Congenital adrenal hyperplasia and risk for psychiatric disorders in girls and women born between 1915 and 2010: A total population study
Congenital adrenal hyperplasia and risk for psychiatric disorders in girls and women born between 1915 and 2010: A total population study
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DOI：
10.1016/j.psyneuen.2015.06.017
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发表时间：
2015-10-01
影响因子：
3.7
通讯作者：
Landen, Mikael
中科院分区：
文献类型：
--
作者：
Engberg, Hedvig;Butwicka, Agnieszka;Landen, Mikael
先天性肾上腺增生（CAH）是一种慢性疾病，由于内源性皮质醇缺乏，个体在子宫内暴露于雄激素水平升高。产前雄激素暴露已被认为会影响心理健康，但对患有CAH的女孩和妇女的精神疾病发病率的基于人群的研究缺乏。因此，我们进行了一项基于瑞典全国登记与国家CAH登记的队列研究。将1915年1月至2010年1月出生的21-羟化酶缺乏症导致的CAH女孩和妇女（n=335）与年龄匹配的女性（n=33500）和男性对照组（n=33500）进行比较。根据表型[盐损耗型（SW）、简单雄性化型（SV）和非经典型（NC）]和CYP21A2基因型亚组（null、I2splice、I172N和P30L）对分析进行分层。结果显示，与年龄匹配的对照组相比，患有CAH的女孩和妇女患精神疾病的估计风险（OR, 95%CI）。与男性和女性人群对照相比，任何精神疾病诊断在CAH女性中更常见[1.9（1.4-2.5）和2.2(1.7-2.9)]。特别是，与女性和男性人口对照相比，酒精滥用的风险增加[2.8（1.7-4.7）和2.1(1.2-3.5)]，并且在最严重的零基因型的女孩和妇女中最常见[6.7(2.6-17.8)]。与女性人群对照相比，应激和适应障碍的风险增加了一倍[2.1(1.3-3.6)]。与未暴露的女性相比，患有CAH的女孩和妇女患一般精神疾病和物质使用障碍的风险增加，在基因型最严重的女性中风险最高。产前雄激素暴露和内源性皮质醇和/或肾上腺素分泌不足可能为这些发现提供了解释，但不能排除与CAH相关的其他因素。(C) 2015 Elsevier Ltd.版权所有。
Congenital adrenal hyperplasia (CAH) is a chronic condition and individuals are exposed to elevated androgen levels in utero as a result of the endogenous cortisol deficiency. Prenatal androgen exposure has been suggested to influence mental health, but population based studies on psychiatric morbidity among girls and women with CAH are lacking.Therefore, we performed a cohort study based on Swedish nationwide registers linked with the national CAH register. Girls and women with CAH due to 21-hydroxylase deficiency (n = 335) born between January 1915 and January 2010 were compared with aged-matched female (n=33500) and male controls (n=33500). Analyses were stratified by phenotype [salt wasting (SW), simple virilizing (SV), and non-classical type (NC)] and by CYP21A2 genotype subgroups (null, I2splice, I172N, and P30L). Results are presented as estimated risks (OR, 95%CI) of psychiatric disorders among girls and women with CAH compared with age-matched controls.Any psychiatric diagnoses were more common in CAH females compared with female and male population controls [1.9 (1.4-2.5), and 2.2 (1.7-2.9)]. In particular, the risk of alcohol misuse was increased compared with female and male population controls [2.8(1.7-4.7) and 2.1 (1.2-3.5)], and appeared most common among the girls and women with the most severe null genotype [6.7 (2.6-17.8)]. The risk of stress and adjustment disorders was doubled compared with female population controls [2.1 (1.3-3.6)].Girls and women with CAH have an increased risk of psychiatric disorders in general and substance use disorders in particular compared with unexposed females, with the highest risk among those with the most severe genotype. Prenatal androgen exposure and deficient endogenous cortisol and/or adrenaline production may provide explanations for these findings, but other factors related to CAH cannot be excluded. (C) 2015 Elsevier Ltd. All rights reserved.