目的 分析儿童注意缺陷多动障碍(ADHD)相关因素,构建并验证风险评估模型,为高危儿童的早期筛查和防治策略的制定提供科学依据。方法 采用回顾性病例对照研究设计,以2024年1—9月大连市妇女儿童医疗中心确诊的348例ADHD儿童作为病例组,通过倾向评分匹配150例性别、年龄(±6月)相符的正常儿童作为对照组。通过问卷调查收集社会人口学、家庭环境及生活方式信息。采用单因素分析和Lasso回归进行变量初筛,经多因素Logistic回归确定相关因素,利用R软件构建Nomogram预测模型并验证。结果 多因素logistic回归分析显示,非双亲抚养(OR=2.267,95%CI:1.089～4.719)、主要饮用桶装水(OR=1.960,95%CI:1.206～3.185)、室内主要依赖空调通风(OR=3.613,95%CI:1.368～9.540)、婴幼儿期入住新装修房屋(OR=1.781,95%CI:1.059～2.996)以及儿童主要活动区域墙面使用溶剂型涂料(OR=2.067,95%CI:1.268～3.368)与ADHD发生呈正向关联;装修后空置≥2年入住与ADHD发生呈负向关联(OR=0.399,95%CI:0.230～0.692)。基于上述6项因素构建的Nomogram模型内部验证结果显示,其区分度良好(AUC=0.73,95%CI:0.69～0.78),校准度较好(Hosmer-Lemeshow检验,P=0.220)。结论 儿童ADHD与家庭抚养方式、生活方式及室内环境暴露因素存在关联。基于上述因素构建的Nomogram模型具有一定预测能力,可为ADHD高危儿童的早期识别及针对性干预提供参考。
Abstract
Objective To investigate factors associated with attention-deficit/hyperactivity disorder (ADHD) in children, and to develop and validate a risk assessment model, so as to provide a scientific basis for early screening of high-risk children and the formulation of prevention and treatment strategies. Methods A retrospective case-control study was conducted, including 348 children diagnosed with ADHD at Dalian Women and Children's Medical Center from January to September 2024 as the case group, and 150 age- and sex-matched healthy controls by propensity score matching.Sociodemographic, household environment, and lifestyle information were collected via questionnaires. Univariate analysis and Lasso regression were used for preliminary variable screening, followed by multivariate logistic regression to identify associated factors. Finally, a Nomogram prediction model was constructed and validated using R software. Results Multivariate logistic regression analysis showed that non-parental rearing (OR=2.267,95%CI:1.089 - 4.719), primary consumption of bottled water (OR=1.960,95%CI: 1.206 - 3.185), reliance on air conditioning for indoor ventilation (OR=3.613,95%CI:1.368 - 9.540), moving into a newly renovated residence during infancy and early childhood (OR=1.781,95%CI:1.059 - 2.996), and use of solvent-based wall coatings in children's main activity areas (OR=2.067, 95%CI:1.268 - 3.368) were positively associated with ADHD, whereas moving into a residence at least 2 years after renovation was negatively associated with ADHD (OR = 0.399, 95%CI: 0.230 - 0.692). The Nomogram model developed using these six variables demonstrated acceptable discrimination (AUC=0.73, 95%CI: 0.69 - 0.78) and good calibration (Hosmer-Lemeshow test, P=0.220). Conclusions Childhood ADHD is associated with family rearing patterns, lifestyle characteristics, and indoor environmental exposure factors. The Nomogram model developed in this study shows moderate predictive performance and may serve as a useful tool for the early identification and targeted intervention among children at increased risk of ADHD.
关键词
注意缺陷多动障碍 /
生活方式 /
环境因素 /
Nomogram模型 /
儿童
Key words
attention-deficit/hyperactivity disorder /
lifestyle /
environmental factors /
Nomogram model /
children
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参考文献
[1] 林惠芳, 李兵, 黄双苗, 等. 儿童多动症相关影响因素分析[J]. 中国妇幼保健, 2021, 36(23): 5484-5486.
Lin HF, Li B, Huang SM, et al. Study on the influence factors of children with attention deficit hyperactivity disorder[J]. Matern Child Health Care China, 2021, 36(23): 5484-5486. (in Chinese)
[2] Abdelnour E, Jansen MO, Gold JA. ADHD diagnostic trends: Increased recognition or overdiagnosis?[J]. Mo Med, 2022, 119(5): 467-473.
[3] Agnew-Blais JC, Wertz J, Arseneault L, et al. Mother's and children's ADHD genetic risk, household chaos and children's ADHD symptoms: A gene-environment correlation study[J]. J Child Psychol Psychiatry, 2022, 63(10): 1153-1163.
[4] 李焱, 杜亚松, 江文庆, 等. 注意缺陷多动障碍儿童发病家庭环境及发育相关危险因素的研究[J]. 中国儿童保健杂志, 2020, 28(5): 559-562.
Li Y, Du YS, Jiang WQ, et al. Study on family environment and development-related risk factors of children with attention deficit hyperactivity disorder[J]. Chin J Child Health Care, 2020, 28(5): 559-562. (in Chinese)
[5] Thygesen M, Holst GJ, Hansen B, et al. Exposure to air pollution in early childhood and the association with attention-deficit hyperactivity disorder[J]. Environ Res, 2020, 183: 108930.
[6] Krauel K, Brauer H, Breitling-Ziegler C, et al. Prefrontal transcranial direct current stimulation in pediatric attention-deficit/hyperactivity disorder: A randomized clinical trial[J]. JAMA Netw Open, 2025, 8(2): e2460477.
[7] 张慧凤, 张劲松, 帅澜, 等. 学龄前儿童中文版SNAP-Ⅳ评定量表父母版的信效度检验[J]. 中国儿童保健杂志, 2016, 24(12): 1253-1256.
Zhang HF, Zhang JS, Shuai L, et al. Reliability and validity of the Chinese version of the Swanson, Nolan, and Pelham, version Ⅳ scale-parent form[J]. Chin J Child Health Care, 2016, 24(12): 1253-1256. (in Chinese)
[8] 吴艳红, 董淑梅, 杨小珍, 等. 25-(OH)D水平检测与小儿多动症量表评分的相关性研究[J]. 宁夏医学杂志, 2024, 46(4): 333-336.
Wu YH, Dong SM, Yang XZ, et al. Research on the correlation between 25-(OH) vitamin D level detection and pediatric ADHD scale scores[J]. Ningxia Med J, 2024, 46(4): 333-336. (in Chinese)
[11] Robinette LM, Johnstone JM, Srikanth P, et al. Evaluating mineral biomarkers as mediators and moderators of behavioural improvements in a randomised controlled trial of multinutrients for children with attention-deficit/hyperactivity disorder[J]. Br J Nutr, 2024, 132(3): 315-329.
[12] Skalny AV, Mazaletskaya AL, Ajsuvakova OP, et al. Se rum zinc, copper, zinc-to-copper ratio, and other essential elements and minerals in children with attention deficit/hyperactivity disorder (ADHD)[J]. J Trace Elem Med Biol, 2020, 58: 126445.
[13] Antoniou EE, Otter R.Phthalate exposure and neurotoxicity in children:A systematic review and meta-analysis[J].Int J Public Health,2024,69:1606802.
[14] Gao CY, Zhao X, Li T. Effects of indoor VOCs from paint on human brain activities during working memory tasks: An electroencephalogram study[J].Indoor Air,2022,32(7):e13062.
[15] Lane M, Oyster E, LuoY, et al. The effects of air pollution on neurological diseases: A narrative review on causes and mechanisms[J]. Toxics, 2025, 13(3): 207.
[16] Ahmad S, Naveen KG, Babu AM, et al. Association between ambient air pollution and attention-deficit/hyperactivity disorder (ADHD) in children:A systematic review and meta-analysis[J].Cureus, 2024,16(10):e71527.
[17] Chen YC, Gui ZH, Bao WW, et al. Chronic exposure to indoor air pollutants in association with attention-deficit/hyperactivity disorder symptoms in Chinese schoolchildren: A cross-sectional study[J]. NeuroToxicology, 2023, 94: 182-190.
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