Lochner Christine, Hemmings Sian M J, Kinnear Craig J, Moolman-Smook Johanna C, Corfield Valerie A, Knowles James A, Niehaus Dana J H, Stein Dan J
MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, Cape Town, South Africa.
Eur Neuropsychopharmacol. 2004 Oct;14(5):437-45. doi: 10.1016/j.euroneuro.2004.05.002.
There is increasing recognition that obsessive-compulsive disorder (OCD) is not a homogeneous entity. It has been suggested that gender may contribute to the clinical and biological heterogeneity of OCD.
Two hundred and twenty patients (n=220; 107 male, 113 female) with DSM-IV OCD (age: 36.40 +/- 13.46) underwent structured interviews. A subset of Caucasian subjects (n=178), including subjects from the genetically homogeneous Afrikaner population (n=81), and of matched control subjects (n=161), was genotyped for polymorphisms in genes involved in monoamine function. Clinical and genetic data were statistically analyzed across gender.
Compared with females, males with OCD (1) had an earlier age of onset, and a trend toward having more tics and worse outcome, (2) had somewhat differing patterns of OCD symptomatology and axis I comorbidity, and (3) in the Caucasian group, were more likely to have the high activity T allele of the EcoRV variant of the monoamine oxidase A (MAO-A) gene compared to controls, and (4) in the Afrikaner subgroup, were more frequently homozygous for the G allele at the G861C variant of the 5HT1Dbeta gene than controls. Females with OCD (1) reported more sexual abuse during childhood than males, (2) often noted changes in obsessive-compulsive symptoms in the premenstrual/menstrual period as well as during/shortly after pregnancy, and with menopause, and (3) in the Caucasian subgroup, were more frequently homozygous for the low activity C allele of the EcoRV variant of the MAO-A gene compared to controls, with this allele also more frequent in female patients than controls.
This study supports the hypothesis that gender contributes to the clinical and biological heterogeneity of OCD. A sexually dimorphic pattern of genetic susceptibility to OCD may be present. Further work is, however, needed to delineate the mechanisms that are responsible for mediating the effects of gender.
人们越来越认识到强迫症（OCD）并非单一的疾病实体。有研究表明，性别可能导致强迫症在临床和生物学上的异质性。
220例符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的强迫症患者（n = 220；男性107例，女性113例；年龄：36.40±13.46）接受了结构化访谈。对一部分白人受试者（n = 178），包括来自基因同质的阿非利卡人群体的受试者（n = 81），以及匹配的对照受试者（n = 161），进行了参与单胺功能的基因多态性基因分型。对临床和遗传数据按性别进行了统计分析。
与女性相比，患有强迫症的男性（1）起病年龄更早，且有更多抽动症状和更差预后的趋势，（2）强迫症症状学和轴I共病模式略有不同，（3）在白人组中，与对照组相比，更有可能拥有单胺氧化酶A（MAO-A）基因EcoRV变体的高活性T等位基因，（4）在阿非利卡人群亚组中，5HT1Dβ基因G861C变体的G等位基因纯合子频率高于对照组。患有强迫症的女性（1）报告童年期遭受性虐待的情况比男性多，（2）常注意到经前/经期以及孕期/产后不久和绝经期间强迫症状的变化，（3）在白人亚组中，与对照组相比，MAO-A基因EcoRV变体低活性C等位基因的纯合子频率更高。在女性患者中，该等位基因也比对照组更常见。
本研究支持性别导致强迫症临床和生物学异质性的假说。可能存在强迫症遗传易感性的性别二态性模式。然而，需要进一步开展工作来阐明介导性别效应的机制。
