院诊治的196例ASD儿童和体检正常的非ASD儿童,填写自拟健康影响因素调查问卷,对比分析两组儿童发育指标及影响因素差异。结果两组间平均身高、体重差异无统计学意义(P0.05),ASD组儿童头围大于对照组,差异有统计学意义(t=2.41,P=0.02)。条件Logistic回归分析显示儿童一眼识别理解能力(β=-3.077)、头围(β=0.341)差异均有统计学意义(P均0.05)。母亲生育年龄35岁、家庭关系、有家族神经障碍类疾病史、父亲从事劳动类型等变量回归系数检验均有统计学意义(P均0.05),与疾病发生有关联;孕期情绪急躁易怒(β=1.966,OR=7.144)、精神刺激(β=2.067,OR=7.902)和妊娠呕吐(β=2.576,OR=13.138)等因素与疾病发生呈正向相关(P均0.05);而补充营养品(β=-2.435,OR=0.088)、胎动正常(β=-2.008,OR=0.134)与ASD呈负向关联(P均0.05)。结论母亲年龄超过35岁、父亲从事体力劳动、家庭关系紧张、有家族神经障碍疾病史、精神刺激、孕期情绪暴躁、妊娠呕吐等因素可能是ASD发病的危险因素;而母亲在35岁前生育、孕期及时补充营养品、保持心情愉悦,同时在儿童生长发育过程中注意与其语言交流、监测头围正常,保持家庭和谐,增加对儿童的陪伴在一定程度上能降低ASD的发生。     

6~12月龄婴儿缺铁性贫血的危险因素分析及对神经心理发育的影响

目的 探讨6~12月龄婴儿中、重度缺铁性贫血(IDA)的危险因素,并初步了解IDA对婴儿神经运动发育的影响及其气质特点。方法 326例6~12月龄IDA患儿为研究对象,按贫血程度分为轻度(176例)、中度(111例)、重度(39例)组 ,采用多因素logistic回归分析对中、重度IDA的危险因素进行调查。另选取同期年龄、性别等背景相匹配的346例非IDA儿童作为对照组。IDA和对照组两组均使用儿童Gesell婴幼儿发育量表、气质量表进行智能发育及气质的评估。结果 单因素分析显示,性别、出生体重、胎龄、多胎、母亲孕期贫血、母亲缺乏IDA相关知识与贫血程度有关(P< 0.05)。以轻度IDA组为对照,多因素logistic回归分析显示,多胎、早产、低出生体重(< 2 500 g)、母亲孕期贫血、母乳喂养、母亲缺乏IDA相关知识是重度贫血的危险因素(OR> 1,P< 0.05);早产,母乳喂养、混合喂养是中度贫血的危险因素(OR> 1,P< 0.05)。IDA组Gesell总发育商、大运动、适应行为、精细动作得分较对照组低(P< 0.05)。IDA组难养型及中间偏难养型气质的比例较高(P< 0.05)。IDA组活动水平、节律性、适应性、坚持性维度得分较对照组高(P< 0.05)。结论 早产、多胎、低出生体重、喂养方式、母亲孕期贫血及母亲缺乏IDA相关知识与6~12月龄婴儿IDA贫血程度相关。IDA患儿神经运动发育落后,消极气质类型居多,需加强对患儿心理行为问题的重视,指导家长选择恰当的喂养及教育方式。     

福州市学龄前儿童单纯性肥胖患病率调查及高危因素分析

目的 调查福州市学龄前儿童单纯性肥胖患病率及高危因素。方法 分层整群随机抽取福建省福州市14所幼儿园体检数据,统计单纯性肥胖检出率。按1：1病例对照方法选择体重正常儿童为对照组。采用自制问卷表及多因素logistic回归分析对可能与儿童单纯性肥胖发生相关的因素进行调查与分析。结果 共纳入5 767例3~6岁儿童,单纯性肥胖检出率为5.01%（289例）,其中轻度肥胖153例,中重度肥胖136例。随着年龄增加,儿童单纯性肥胖检出率逐步增加。多因素logistic回归分析显示,偏爱油炸食品（OR=4.789）、养育者过度关注饮食（OR=4.620）、睡前进食（OR=4.006）、进食快（OR=3.221）、偏爱甜食（OR=2.282）、出生体重大（OR=2.202）、父亲超重或肥胖（OR=2.074）、母亲超重或肥胖（OR=2.047）、进食量超过同龄20%以上（OR=2.013）、爱看电视（OR=1.665）、运动不足（OR=1.463）等是引起学龄前儿童单纯性肥胖的独立危险因素（均P < 0.05）。结论 福州市学龄前儿童单纯性肥胖的患病率为5.01%,其发病受诸多因素影响,提示需要在医生、家长和老师的共同参与下,加强学龄前儿童健康教育、培养儿童良好生活习惯和饮食习惯、增强体育锻炼等多途径综合干预,以降低学龄前儿童单纯性肥胖的发生。     

影响新生儿出生体质量的多因素分析

目的了解新生儿出生体质量的影响因素。方法采取随机整群抽样方法收集北京、哈尔滨、长沙及广州4个城市5 539例单胎活产新生儿出生体质量及相关数据,运用单因素分析及多元Logistic回归分析,筛选新生儿出生体质量的影响因素。结果单因素分析显示,新生儿性别和胎龄,母亲产次、年龄、妊娠前体质指数(BMI)、孕期增加体质量、文化程度和职业8个因素对新生儿出生体质量有影响。采用Logistic回归分析发现,胎儿为男性(OR=2.13)、母亲年龄≥25岁(OR=3.30)、母亲妊娠前BMI≥24.0 kg/m2(OR=3.77)、母亲孕期体质量增加≥12.5 kg(OR=1.64)为巨大儿发生的危险因素;而母亲妊娠前BMI18.5 kg/m2(OR=2.25)、早产(OR=16.43)是低出生体质量儿发生的危险因素。结论早产、孕期体质量增加过多、母亲孕前BMI偏高或偏低是导致异常出生体质量发生的主要因素。     

Perinatal risk factors interacting with catechol O‐methyltransferase and the serotonin transporter gene predict ASD symptoms in children with ADHD

Background: Symptoms of autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) often co‐occur. Given the previously found familiality of ASD symptoms in children with ADHD, addressing these symptoms may be useful for genetic association studies, especially for candidate gene findings that have not been consistently replicated for ADHD. Methods: We studied the association of the catechol O‐methyltransferase (COMT) Val158Met polymorphism and the serotonin transporter (SLC6A4/SERT/5‐HTT) 5‐HTTLPR insertion/deletion polymorphism with ASD symptoms in children with ADHD, and whether these polymorphisms would interact with pre‐ and perinatal risk factors, i.e., maternal smoking during pregnancy and low birth weight. Analyses were performed using linear regression in 207 Dutch participants with combined type ADHD of the International Multicenter ADHD Genetics (IMAGE) study, and repeated in an independent ADHD sample (n = 439) selected from the TRracking Adolescents’ Individual Lives Survey (TRAILS). Dependent variables were the total and subscale scores of the Children’s Social Behavior Questionnaire (CSBQ). Results: No significant main effects of COMT Val158Met, 5‐HTTLPR, maternal smoking during pregnancy and low birth weight on ASD symptoms were found. However, the COMT Val/Val genotype interacted with maternal smoking during pregnancy in increasing stereotyped behavior in the IMAGE sample (p = .008); this interaction reached significance in the TRAILS sample after correction for confounders (p = .02). In the IMAGE sample, the 5‐HTTLPR S/S genotype interacted with maternal smoking during pregnancy, increasing problems in social interaction (p = .02), and also interacted with low birth weight, increasing rigid behavior (p = .03). Findings for 5‐HTTLPR in the TRAILS sample were similar, albeit for related CSBQ subscales. Conclusions: These findings suggest gene–environment interaction effects on ASD symptoms in children with ADHD.     

Sex-specific differences in birth weight due to maternal smoking during pregnancy

Introduction We investigated the sex-specific risk of maternal smoking during pregnancy on the birth weight and the proportion of small-for-gestational-age (SGA) newborns in 888,632 (49.9%) of 1,815,318 singleton births (ca. 80% of all singleton births in Germany from 1995 to 1997) in whom data on maternal cigarette consumption were available.Results and discussion Newborns below the 10th percentile for weight and duration of pregnancy were classified SGA. Maternal smoking during pregnancy lowers the mean birth weight and increases the risk of SGA newborns. The negative effect depends on the daily number of cigarettes consumed, and is greater in girls than in boys. In non-smokers, 9.8% of the newborns were SGA, with a sex-ratio of females:males=1, but this percentage increased with increasing number of cigarettes consumed (p<0.001), as did the sex-ratio, i.e. the negative effect of smoking on growth was greater in girls than in boys. In mild smokers (1–5 cigarettes/day), the risk of giving birth to an SGA girl was 1.7275-fold (95% CI: 1.7266–1.7284) above normal, but was 1.7143-fold (95% CI: 1.7137–1.7150) in boys. More than 21 cigarettes/day increased the risk of SGA 3.15-fold for a boy, but 3.51-fold for a girl (p<0.001).Conclusion In conclusion, particularly in heavy smokers, the negative effect of maternal smoking during pregnancy on the mean birth weight and risk of SGA is significantly greater in newborn girls than in newborn boys.     

维吾尔族和汉族足月新生儿低出生体重发生的危险因素比较

目的 比较维吾尔族(简称维族)和汉族足月新生儿低出生体重(LBW)发生的危险因素的不同,为预防和控制LBW 的发生提供依据.方法 2013 年3 月至2014 年6 月间足月LBW 新生儿 87 例为病例组(汉族38 例,维族49 例),同期足月正常体重儿186 例为对照组(汉族92 例,维族94 例),进行"低出生体重可能的环境危险因素"问卷调查,并采用多因素logistic 回归分析比较维汉族新生儿LBW 发生的危险因素.结果 维族LBW 新生儿出生体重低于汉族(P<0.05).多因素logistic 回归分析显示,父亲饮酒(OR=2.472,P=0.015)、吸烟(OR=2.323,P=0.007)、母孕期并发症(OR=14.377,P<0.001)、孕次(OR=2.995,P=0.001) 是汉族新生儿LBW 发生的危险因素; 父亲饮酒(OR=1.968,P=0.007)、母孕次(OR=1.953,P=0.005)、母孕期并发症(OR=10.283,P=0.002)、室内环境不良(OR=1.367,P=0.027)是维族新生儿LBW发生的危险因素.结论 维族和汉族足月LBW 新生儿的体格发育状况有差异.维汉族新生儿LBW 的发生在传统因素,如父亲饮酒等不良行为、孕母孕次和孕期并发症等上比较一致,但室内环境因素在维族新生儿LBW 的发生中也起了作用.     

Epidemiological and genetic characteristics associated with the severity of acute viral bronchiolitis by respiratory syncytial virus

Objectiveto assess the epidemiological and genetic factors associated with severity of acute viral bronchiolitis (AVB) by respiratory syncytial virus (RSV).Data sourcethe key words “bronchiolitis”, “risk factor”, “genetics” and “respiratory syncytial virus”, and all combinations among them were used to perform a search in the PubMed, SciELO, and Lilacs databases, of articles published after the year 2000 that included individuals younger than 2 years of age.Data synthesisa total of 1,259 articles were found, and their respective summaries were read. Of these, 81 were selected, which assessed risk factors for the severity of AVB, and were read in full; the 60 most relevant studies were included. The epidemiologic factors associated with AVB severity by RSV were prematurity, passive smoking, young age, lack of breastfeeding, chronic lung disease, congenital heart disease, male gender, ethnicity, viral coinfection, low weight at admission, maternal smoking during pregnancy, atopic dermatitis, mechanical ventilation in the neonatal period, maternal history of atopy and/or asthma during pregnancy, season of birth, low socioeconomic status, Down syndrome, environmental pollution, living at an altitude > 2,500 meters above sea level, and cesarean section birth. Conversely, some children with severe AVB did not present any of these risk factors. In this regard, recent studies have verified the influence of genetic factors on the severity of AVB by RSV. Polymorphisms of the TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs, and VDR genes have been shown to be associated with more severe evolution of AVB by RSV.Conclusionthe severity of AVB by RSV is a phenomenon that depends on the varying degrees of interaction among epidemiological, environmental, and genetic variables.     

来曲唑治疗特发性中枢性性早熟男童的临床观察

目的 对骨龄大于13岁、身高偏矮小的中枢性性早熟（ICCP）男童应用来曲唑（letrozole）治疗,观察该治疗方案对延缓骨龄老化和改善成年预测身高的效果和不良反应。方法 将骨龄大于13岁的ICCP男童20例随机分为2组,每组10例,一组予来曲唑口服治疗6个月[2.5 mg/（m2·d）,Qd];另一组为对照组,定期观察,不予特殊治疗。观察两组男童骨龄、生长速度、身高标准差积分、预测成年身高标准差积分、性征发育情况及性激素水平的变化。并观察来曲唑治疗相关不良反应。结果 试验开始6个月后,来曲唑组和对照组男童骨龄均显著增加,但来曲唑组男童骨龄增长（13.82±0.23岁）较对照组男童（14.47±0.30岁）明显缓慢（PPP结论 对骨龄超过13岁、身高受损显著的ICCP男童应用来曲唑能够有效减缓骨龄老化,改善预测成年身高,且未见明显不良反应。     

Wheeze associated with prenatal tobacco smoke exposure: a prospective, longitudinal study. ALSPAC Study Team

AIMS—To determine whether maternal smoking during pregnancy is a risk factor for reported wheeze in early childhood that is independent of postnatal environmental tobacco smoke (ETS) exposure and other known risk factors.METHODS—A total of 8561 mothers and infants completed questions about smoking during pregnancy, ETS exposure, and the mother''s recall of wheeze during early childhood.RESULTS—A total of 1869 (21.8%) children had reported wheeze between 18 and 30 months of age, and 3496 (40.8%) had reported wheeze in one or more of the three study periods (birth to 6 months, 6-18 months, 18-30 months). The risk of wheeze between 18 and 30 months of age was higher if the mother smoked during pregnancy. This relation did not show a dose-response effect and became less obvious after adjustment for the effects of other factors. Average daily duration of ETS exposure reported at 6 months of age showed a dose-response effect and conferred a similar risk of reported wheeze. Factors associated with early childhood wheeze had the following adjusted odds ratios: maternal history of asthma 2.03(1.74 to 2.37); preterm delivery 1.66 (1.30 to 2.13); male sex 1.42 (1.28 to 1.59); rented accommodation 1.29 (1.11 to 1.51); and each additional child in household 1.13 (1.04 to 1.24).CONCLUSIONS—Maternal smoking during pregnancy may be a risk factor for reported wheeze during early childhood that is independent of postnatal ETS exposure. For wheeze between 18 and 30 months of age, light smoking during the third trimester of pregnancy appears to confer the same risk as heavier smoking.     

学龄双生子儿童心理行为问题及其影响因素

目的探讨影响学龄双生子儿童心理行为问题的因素,为减少其心理行为问题的发生提供依据。方法采用Achenbach儿童行为量表(CBCL)对内蒙古呼和浩特市147对6~12岁学龄双生子心理行为问题进行调查,运用家庭亲密度与适应性量表(FACESⅡ-CV)和家庭一般情况问卷了解儿童生活环境因素。结果学龄双生子心理行为问题检出率为24.1%,单项行为问题中思维问题检出率(15.3%)最高,身体不适检出率(3.4%)最低。多因素logistic回归分析显示,是否足月产对退缩行为的发生及CBCL总粗分有显著影响(P0.05),气质类型对思维问题的发生及心理行为问题总检出率有显著影响(P0.05),父亲生育年龄对思维问题的发生有显著影响(P0.05),家庭亲密度对违纪行为的发生有显著影响(P0.05),家庭适应性对思维问题的发生有显著影响(P0.05),家庭教养方式对社会化问题的发生有显著影响(P0.05)。结论儿童气质类型、是否足月产、父亲生育年龄、家庭亲密度、适应性及教养方式是影响学龄双生子心理行为问题的主要因素。     

早产儿坏死性小肠结肠炎围产高危因素的病例对照研究

目的 分析胎龄小于33周早产儿坏死性小肠结肠炎（NEC）发病时间及围产高危因素。方法 回顾性分析2010年10月至2012年12月收治的49例胎龄小于33周早产儿NEC的发病时间,通过logistic 回归分析NEC的围产高危因素。以确诊NEC的49例患儿为NEC组,121例非NEC早产儿为对照组,进行病例对照研究。结果 49例NEC患儿发病日龄中位数为17.5 d（范围3~106 d）。性别、小于胎龄儿、出生方式、产前应用激素等对NEC发病无影响,而小胎龄、低出生体重和新生儿窒息可增加NEC发病风险,其中小胎龄是NEC发病的独立高危因素。结论 胎龄小于33周早产儿NEC发病主要与胎龄小有关;发病日龄中位数为17.5 d。