家庭创伤、校园霸凌与青少年自杀行为的关系：DRD2 基因多态性的调节作用

Relationship between family trauma，school bullying and suicidal behavior in adoles- cents：Regulatory effect of DRD2 gene polymorphism

摘要

目的：探究家庭创伤、校园霸凌与青少年自杀行为的关系，以及 DRD2 基因多态性的调节作用。方法：连续选择2022年6月—2024年6月于宁夏回族自治区宁安医院就诊的确诊为青少年抑郁障碍患者 98 例，根据就诊前 6 个月是否有自杀行为和对自杀行为态度得分分为非自杀组（n=62）和自杀倾向组（n=36）。比较两组患者一般资料。分析各基因型与自杀行为的关系、自杀行为的影响因素、家庭创伤和校园霸凌对自杀行为的交互作用。分析基因多态性对抑郁障碍可能存在的调节效应。结果：与非自杀组比较，自杀倾向组病程、非自杀性自伤行为、家庭创伤、校园霸凌、焦虑、抑郁评分增加，生命意义评分降低（P<0.05）。基因型A2A2较A1A1可增加自杀行为风险（P<0.05）。隐性模式中，基因型 A2A2 较 A1A1 和 A1A2 增加自杀行为风险（P<0.05）；加性遗传模式中，基因型A1A1、A1A2、A2A2 与自杀行为之间均有重要关联（P<0.05）。非自杀性自伤行为、家庭创伤、校园霸凌、抑郁障碍以及 A2A2 基因型是自杀行为的独立危险因素，生命意义是独立保护因素。家庭创伤 >54.78 分和校园霸凌 >10.37分对青少年自杀行为存在相乘（$\mathit{O}\mathit{R}=\mathrm{6.585,95}\mathrm{\%}\mathit{C}\mathit{I}:5.478\sim 7.367$）及相加（$\mathit{O}\mathit{R}=\mathrm{7.849,95}\mathrm{\%}\mathit{C}\mathit{I}:7.231\sim 8.294$）的交互作用。抑郁障碍在家庭创伤（$\mathit{\beta }=\mathrm{0.092,95}\mathrm{\%}\mathit{C}\mathit{I}:0.084\sim 0.103$）、校园霸凌（$\mathit{\beta }=\mathrm{0.090,95}\mathrm{\%}\mathit{C}\mathit{I}:0.081\sim 0.098$）与自杀行为间发挥调节效应。加性遗传模式下，Taq IA 基因在携带 A1A2/A2A2 分型的青少年中对＂家庭创伤、校园霸凌 → 抑郁障碍 → 自杀行为＂的调节效应显著。结论：家庭创伤和校园霸凌同时存在时青少年自杀行为风险更高，抑郁障碍在其中发挥调节效应，DRD2 基因 Taq IA 位点多态性对携带 A2 等位基因的青少年具有显著的调节效应。

Abstract

Objective：To explore the relationship between family trauma，school bullying and adoles- cent suicidal behavior，and the regulatory role of DRD2 gene polymorphism. Methods：A total of 98 ado- lescent patients with depressive disorders who visited our hospital from June 2022 to June 2024 were se- lected.They were divided into the non-suicide group (n=62) and the suicide group (n=36) based on their suicide behavior in the previous 6 months and their attitudes towards suicide behavior.The general data of the two groups were compared.The relationship between each genotype and suicide behavior，the influencing factors of suicide behavior，the interaction between family trauma and school bullying on sui- cide behavior，and the regulatory effects of depression and genetic polymorphisms were analyzed.The possible regulatory effects of depression and genetic polymorphisms were also investigated. Results：Com- pared with the non-suicide group，the duration of illness，non-suicidal self-harm behavior，family trau- ma，school bullying，anxiety，depression scores in the suicide group increased，while the life meaning score decreased (P<0.05).The genotype A2A2 was associated with an increased risk of suicidal behavior compared to genotype A1A1 (P<0.05).In the recessive model，the genotype A2A2 was associ- ated with an increased risk of suicidal behavior compared to genotype A1A1 and A1A2（P<0.05）；in the additive model，there were significant associations between the genotypes A1A1，A1A2，A2A2 and suicidal behavior (P<0.05).Non-suicidal self-harm behavior，family trauma，school bullying，depres- sion，and the A2A2 genotype were independent risk factors for suicidal behavior，while life meaning was an independent protective factor.Family trauma> 54.78 points and school bullying> 10.37 points had a multiplicative $(\mathit{O}\mathit{R}=\mathrm{6.585,95}\mathrm{\%}\mathit{C}\mathit{I}:5.478-7.367)$ and additive $(O R=7.849,95 % C I: 7.231-$8.294）interaction effect on adolescent suicidal behavior.Depression exerted a regulatory effect between family trauma $(\mathit{\beta }=\mathrm{0.092,95}\mathrm{\%}\mathit{C}\mathit{I}:0.084-0.103)$ ，school bullying $(\mathit{\beta }=\mathrm{0.090,95}\mathrm{\%}\mathit{C}\mathit{I}:0.081-0.098)$ and suicidal behavior.In the additive genetic model，the Taq IA gene had a significant regulatory effect on＂family trauma，school bullying depression suicidal behavior＂in adolescents with the A1A2/A2A2 genotype. Conclusion：The risk of suicidal behavior is higher in adolescents with both family trauma and school bullying，and depression plays a part of the mediating effect.The Taq IA polymor- phism of DRD2 gene has a significant regulatory effect on adolescents carrying A2 allele.

关键词

家庭创伤 / 校园霸凌 / 自杀行为 / DRD2 基因多态性 / 调节作用

Key words

Family trauma / School bullying / Suicidal behavior / DRD2 gene polymorphism / Regula-ting effect

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基金资助

宁夏回族自治区卫生健康科研项目(2025-NWZC-A019)