儿童特应性疾病、抑郁或焦虑的家族聚集性。
The familial aggregation of atopic diseases and depression or anxiety in children.
机构信息
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
出版信息
Clin Exp Allergy. 2018 Jun;48(6):703-711. doi: 10.1111/cea.13127. Epub 2018 Apr 1.
BACKGROUND
Children with asthma and atopic diseases have an increased risk of depression or anxiety. Each of these diseases has strong genetic and environmental components; therefore, it seems likely that there is a shared liability rather than causative risk.
OBJECTIVE
To investigate the existence and nature of familial aggregation for the comorbidity of atopic diseases and depression or anxiety.
METHODS
Participants came from the Childhood and Adolescent Twin Study in Sweden (CATSS), n = 14 197. Current and ever asthma, eczema, hay fever and food allergy were reported by parents. Internalizing disorders were identified using validated questionnaires. Familial co-aggregation analysis compared monozygotic (MZ) twins and same-sex dizygotic (DZ) twins for atopic disease in 1 twin with internalizing disorder in the other to test for genetic liability. Several familial liability candidates were also tested including parental education, recent maternal psychological stress, childhood family trauma and parental country of birth.
RESULTS
Familial co-aggregation analysis found that if 1 twin had at least 1 current atopic disease the partner twin was at risk of having an internalizing disorder regardless of their own atopic status (adjusted OR 1.22 (95% CI 1.08, 1.37). Similar results were found for each atopic disease ever and current. MZ associations were not higher than DZ associations, suggesting that the liability is not genetic in nature. Including other familial candidates to the models made little difference to effect estimates.
CONCLUSIONS AND CLINICAL RELEVANCE
Atopic diseases and depression or anxiety tend to occur together in families; therefore, when treating for 1 disease, the physician should consider comorbidity in both the individual and the individual's siblings. We did not find evidence to support a genetic explanation for comorbidity, and further exploration is needed to disentangle the environmental and epigenetic reasons for familial aggregation.
背景
患有哮喘和特应性疾病的儿童患抑郁症或焦虑症的风险增加。这些疾病每一种都有很强的遗传和环境因素；因此，似乎存在共同的易感性，而不是因果风险。
目的
研究特应性疾病与抑郁或焦虑共病的家族聚集的存在和性质。
方法
参与者来自瑞典儿童和青少年双胞胎研究（CATSS），n=14197。父母报告当前和曾经的哮喘、湿疹、花粉症和食物过敏。使用经过验证的问卷识别内化障碍。对同卵（MZ）双胞胎和同性别异卵（DZ）双胞胎进行家族性聚集分析，以比较 1 对双胞胎中 1 对患有特应性疾病，另 1 对患有内化障碍，以测试遗传易感性。还测试了几个家族易感性候选因素，包括父母教育、近期母亲心理压力、儿童期家庭创伤和父母的出生国。
结果
家族聚集分析发现，如果 1 对双胞胎中至少有 1 对当前患有特应性疾病，那么双胞胎的伴侣患内化障碍的风险增加，而不论其自身的特应性状况如何（调整后的 OR 1.22（95%CI 1.08，1.37）。对于每种既往和当前的特应性疾病，都得到了类似的结果。MZ 关联并不高于 DZ 关联，表明这种易感性不是遗传性质的。将其他家族候选因素纳入模型对效应估计影响不大。
结论和临床相关性
特应性疾病和抑郁或焦虑在家庭中往往同时发生；因此，在治疗 1 种疾病时，医生应考虑个体和个体兄弟姐妹的共病情况。我们没有发现证据支持共病的遗传解释，需要进一步探索以厘清家族聚集的环境和表观遗传原因。
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