环境因素与自闭症

····201210205ChinJPrevContrChronDisOctober2012Vol．20No．5······郭德华，杨广学200062R749.94A1004-6194（2012）05-0599-05、。34∶1~6∶1。。、[1]。。12060~70。。1.1环境因素的界定。、、。、、。1.2与自闭症有关的环境因素1.2.1、、、、、、。。Volk[2]。1。310002.2。、。1.2.2、、、、、、、。。、、、、。。DNA[3]。1Th12Th2。10-6IL-6[4]。1.2.3、。、、、、GI、、、、、、、[5]。[6]、[7][8]。2。599··201210205ChinJPrevContrChronDisOctober2012Vol．20No．5······、、[9]。。2.1遗传因素不能完全解释的现象207060％～90％2%~6%[10]100％[11]。、、、。。19254138。42．5％43％12．9％20％。。[12]。2.2自闭症的发病率上升20504/10000～5/10000901/250[13]20021/15020061/110[14]20071/91[15]1/88[16]。1/86～1/64[17-18]。[19]。。。2.3疫苗等化学环境因素与自闭症的关系30--MMR[20]。。[21]。MMR。2.4环境因素对自闭症的干预有调节作用。。、、。。[5]。2.5孕产期与儿童成长的环境因素、。、[22]、1022%38%[23]。、、、、、、、、、GI。3、、。、。、43.1直接作用。、。。。20~24。[11]。[7]。3.2间接作用。IX、、、、[24]。600····201210205ChinJPrevContrChronDisOctober2012Vol．20No．5····PCB[25]。。5-5-[26]。γ-GABA[27]。-、。、、[28]。3.3激发作用（板机效应）。。。“”、、[29]。。。[30]。。3.4加重作用GI、。。GI9%～91%[31]。ASDGI、。ASD[32]。、。。44.1自闭症出生队列研究106、18、36。、。。ASD[33]。、ASD。4.2病例对照研究“”CHARGE、、。[32]。、1。。4.3环境基因组方法。Herbert。Herbert[5]、。Herbert2“”“”。“”。601··201210205ChinJPrevContrChronDisOctober2012Vol．20No．5······。、。55.1加强孕产期保健。[6]。、。。5.2避免有害环境因素暴露。。、、、、、、、、[34]。。5.3治疗理念与方法的突破。。。。[5]。。。。。6。。、。。。、。1KiddPM．Autismanextremechallengetointegrativemedicine．Part1TheknowledgebaseJ．AlternMedRev200274292－316．2VolkHEHertz－PicciottoIDelwicheL,etal．ResidentialproximitytofreewaysandautismintheCHARGEstudyJ．EnvironHealthPerspect20111196873－877．3RossignolDABradstreetJJ．EvidenceofmitochondrialdysfunctioninautismandimplicationsfortreatmentJ．AmJBiochemBiotechnol200842208-217．4KempurajDAsadiSZhangBetal．MercuryinducesinflammatorymediatorreleasefromhumanmastcellsJ．JNeuroinflammation2010720．5HerbertMRArrangaT．AutismabraindisorderoradisorderthataffectsthebrainJ．MedVeritas2006331182-1194.6KogaKMorG．Toll－likereceptorsatthematernal－fetalinterfaceinnormalpregnancyandpregnancydisordersJ．AmJReprodImmunol2010636587－600．7LiQCheungCWeiRetal．Prenatalimmunechallengeisanenvi－ronmentalriskfactorforbrainandbehaviorchangerelevanttoSchizophreniaevidencefromMRIinamousemodelJ．PlosOne2009476354-6362．8Baron－CohenS．TheoryofmindandautismareviewJ．IntRevofRMentalRetardation20012310169－184．9LevySEMandellDSSchultzRT．AutismJ．Lancet200937497011627－1638．10BaileyAPhillipsWRutterM．Autismtowardsanintegrationofclin－icalgeneticneuropsychologicalandneurobiologicalperspectivesJ．JChildPsycholPsychiatry199637189－126．11LondonEA．TheenvironmentasanetiologicfactorinautismanewdirectionforresearchJ．EnvironHealthPerspect2000108Suppl3401－404．12HallmayerJClevelandSTorresAetal．GeneticheritabilityandsharedenvironmentalfactorsamongtwinpairswithautismJ．ArchGenPsychiatry201168111095－1102．13DefrancescoL．AutismontheriseJ．Scientist2001151016-19．14RatajczakHV．Theoreticalaspectsofautismcauses－areviewJ．JImmunotoxicol20118168－79．15KoganMDBlumbergSJSchieveLAetal．Prevalenceofparent－reporteddiagnosisofautismspectrumdisorderamongchildrenintheUS2007J．Pediatrics200912451395-1403．602····201210205ChinJPrevContrChronDisOctober2012Vol．20No．5····16BaioJ．Prevalenceofautismspectrumdisorders—AutismandDevelop－mentalDisabilitiesMonitoringNetwork14sitesUnitedStates2008J．MMWRSurveillSumm20126131－19．17BairdGSimonoffEPicklesAetal．PrevalenceofdisordersoftheautismspectruminapopulationcohortofchildreninSouthThamestheSpecialNeedsandAutismProjectSNAPJ．Lancet20063689531210－215．18Baron－CohenSScottFAllisonCetal．Prevalenceofautism－spec－trumconditionsUKschool－basedpopulationstudyJ．BrJPsychiatry20091946500－509．19KarenWS．Diagnosesandheightenedawarenessexplainonlypartoftheapparentriseinautism．ScientistsarestrugglingtoexplaintherestJ．Nature20114791122－24．20McDonaldMEPaulJE．TimingofincreasedautisticdisordercumulativeincidenceJ．EnvironSciTechnol20104462112－2118．21GeierDASykesLKGeierMR．AreviewofThimerosalMerthiolateanditsethylmercurybreakdownproductspecifichistoricalconsiderationsregardingsafetyandeffectivenessJ．JToxicolEnvironHealthBCritRev2007108575-596．22Atlad仵ttirHOThorsenPstergaardLetal．MaternalinfectionrequiringhospitalizationduringpregnancyandautismspectrumdisordersJ．JAutismDevDisord201040121423－1430．23CroenLANajjarDVFiremanBetal．MaternalandpaternalageandriskofautismspectrumdisordersJ．ArchPediatrAdolescMed20071614334－340．24D觟lenGBearMF．CourtingacureforfragileXJ．Neuron2005455642－644．25CafniJWongPWPessahIN．Non－coplanar22’35’6－pentachlorobiphenylPCB95amplifiesionotropicglutamatereceptorsignalinginembryoniccerebellargranuleneuronsbyamechanisminvolvingryanodineReceptorsJ．ToxicolSci200477172－82．26BarhudaryanNDunnAJ．Molecularmechanismsofactionsofinterleukin－6onthebrainwithspecialreferencetoserotoninandthehypothalamo－pituitary－adreno－corticalaxisJ．NeurochemRes19992491169－1180．27RubensteinJLMerzenichMM．Modelofautismincreasedratioofexcitation/inhibitioninkeyneuralsystemsJ．GenesBrainBehav200325255-267．28FlilipovNMSeegalRFLawrenceDA．ManganesepotentiatesinvitroproductionofproinflammatorycytokinesandnitricoxidebymicrogliathroughanuclearfactorkappaB－dependentmechanismJ．ToxicolSci2005841139－148．29KorvatskaEVandeWaterJAndersTFetal．GeneticandimmunologicconsiderationsinautismJ．NeurobiolDis20