母親的自體免疫疾病和孩子的自閉症之間的相關性：台灣的全國性研究

Association of Maternal Autoimmune Diseases and Autism Spectrum Disorders: A Nationwide Population Study in Taiwan

目的：過去已有研究發現自閉症類群障礙的病人較易有自體免疫疾病的家族病史，較近期的研究發現母親懷孕中的免疫失調會增加孩子罹患自閉症類群障礙，因此本研究想驗証母親的自體免疫疾病是否和小孩的自閉症類群障礙發生的機率有關。方法：本研究從1997- 2011年健保資料庫所有持有重大傷病卡的納保人中，用國際疾病分類ICD-9找出有自閉症類群障礙的病人，再用承保身份當中的親屬關係找到病人的母親，並再以小孩出生日及母親的生產日的資料去確認其親子關係，共找出8,428對母親及孩子；對照組為未患自閉症類群障礙的孩子及他們的母親，是用健保資料庫依1：4的比例將小孩的年紀、性別及母親的年紀做配對的，共找出33,712對母親及孩子，最後再分析這二組母親罹患自體免疫疾病的比例。結果：自閉症類群障礙病人的母親中，有60人（0.7%）患有自體免疫疾病，但是此比例並未明顯的高於對照組的母親。結論：本篇是目前關於母親的自體免疫疾病和小孩自閉症類群障礙研究最大樣本數的研究，然而未發現此二者的相關性。

Objective: Increased risk of autism spectrum disorder (ASD) has been observed in children with family history of autoimmune diseases, implying a common genetic background in these two conditions. In recent years, more evidence supports the hypothesis that maternal immune activation during pregnancy may also play a rôle in offspring during neural developmental process, leading to ASD-associated pathophysiology. We intended to study whether maternal autoimmune diseases are associated with ASD children. Method: We enrolled the patients with ASD from the Taiwan National Health Insurance (NHI) database in year 1997- 2011. We identified 8,428 mother-child dyads in patients diagnosed with ASD retrieved from the Registry for Catastrophic Illness Patients database. The control group of individuals without ASD was selected from NHI database with the ratio of 1: 4. They were matched with each individual in the ASD group on the basis of age, gender, and time of enrollment. The autoimmune disorders in their mothers were also based on the certificate of catastrophic illness. The risks of mothers' autoimmune disorders were compared between the ASD group and the control group. Results: Autoimmune disorders were documented in 60 (0.71%) mothers with an ASD child. The percentage of overall and each autoimmune disorder did not show any significant difference between those mothers with and without an ASD children. Conclusion: In this retrospective study, we did not demonstrate that maternal autoimmune disorders are significantly associated with the risk of ASD in children.