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环境与儿童健康研究的设计：现状与发展

泰然健康网
2024-12-02 09:22

摘要:

儿童健康是全民健康和素质的基础，对儿童的终身发展至关重要。生命早期经历不良环境因素，往往会对儿童健康产生深远影响。本文从不同研究设计角度出发，介绍了环境与儿童健康相关研究的现状，探讨了不同研究设计存在的不足，包括：因果方向的不确定性，研究的论证力度不足，大样本、前瞻性、多中心、代表性出生队列研究的缺乏。因此，需要加强出生队列建设，为环境与儿童健康相关公共卫生政策的制定提供高质量证据。

关键词: 出生队列 / 生命早期 / 环境 / 儿童健康

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 环境与儿童健康的国内外出生队列研究节选

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

出生队列/国家年份研究人群暴露指标主要结局结果公共卫生学意义CANDLE/美国[37]2006—2011822对母婴对产前和产后NO2和PM2.54~6岁儿童收缩压和舒张压孕期PM2.5水平（尤其是孕中期）与儿童收缩压和舒张压升高有关。制定可接受的空气污染物水平和恰当的监管政策，保护儿童心血管健康。ALSPAC/英国[38]1991—199213963对母婴对孕期和儿童期PM108岁和15岁儿童肺功能孕期和儿童早期暴露于PM10（源于道路交通）显著降低儿童肺功能。采取与道路交通相关的空气污染控制措施，保护儿童呼吸健康。SBC/中国[39]2013—2016752对母婴对孕期PFAS及其替代物全氟丁烷磺酸盐和全氟庚酸新生儿性激素孕早期全氟丁烷磺酸盐和全氟庚酸水平与新生儿促性腺激素呈负相关。环境EDCs的替代物造成的危害不容小觑。TMCHD/中国[40]2004—2011191330对母婴对产前和产后环境重金属砷、镉、铅、汞儿童哮喘孕期和新生儿时期铅暴露与儿童哮喘发生风险相关。孕妇和婴儿尽量避免接触到空气污染、环境毒物和过敏原。Dunedin study/新西兰[41]1972—1973564名成人11岁儿童血铅45岁成人脑结构成像和认知测试儿童期血铅水平越高，成人大脑皮质表面积越小，海马灰质体积越小，整体各向异性分数越低，脑龄指数越大。儿童期暴露于高铅环境中的成年人，可能存在患神经退行性疾病风险。DNBC/丹麦[42]1996—200267565对母婴对孕期谷蛋白摄入儿童1型糖尿病孕期谷蛋白摄入量与儿童1型糖尿病发生风险密切相关。关注含麸质食物的安全性。MoBa/挪威[43]1999—2008104946名孕妇孕期叶酸补充和抗癫痫药物使用儿童ASD孕期服用抗癫痫药物且不补充叶酸的孕妇所孕育的儿童患ASD风险会增加5~8倍。所有服用抗癫痫药物的孕妇均应持续补充叶酸。NCDS/英国[44]19587466名成人儿童青少年时期行为问题和情感症状中年期炎症和心血管疾病指标、腰臀比、全因死亡率儿童青少年时期持续行为问题和情感症状会增加中年期纤维蛋白原和C-反应蛋白水平，降低高密度脂蛋白水平，增加腹部肥胖和过早全因死亡率发生风险。早期心理问题的有效干预可改善身体健康状况，降低过早死亡风险。[注]CANDLE，儿童早期神经认知发育和学习影响因素；TMCHD，台湾母婴健康数据库；Dunedin study，新西兰但尼丁研究 [1]

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