Choi Wooseok, Hong Soon-Beom, Kim Johanna Inhynag, Lee Jung, Jang Soomin, Ahn Yebin D, Lim You Bin, Kim Sumin, Oh Mee Rim, Kim Bung-Nyun
Department of Psychiatry, Seoul National University Hospital, Seoul, Korea.
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea.
J Korean Acad Child Adolesc Psychiatry. 2023 Jan 1;34(1):37-44. doi: 10.5765/jkacap.220024.
Tic disorders are highly heritable; however, growing evidence suggests that environmental factors play a significant role in their pathogenesis. Studies on these factors have been inconsistent, with conflicting results. Therefore, this study aimed to examine the associations of pre- and perinatal exposure to Tourette syndrome (TS) or chronic tic disorders (CTD) in Korean school-aged children.
This case-control study used data from a large prospective cohort study. The primary outcome was TS/CTD diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. Demographic, pre-, and perinatal information was obtained from the maternal questionnaires. Data between the TS/CTD and control groups were compared using the chi-squared or Student's t-test, as appropriate. Two-step logistic regression analyses were used to test the association between TS/CTD and pre- and perinatal risk factors.
We included of 223 children (78 with TS/CTD and 145 controls). Significant differences in the demographic data between the two groups were observed. The male sex ratio, mean parental age, parental final education level, and family history of tics were included as confounders. In the final adjusted multivariable model, TS/CTD was significantly associated with antiemetic exposure during pregnancy (odds ratio [OR]=16.61, 95% confidence interval [CI] 1.49-185.22, p=0.02) and medically assisted reproduction (OR=7.89, 95% CI 2.28-27.28, p=0.01).
Antiemetic exposure and medically assisted reproduction are significantly associated with the risk of TS/CTD. These results should be replicated in future prospective and gene-by-environment studies.
抽动障碍具有高度遗传性；然而，越来越多的证据表明环境因素在其发病机制中起重要作用。对这些因素的研究结果并不一致，相互矛盾。因此，本研究旨在探讨韩国学龄儿童产前和围产期暴露于抽动秽语综合征（TS）或慢性抽动障碍（CTD）的相关性。
本病例对照研究使用了一项大型前瞻性队列研究的数据。主要结局是根据《精神疾病诊断与统计手册》第5版（DSM-5）标准以及《儿童情感障碍和精神分裂症量表-目前和终生版-韩语版》诊断的TS/CTD。人口统计学、产前和围产期信息通过母亲问卷获得。TS/CTD组与对照组的数据根据情况使用卡方检验或学生t检验进行比较。采用两步逻辑回归分析来检验TS/CTD与产前和围产期危险因素之间的关联。
我们纳入了223名儿童（78名患有TS/CTD，145名作为对照）。观察到两组之间的人口统计学数据存在显著差异。将男性性别比例、父母平均年龄、父母最终教育水平和抽动家族史作为混杂因素。在最终调整的多变量模型中，TS/CTD与孕期使用止吐药（优势比[OR]=16.61，95%置信区间[CI]1.49-185.22，p=0.02）和辅助生殖（OR=7.89，95%CI 2.28-27.28，p=0.01）显著相关。
孕期使用止吐药和辅助生殖与TS/CTD风险显著相关。这些结果应在未来的前瞻性研究和基因-环境研究中得到重复验证。
