儿童注意缺陷多动障碍的环境与生活方式相关因素分析及Nomogram风险评估模型构建

Environmental and lifestyle factors associated with attention-deficit/hyperactivity disorder in children and development of a Nomogram risk assessment model

摘要

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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基金资助

大连市重大传染病防控项目(大卫发[2023]147号)