摘要:

兒童健康是全民健康和素質(zhì)的基礎(chǔ)，對兒童的終身發(fā)展至關(guān)重要。生命早期經(jīng)歷不良環(huán)境因素，往往會(huì)對兒童健康產(chǎn)生深遠(yuǎn)影響。本文從不同研究設(shè)計(jì)角度出發(fā)，介紹了環(huán)境與兒童健康相關(guān)研究的現(xiàn)狀，探討了不同研究設(shè)計(jì)存在的不足，包括：因果方向的不確定性，研究的論證力度不足，大樣本、前瞻性、多中心、代表性出生隊(duì)列研究的缺乏。因此，需要加強(qiáng)出生隊(duì)列建設(shè)，為環(huán)境與兒童健康相關(guān)公共衛(wèi)生政策的制定提供高質(zhì)量證據(jù)。

關(guān)鍵詞: 出生隊(duì)列  /  生命早期  /  環(huán)境  /  兒童健康  

Abstract:

Children's health is the foundation of the health and well-being of the entire population, and it is vital to the life-long development of children. Exposure to adverse environmental factors in early life has a lifelong impact on children's health. From the perspective of different research designs, this review introduced the current status of research related to environment and children's health and pointed out the short comings of the applied designs, including uncertain causality, insufficient strength of evidence, and lack of large-sample, prospective, multi-center, and representative birth cohort studies. Therefore, it is necessary to strengthen the establishment of birth cohorts to provide high-quality evidence for the formulation of public health policies related to environment and children's health.

表  1   環(huán)境與兒童健康的國內(nèi)外出生隊(duì)列研究節(jié)選

Table  1   Representative domestic and foreign birth cohort studies on environment and children's health

出生隊(duì)列/國家年份研究人群暴露指標(biāo)主要結(jié)局結(jié)果公共衛(wèi)生學(xué)意義CANDLE/美國[37]2006—2011822對母嬰對產(chǎn)前和產(chǎn)后NO2和PM2.54~6歲兒童收縮壓和舒張壓孕期PM2.5水平（尤其是孕中期）與兒童收縮壓和舒張壓升高有關(guān)。制定可接受的空氣污染物水平和恰當(dāng)?shù)谋O(jiān)管政策，保護(hù)兒童心血管健康。ALSPAC/英國[38]1991—199213963對母嬰對孕期和兒童期PM108歲和15歲兒童肺功能孕期和兒童早期暴露于PM10（源于道路交通）顯著降低兒童肺功能。采取與道路交通相關(guān)的空氣污染控制措施，保護(hù)兒童呼吸健康。SBC/中國[39]2013—2016752對母嬰對孕期PFAS及其替代物全氟丁烷磺酸鹽和全氟庚酸新生兒性激素孕早期全氟丁烷磺酸鹽和全氟庚酸水平與新生兒促性腺激素呈負(fù)相關(guān)。環(huán)境EDCs的替代物造成的危害不容小覷。TMCHD/中國[40]2004—2011191330對母嬰對產(chǎn)前和產(chǎn)后環(huán)境重金屬砷、鎘、鉛、汞兒童哮喘孕期和新生兒時(shí)期鉛暴露與兒童哮喘發(fā)生風(fēng)險(xiǎn)相關(guān)。孕婦和嬰兒盡量避免接觸到空氣污染、環(huán)境毒物和過敏原。Dunedin study/新西蘭[41]1972—1973564名成人11歲兒童血鉛45歲成人腦結(jié)構(gòu)成像和認(rèn)知測試兒童期血鉛水平越高，成人大腦皮質(zhì)表面積越小，海馬灰質(zhì)體積越小，整體各向異性分?jǐn)?shù)越低，腦齡指數(shù)越大。兒童期暴露于高鉛環(huán)境中的成年人，可能存在患神經(jīng)退行性疾病風(fēng)險(xiǎn)。DNBC/丹麥[42]1996—200267565對母嬰對孕期谷蛋白攝入兒童1型糖尿病孕期谷蛋白攝入量與兒童1型糖尿病發(fā)生風(fēng)險(xiǎn)密切相關(guān)。關(guān)注含麩質(zhì)食物的安全性。MoBa/挪威[43]1999—2008104946名孕婦孕期葉酸補(bǔ)充和抗癲癇藥物使用兒童ASD孕期服用抗癲癇藥物且不補(bǔ)充葉酸的孕婦所孕育的兒童患ASD風(fēng)險(xiǎn)會(huì)增加5~8倍。所有服用抗癲癇藥物的孕婦均應(yīng)持續(xù)補(bǔ)充葉酸。NCDS/英國[44]19587466名成人兒童青少年時(shí)期行為問題和情感癥狀中年期炎癥和心血管疾病指標(biāo)、腰臀比、全因死亡率兒童青少年時(shí)期持續(xù)行為問題和情感癥狀會(huì)增加中年期纖維蛋白原和C-反應(yīng)蛋白水平，降低高密度脂蛋白水平，增加腹部肥胖和過早全因死亡率發(fā)生風(fēng)險(xiǎn)。早期心理問題的有效干預(yù)可改善身體健康狀況，降低過早死亡風(fēng)險(xiǎn)。[注]CANDLE，兒童早期神經(jīng)認(rèn)知發(fā)育和學(xué)習(xí)影響因素；TMCHD，臺(tái)灣母嬰健康數(shù)據(jù)庫；Dunedin study，新西蘭但尼丁研究 [1]

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