风湿

RA后代自闭症谱系障碍的风险

作者:翻译:黄学婵 来源:广东省第二人民医院风湿免疫科 日期:2017-09-06
导读

         类风湿关节炎(RA)是一种常见的自身免疫性疾病,高发人群为15-45岁育龄期女性。因此近年来,评估类风湿关节炎患者孕育后代的风险也越来越受关注。

关键字:  RA | 自闭症 

        许多研究表明,自身免疫性疾病患者由于体内自身抗体及细胞因子水平较高,胎儿在母体接触到相关因素可能与自闭症谱系障碍(ASD)的发生相关。ASD是学龄儿童最常见的神经发育障碍疾病之一,而母亲的自身免疫性和炎症在ASD病理生理学中发挥重要的作用。

        本次笔者与大家分享最近的一篇报道,该报道指出RA患者的后代与健康母亲的后代相比,ASD发生的风险更大。这也从另一角度提醒医患双方在RA患者备孕时应注意的问题,而疾病活动度,细胞因子水平和自身抗体状态,可能会对ASD风险起到一定的调节作用。

        研究目的

        最近的证据表明,胎儿在子宫内暴露于母体的抗体和细胞因子是自闭症谱系障碍(ASD)的重要危险因素。 我们的目的是系统地回顾与非风湿关节炎(RA)的母亲所生的孩子比较,患有RA的母亲所生的孩子患ASD的风险。

        研究方法

        我们对电子数据库PubMed,EMBASE和Web of Science里的原创文章进行了系统回顾。

        研究结果

        我们共检索到70篇文献。 在检索到的潜在的相关研究中,67个研究由于缺乏相关性和/或因为没有报道原始数据被排除。最后分析了三项研究,一项病例对照研究无法检测ASD患者与对照组其母亲的RA患病率差异。另一项病例对照研究显示与对照组相比,母亲有自身免疫性疾病(包括RA)其后代患ASD几率增加8倍,具有统计学意义。46%的ASD后代与RA一级相关,而对照组为26%。此外,在基于人群的队列研究中,调查人员观察到,与健康母亲(不患RA)所生的孩子相比,有RA病史的母亲的子女ASD风险增加。这些研究都具有方法上的局限性:没有控制药物暴露,只有1个研究控制了产科并发症,并考虑了RA诊断的时间与妊娠相关性;除1个研究外,所有研究均用病例对照研究设计。

        研究结论

        尽管该研究数据有限,但这个观察性研究表明,与没有RA的母亲所生的孩子相比,患RA的母亲所生的孩子ASD的风险可能会增加。

        References:

        Wojcik S, Bernatsky S, Platt RW, Pineau CA, Clarke AE, Fombonne E, et al. Risk of autism spectrum disorders in children born to mothers with rheumatoid arthritis: A systematic literature review. Arthritis Care Res (Hoboken). [Journal Article]. 2017 2017-03-20.

        Risk of autism spectrum disorders in children born to mothers with rheumatoid arthritis: A systematic literature review(1).

        OBJECTIVE

        Recent evidence suggests in utero exposure to maternal antibodies and cytokines as important risk factors for autism spectrum disorders (ASD). We aimed to systematically review the risk of ASD in children born to mothers with rheumatoid arthritis (RA) compared to children born to mothers without RA.

        METHODS

        We conducted a systematic review of original articles using electronic databases: PubMed, EMBase, and Web of Science.

        RESULTS

        Our literature search identified a total of 70 articles. Of the potentially relevant studies retrieved, 67 were excluded for lack of relevance and/or because they did not report original data. Three studies were included in the final analysis. A case-control study was unable to detect a difference in the prevalence of RA in ASD mothers versus control mothers. Another case-control study showed a statistically significant 8-fold increase in autoimmune disorders, including RA, in mothers of ASD offspring compared to controls. Forty-six percent of ASD offspring had a first-degree relative with RA compared to 26% of controls. Moreover, in a population-based cohort study, investigators observed an increased risk of ASD in children with a maternal history of RA compared to children born to unaffected mothers. These studies had methodological limitations: none controlled for medication exposures, only 1 controlled for obstetrical complications and considered the timing of RA diagnosis in relation to pregnancy, and all but 1 used a case-control study design.

        CONCLUSION

        Observational studies suggest a potentially increased risk of ASD in children born to mothers with RA compared to children born to unaffected mothers, although data are limited.

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