Hounie Ana Gabriela, Pauls David L, do Rosario-Campos Maria Conceição, Mercadante Marcos Tomanik, Diniz Juliana Belo, De Mathis Maria Alice, De Mathis Maria Eugênia, Chacon Priscila, Shavitt Roseli Gedanke, Curi Mariana, Guilherme Luiza, Miguel Eurípedes Constantino
Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
Biol Psychiatry. 2007 Feb 1;61(3):266-72. doi: 10.1016/j.biopsych.2006.02.021. Epub 2006 Apr 17.
Obsessive-compulsive spectrum disorders (OCSDs) are more frequent in patients with active or prior rheumatic fever (RF), suggesting that OCSD and RF may share underlying etiologic mechanisms. Our objective was to estimate the frequency of OCSD in first-degree relatives (FDRs) of RF patients and controls to determine whether there is a familial relationship between OCSD and RF.
This is a case-control family study. Of the 98 probands included in this study, 31 had RF without Sydenham's chorea (SC) and had 131 relatives, 28 had RF with SC and had 120 relatives, and 39 were controls without RF. All probands, 87.9% of the RF FDRs and 93.7% of the control FDRs were assessed directly with structured psychiatric interviews and best-estimate diagnoses were assigned. Odds ratios of morbid risks were estimated using logistic regression by the generalized estimating equations (GEE) method and compared between groups.
The rate of OCSDs was significantly higher among FDRs of RF probands than among FDRs of controls (n=37; 14.7% vs. n=10; 7.3%, i=.0279). A diagnosis of OCSDs in an RF proband was associated with a higher rate of OCSDs among FDRs when compared to control FDRs (p-GEE=.02). There was a trend for a higher rate of OCSDs among FDRs of RF probands presenting no OCSD, although the difference was not significant (p-GEE=.09).
The results are consistent with the hypothesis that a familial relationship exists between OCSD and RF, since an OCSD in the RF proband was found to increase the risk of OCSDs among FDRs. Additional neuroimmunological and genetic studies involving larger samples are needed to further elucidate this apparent familial relationship between RF and OCSD.
强迫谱系障碍（OCSDs）在患有活动性或既往风湿热（RF）的患者中更为常见，这表明OCSD和RF可能共享潜在的病因机制。我们的目的是估计RF患者和对照组的一级亲属（FDRs）中OCSD的发生率，以确定OCSD和RF之间是否存在家族关系。
这是一项病例对照家庭研究。在本研究纳入的98名先证者中，31名患有无Sydenham舞蹈病（SC）的RF，有131名亲属，28名患有伴SC的RF，有120名亲属，39名是无RF的对照组。所有先证者、87.9%的RF FDRs和93.7%的对照FDRs均通过结构化精神科访谈直接评估，并给出最佳估计诊断。使用广义估计方程（GEE）方法通过逻辑回归估计患病风险的比值比，并在组间进行比较。
RF先证者的FDRs中OCSDs的发生率显著高于对照组的FDRs（n = 37；14.7%对n = 10；7.3%，P = 0.0279）。与对照FDRs相比，RF先证者中OCSDs的诊断与FDRs中OCSDs的较高发生率相关（P - GEE = 0.）。在无OCSD的RF先证者的FDRs中，OCSDs的发生率有升高趋势，尽管差异不显著（P - GEE = 0.09）。
结果与OCSD和RF之间存在家族关系的假设一致，因为发现RF先证者中的OCSD会增加FDRs中OCSDs的风险。需要进行更多涉及更大样本的神经免疫学和遗传学研究，以进一步阐明RF和OCSD之间这种明显的家族关系。
