目的 通过Meta评价儿童孤独症的父母孕产期及环境高危因素,为儿童孤独症的预防及早期发现提供科学循证依据。 方法 分别检索万方、维普、CNKI 及 PubMed 数据库中的中英文病例对照研究,评价文献质量,搜集风险条目,运用Review manager 5.3 软件统计分析数据,计算OR值及其 95%CI。结果 最终纳入15篇文献,累计观察组病例 1 758例,对照组健康儿童7 848例,涉及6个国家。资料分析显示,父亲年龄>35岁(OR=2.60,95%CI:1.58~4.61)、母孕期情绪不良史(焦虑、抑郁、压力大)(OR=3.06,95%CI:2.23~4.20)、母孕期主被动吸烟史(OR=3.57,95%CI:2.68~4.75)、父亲性格内向(OR=2.55,95%CI:1.35~4.78)、母亲人工流产史(OR=3.76,95%CI:2.54~5.57)、母亲职业毒物暴露史(OR=2.24,95%CI:1.35~3.70)、孕期疾病史(妊娠期高血压、糖尿病、甲减等)(OR=2.47,95%CI:1.22~4.98)、母亲怀孕6月内接触电离辐射(经常使用电脑)(OR=2.35,95%CI:1.39~3.98)、家族中有精神疾病病史(OR=8.26,95%CI:2.90~23.50)、母孕期用药史(抗感染药、激素类)(OR=5.24,95%CI:2.50~10.96)10项因素与儿童孤独症的发生风险相关(P<0.05)。结论 父母孕产期及环境不良因素与儿童孤独症的发病密切相关,在母亲孕期应积极监测高危风险因素的暴露,减少、减低患病诱因,对高危群体应早期监测其发育行为发展轨迹,早发现、早干预。
Abstract
Objective To assess the association of maternal and environmental factors with the risk of autism in children, thereby informing strategies for prevention and early intervention. Methods A comprehensive search was conducted for case-control studies in both Chinese and English, utilizing databases including Wanfang, VIP, CNKI, and PubMed.The quality of the retrieved literature was rigorously assessed, and relevant risk factors were extracted for analysis.Statistical evaluation was performed using Review Manager 5.3, focusing on odds ratios (OR) and 95% confidence intervals (CI) as primary measures. Results Fifteen articles, encompassing a total of 1 758 cases in the observation group and 7 848 healthy children in the control group from six countries, were included in the final analysis.The Results indicated significant associations between autism and several factors, including paternal age over 35 years old (OR=2.60, 95%CI:1.58 - 4.61), maternal emotional disorders during pregnancy (anxiety, depression, stress) (OR=3.06, 95%CI:2.23 - 4.20), maternal smoking (active and passive) during pregnancy (OR=3.57, 95%CI:2.68 - 4.75), paternal introversion (OR=2.55, 95%CI:1.35 - 4.78), history of maternal induced abortion (OR=3.76, 95% CI:2.54 - 5.57), and maternal occupational exposure to toxins (OR=2.24, 95%CI:1.35 - 3.70).Additional significant associations were observed with maternal pregnancy-related diseases (hypertension, diabetes, hypothyroidism, etc.) (OR=2.47, 95%CI:1.22 - 4.98), maternal exposure to ionizing radiation (including frequent computer use) during the first six months of pregnancy (OR=2.35, 95%CI:1.39 - 3.98), family history of mental illness (OR=8.26, 95%CI:2.90 - 23.50), and maternal use of certain medications (anti-infective drugs, hormones) (OR=5.24, 95%CI:2.50 - 10.96). Conclusions The findings suggest a complex interplay of genetic, environmental and maternal health factors in the etiology of childhood autism.Early identification and mitigation of these risk factors, alongside vigilant monitoring during pregnancy, are imperative for reducing the incidence of autism and improving child health outcomes.
关键词
儿童孤独症 /
环境因素 /
孕产期因素 /
Meta分析
Key words
childhood autism /
environmental factors /
maternal factors /
Meta-analysis
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基金
湖南省残联康复课题(2023XK0317,2023XK0328);湖南省卫生健康委科研项目(D202319017653);长沙市中医药科研课题(B202206)
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