出生窒息与热性惊厥对自闭症谱系障碍的相加交互作用：一项基于人群的研究。
Additive interaction between birth asphyxia and febrile seizures on autism spectrum disorder: a population-based study.
机构信息
Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
出版信息
Mol Autism. 2024 Apr 10;15(1):17. doi: 10.1186/s13229-024-00596-3.
BACKGROUND
Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder that can significantly impact an individual's ability to socially integrate and adapt. It's crucial to identify key factors associated with ASD. Recent studies link both birth asphyxia (BA) and febrile seizures (FS) separately to higher ASD prevalence. However, investigations into the interplay of BA and FS and its relationship with ASD are yet to be conducted. The present study mainly focuses on exploring the interactive effect between BA and FS in the context of ASD.
METHODS
Utilizing a multi-stage stratified cluster sampling, we initially recruited 84,934 Shanghai children aged 3-12 years old from June 2014 to June 2015, ultimately including 74,251 post-exclusion criteria. A logistic regression model was conducted to estimate the interaction effect after controlling for pertinent covariates. The attributable proportion (AP), the relative excess risk due to interaction (RERI), the synergy index (SI), and multiplicative-scale interaction were computed to determine the interaction effect.
RESULTS
Among a total of 74,251 children, 192 (0.26%) were diagnosed with ASD. The adjusted odds ratio for ASD in children with BA alone was 3.82 (95% confidence interval [CI] 2.42-6.02), for FS alone 3.06 (95%CI 1.48-6.31), and for comorbid BA and FS 21.18 (95%CI 9.10-49.30), versus children without BA or FS. The additive interaction between BA and FS showed statistical significance (P < 0.001), whereas the multiplicative interaction was statistically insignificant (P > 0.05).
LIMITATIONS
This study can only demonstrate the relationship between the interaction of BA and FS with ASD but cannot prove causation. Animal brain experimentation is necessary to unravel its neural mechanisms. A larger sample size, ongoing monitoring, and detailed FS classification are needed for confirming BA-FS interaction in ASD.
CONCLUSION
In this extensive cross-sectional study, both BA and FS were significantly linked to ASD. The coexistence of these factors was associated with an additive increase in ASD prevalence, surpassing the cumulative risk of each individual factor.
背景
自闭症谱系障碍（ASD）是一种普遍的神经发育障碍，会显著影响个体的社交融合和适应能力。识别与 ASD 相关的关键因素至关重要。最近的研究分别将出生窒息（BA）和热性惊厥（FS）与更高的 ASD 患病率联系起来。然而，BA 和 FS 之间相互作用及其与 ASD 之间关系的研究仍有待开展。本研究主要关注在 ASD 背景下探索 BA 和 FS 之间的交互作用。
方法
我们采用多阶段分层聚类抽样，于 2014 年 6 月至 2015 年 6 月期间，最初招募了 84934 名年龄在 3-12 岁的上海儿童，最终排除了 84934 名儿童。在控制相关协变量后，采用 logistic 回归模型估计交互作用。计算归因比例（AP）、交互超额相对风险（RERI）、协同指数（SI）和乘法交互作用来确定交互作用。
结果
在总共 74251 名儿童中，有 192 名（0.26%）被诊断为 ASD。BA 单独的 ASD 调整后比值比为 3.82（95%置信区间 [CI] 2.42-6.02），FS 单独为 3.06（95%CI 1.48-6.31），BA 和 FS 共病为 21.18（95%CI 9.10-49.30），与无 BA 或 FS 的儿童相比。BA 和 FS 之间的相加交互作用具有统计学意义（P < 0.001），而乘法交互作用无统计学意义（P > 0.05）。
局限性
本研究只能证明 BA 和 FS 相互作用与 ASD 之间的关系，但不能证明因果关系。有必要进行动物大脑实验来揭示其神经机制。需要更大的样本量、持续监测和详细的 FS 分类来确认 ASD 中 BA-FS 相互作用。
结论
在这项广泛的横断面研究中，BA 和 FS 均与 ASD 显著相关。这些因素的共存与 ASD 患病率的相加增加有关，超过了每个单独因素的累积风险。
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