生命早期空气污染物暴露与儿童孤独症谱系障碍患病关联的巢式病例对照研究

doi:10.12183/j.scjpm.2026.0067

华南预防医学 ›› 2026, Vol. 52 ›› Issue (1): 67-73.doi: 10.12183/j.scjpm.2026.0067

生命早期空气污染物暴露与儿童孤独症谱系障碍患病关联的巢式病例对照研究

梁晓健^1,2, 林青梅², 黄赛君², 张子龙³, 高永贵³, 丘圣⁴, 辛晶⁵, 黄燕灵⁶, 农雪艳⁶, 苏晞^1,2

1.南方医科大学公共卫生学院,广东广州 510515;
2.佛山市妇幼保健院;
3.中山大学公共卫生学院;
4.佛山市南海区妇幼保健院;
5.广州中医药大学佛山临床医学院;
6.广东医科大学顺德妇女儿童医院（佛山市顺德区妇幼保健院）

收稿日期:2025-10-23 出版日期:2026-01-20 发布日期:2026-02-06
通讯作者: 苏晞,E-mail：849527809@qq.com
作者简介:梁晓健（1999—）,女,在读硕士研究生,研究方向为儿少卫生与妇幼保健
基金资助:
国家自然科学基金项目（32270786）; 佛山市医学类科技攻关项目（2120001008276）; 佛山市孤独症谱系障碍早期救助工程技术研究中心（2020001003942）

A nested case-control study on the association between early-life exposure to air pollution and the risk of autism spectrum disorder in children

Liang Xiaojian^1,2, Lin Qingmei², Huang Saijun², Zhang Zilong³, Gao Yonggui³, Qiu Sheng⁴, Xin Jing⁵, Huang Yanling⁶, Nong Xueyan⁶, Su Xi^1,2

1. School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China;
2. Foshan Women and Children Hospital;
3. School of Public Health, Sun Yat-sen University;
4. Nanhai Maternity & Child Healthcare Hospital of Foshan;
5. Foshan Clinical Medical School, Guangzhou University of Chinese Medicine;
6. Shunde Women and Children's Hospital of Guangdong Medical University

Received:2025-10-23 Online:2026-01-20 Published:2026-02-06

摘要/Abstract

摘要： 目的探讨生命早期空气污染物（PM_2.5、PM₁₀、SO₂、NO₂）暴露与儿童孤独症谱系障碍（autism spectrum disorder,ASD）的发病风险关联。方法本研究采用巢式病例对照设计,研究队列源于佛山市妇幼保健信息系统2019—2021年的出生人口。选取经指定诊断中心确诊的725例ASD患儿为病例组,通过倾向性评分法,按1∶2的比例匹配1 445名同期健康儿童作为对照组。应用多因素条件logistic回归模型,分析孕早期、孕中期、孕晚期、全孕期及出生后第一年5个关键窗口期内,不同空气污染物暴露水平与ASD发病风险的关联强度。结果在校正了母亲妊娠期糖尿病等一系列混杂因素后,回归分析显示,全孕期PM_2.5（OR=2.37,95% CI：1.44~3.90）、PM₁₀（OR=1.80,95% CI：1.07~3.04）暴露,以及出生后第一年PM_2.5（OR=1.68,95% CI：1.13~2.51）、NO₂（OR=1.58,95% CI：1.27~1.97）暴露,均与ASD发病风险呈显著正相关（均P<0.05）。分阶段暴露分析进一步提示,孕早期PM_2.5（OR=2.75,95% CI：1.22~6.21）和PM₁₀（OR=3.26,95% CI：1.40~7.63）暴露的关联尤为突出（均P<0.05）。结论孕期和出生后第一年PM_2.5、PM₁₀、NO₂暴露可能增加儿童罹患ASD的风险,其中孕早期或为颗粒物暴露影响神经发育的关键敏感窗口。

关键词: 孤独症谱系障碍, 生命早期, 空气污染物, 儿童, 巢式病例对照研究

Abstract: Objective To investigate the association between early-life exposure to air pollutants (PM_2.5, PM₁₀,SO₂, NO₂) and the risk of autism spectrum disorder (ASD) in children. Methods A nested case-control study was conducted based on a birth cohort from the Foshan Maternal and Child Health Information System between 2019 and 2021. A total of 725 children diagnosed with ASD at designated diagnostic centers were enrolled as the case group. For each case, two healthy children from the same birth cohort were selected as controls, matched 1∶2 using propensity score matching, resulting in 1 445 control subjects. Multivariable conditional logistic regression models were employed to analyze the association between exposure to various air pollutants during five critical windows—the first, second, and third trimesters, the entire pregnancy, and the first year of life—and the risk of developing ASD. Results After adjusting for a range of confounding factors, including maternal gestational diabetes mellitus, the regression analysis revealed a significant positive association between ASD risk and exposure to PM_2.5 (OR=2.37, 95% CI:1.44-3.90) and PM₁₀ (OR=1.80, 95% CI:1.07-3.04) throughout the entire gestational period. Furthermore, exposure to PM_2.5 (OR=1.68, 95% CI:1.13-2.51) and NO₂ (OR=1.58, 95% CI:1.27-1.97) during the first year of life was also significantly associated with an elevated risk of ASD(all P<0.05). Stratified analysis by exposure window further indicated that the associations were particularly prominent for exposure to PM_2.5 (OR=2.75, 95% CI:1.22-6.21) and PM₁₀ (OR=3.26, 95% CI:1.40-7.63) during the first trimester (all P<0.05). Conclusion Exposure to PM_2.5, PM₁₀, and NO₂ during the prenatal period and the first year of life may increase the risk of ASD in children. The first trimester of pregnancy appears to be a critical sensitive window for the adverse effects of particulate matter exposure on neurodevelopment.

Key words: Autism spectrum disorder, Early life, Air pollutants, Children, Nested case-control study

中图分类号:

R749.94

梁晓健, 林青梅, 黄赛君, 张子龙, 高永贵, 丘圣, 辛晶, 黄燕灵, 农雪艳, 苏晞. 生命早期空气污染物暴露与儿童孤独症谱系障碍患病关联的巢式病例对照研究[J]. 华南预防医学, 2026, 52(1): 67-73.

Liang Xiaojian, Lin Qingmei, Huang Saijun, Zhang Zilong, Gao Yonggui, Qiu Sheng, Xin Jing, Huang Yanling, Nong Xueyan, Su Xi. A nested case-control study on the association between early-life exposure to air pollution and the risk of autism spectrum disorder in children[J]. South China Journal of Preventive Medicine, 2026, 52(1): 67-73.

参考文献

[1] Hirota T, King BH.Autism spectrum disorder: a review[J]. JAMA, 2023, 329(2): 157-168.
[2] Lord C, Brugha TS, Charman T, et al.Autism spectrum disorder[J]. Nat Rev Dis Primers, 2020, 6(1): 5.
[3] 赵亚楠, 李智文, 李琳, 等. 中国0~6岁儿童孤独症谱系障碍筛查患病现状[J]. 中国生育健康杂志, 2023, 34(5): 423-428.
[4] 赵亚楠, 罗雅楠, 王翔宇, 等. 中国2~6岁孤独症儿童家庭直接经济负担研究[J]. 中华疾病控制杂志, 2021, 25(9): 1085-1090.
[5] Cheroni C, Caporale N, Testa G.Autism spectrum disorder at the crossroad between genes and environment: Contributions, convergences, and interactions in ASD developmental pathophysiology[J]. Mol Autism, 2020, 11(1): 69.
[6] Miguel PM, Pereira LO, Silveira PP, et al.Early environmental influences on the development of children's brain structure and function[J]. Dev Med Child Neurol, 2019, 61(10): 1127-1133.
[7] Huang W, Zhou Y, Chen X, et al.Individual and joint associations of long-term exposure to air pollutants and cardiopulmonary mortality: A 22-year cohort study in Northern China[J]. Lancet Reg Health West Pac, 2023, 36: 100776.
[8] Duque-Cartagena T, Dalla MDB, Mundstock E, et al.Environmental pollutants as risk factors for autism spectrum disorders: A systematic review and meta-analysis of cohort studies[J]. BMC Public Health, 2024, 24(1): 2388.
[9] Liu H, Ding L, Qu G, et al.Particulate matter exposure during pregnancy and infancy and risks of autism spectrum disorder in children: A systematic review and meta-analysis[J]. Sci Total Environ, 2023, 855: 158830.
[10] Dutheil F, Comptour A, Morlon R, et al.Autism spectrum disorder and air pollution: A systematic review and meta-analysis[J]. Environ Pollut, 2021, 278: 116856.
[11] Su X, Zhang S, Lin Q, et al.Prenatal exposure to air pollution and neurodevelopmental delay in children: A birth cohort study in Foshan, China[J]. Sci Total Environ, 2022, 816: 151658.
[12] Fu J, Lin Q, Ai B, et al.Associations between maternal exposure to air pollution during pregnancy and trajectories of infant growth: A birth cohort study[J]. Ecotoxicol Environ Saf, 2024, 269: 115792.
[13] Chen G, Jin Z, Li S, et al.Early life exposure to particulate matter air pollution (PM1, PM2.5 and PM10) and autism in Shanghai, China: A case-control study[J]. Environ Int, 2018, 121(Pt 2): 1121-1127.
[14] 詹晓玲, 陈宇靖, 欧晓璇, 等. 生命早期细颗粒物暴露与学龄期儿童孤独症谱系障碍患病风险的关联[J]. 中国学校卫生, 2023, 44(2): 195-199.
[15] CSCO生物统计学专家委员会RWS方法学组. 倾向性评分方法及其规范化应用的统计学共识[J]. 中国卫生统计, 2020, 37(6): 952-958.
[16] 国家卫生健康委办公厅. 0~6岁儿童孤独症筛查干预服务规范(试行)[J]. 中华人民共和国国家卫生健康委员会公报, 2022(8): 4-26.
[17] 中华医学会儿科学分会发育行为学组, 中国医师协会儿科分会儿童保健学组. 中国低龄儿童孤独症谱系障碍早期诊断专家共识[J]. 中华儿科杂志, 2022, 60(7): 640-646.
[18] Wei J, Li Z, Wang J, et al.Ground-level gaseous pollutants (NO₂, SO₂, and CO) in China: Daily seamless mapping and spatiotemporal variations[J]. Atmos Chem Phys, 2023, 23(2): 1511-1532.
[19] Wei J, Li Z, Lyapustin A, et al.First close insight into global daily gapless 1 km PM_2.5 pollution, variability, and health impact[J]. Nat Commun, 2023, 14(1): 8349.
[20] Han S, Liu B, Shi C, et al.Evaluation of CLDAS and GLDAS datasets for near-surface air temperature over major land areas of China[J]. Sustainability, 2020, 12(10): 19.
[21] O'Sharkey K, Mitra S, Chow T, et al. Air pollution and autism spectrum disorder: Unveiling multipollutant risks and sociodemographic influences in California[J]. Environ Health Perspect, 2025, 133(6): 67010.
[22] Rahman MM, Shu Y, Chow T, et al.Prenatal exposure to air pollution and autism spectrum disorder: Sensitive windows of exposure and sex differences[J]. Environ Health Perspect, 2022, 130(1): 17008.
[23] Santos JX, Sampaio P, Rasga C, et al.Evidence for an association of prenatal exposure to particulate matter with clinical severity of autism spectrum disorder[J]. Environ Res, 2023, 228: 115795.
[24] Kalenik S, Zaczek A, Rodacka A.Air pollution-induced neurotoxicity: The relationship between air pollution, epigenetic changes, and neurological disorders[J]. Int J Mol Sci, 2025, 26(7): 3402.
[25] Zhang L, Xu F, Yang Y, et al.PM_2.5 exposure upregulates pro-inflammatory protein expression in human microglial cells via oxidant stress and TLR4/NF-κB pathway[J]. Ecotoxicol Environ Saf, 2024, 277: 116386.
[26] Wei C, Jiang W, Wang R, et al.Brain endothelial GSDMD activation mediates inflammatory BBB breakdown[J]. Nature, 2024, 629(8013): 893-900.
[27] Love C, Sominsky L, O'Hely M, et al. Prenatal environmental risk factors for autism spectrum disorder and their potential mechanisms[J]. BMC Med, 2024, 22(1): 393.
[28] Feig DS, Artani A, Asaf A, et al.Long-term neurobehavioral and metabolic outcomes in offspring of mothers with diabetes during pregnancy: A large, population-based cohort study in Ontario, Canada[J]. Diabetes Care, 2024, 47(9): 1568-1575.
[29] Jo H, Eckel SP, Chen J, et al.Gestational diabetes mellitus, prenatal air pollution exposure, and autism spectrum disorder[J]. Environ Int, 2019, 133(Pt A): 105110.

生命早期空气污染物暴露与儿童孤独症谱系障碍患病关联的巢式病例对照研究

A nested case-control study on the association between early-life exposure to air pollution and the risk of autism spectrum disorder in children

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	赵宇腾, 地门牟巫, 卢绍荣, 黎庆梅, 韩志刚. 1996—2022年四川省凉山州昭觉县儿童HIV感染者生存状况及影响因素分析[J]. 华南预防医学, 2026, 52(1): 7-11.
[2]	蒋倩倩, 李艳飞, 李梦玥, 庞鸣, 彭薇蓉, 郭韦艳. 柳州市7~9岁儿童第一恒磨牙患龋现状及窝沟封闭参与率与家长知信行的关联性研究[J]. 华南预防医学, 2026, 52(1): 109-112.
[3]	李冰, 韩吉楠, 张向阳. 郑州市儿童家长对非免疫规划疫苗接种犹豫调查[J]. 华南预防医学, 2025, 51(9): 997-1000.
[4]	王莹, 田雨飞, 赵亚坤. 儿童肺炎支原体混合感染特征及其短期预后风险分析[J]. 华南预防医学, 2025, 51(9): 1025-1029.
[5]	刘竟慧, 夏丹, 郭彬, 曾令岩, 李英俊. 阜阳地区儿童干眼症患病现况及防控对策研究[J]. 华南预防医学, 2025, 51(8): 870-874.
[6]	谢国强, 任广立. 2023—2024年肺炎支原体感染流行期儿童肺炎支原体肺炎特征分析[J]. 华南预防医学, 2025, 51(8): 899-902.
[7]	黎旭曦, 何莉, 赵靖云. 贵港地区家长对儿童全麻苏醒期躁动的认知调查及社区健康教育需求分析[J]. 华南预防医学, 2025, 51(8): 928-932.
[8]	张慧, 李晶晶, 王辉辉, 范艳萍, 王小青, 刘枝鑫, 周雪红, 张彦杰. 焦作市解放区中小学生超重/肥胖情况调查[J]. 华南预防医学, 2025, 51(6): 617-620.
[9]	韩磊, 韩亚昆, 王磊. 海淀区学龄前儿童家长对非免疫规划疫苗接种意愿及其影响因素[J]. 华南预防医学, 2025, 51(6): 673-676.
[10]	许嘉, 王银会, 姜薇. 北京市朝阳区6~14岁儿童青少年血尿酸水平及影响因素分析[J]. 华南预防医学, 2025, 51(5): 570-573.
[11]	付晓庆, 熊宇, 李柏松, 杨举乐, 李知晋, 漆莉. 2010—2019年重庆市0~14岁儿童流行性感冒特征分析[J]. 华南预防医学, 2025, 51(4): 426-431.
[12]	郭晓瑨, 卢茜, 张凯驰, 郭晓琳. 秦皇岛市重度儿童早期龋相关影响因素分析[J]. 华南预防医学, 2025, 51(4): 431-434.
[13]	彭春梅, 刘琳, 陈晓萍, 赵怡, 王娟, 陈园园, 谭举方. 家校医结合行为干预对学龄前儿童专注力促进模式研究[J]. 华南预防医学, 2025, 51(4): 435-439.
[14]	张梦佳, 王宏, 朱希倩, 王佳, 孙祖贤, 冯建秀, 姜敏敏. 上海市杨浦区6~12岁学龄儿童屈光不正与戴镜情况的现状分析[J]. 华南预防医学, 2025, 51(4): 455-458.
[15]	兰兆国, 符文慧, 哈力木别克·那扎尔别克, 田甜, 叶斯泰·木黑牙提, 乌其尔加甫·才媲丽玛, 谢娜. 2013—2023年新疆百日咳流行特征及6岁以下儿童抗体水平调查[J]. 华南预防医学, 2025, 51(3): 332-335.