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Article(id=1240722570773852333, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240722566957027366, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406031, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1717344000000, receivedDateStr=2024-06-03, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773740912382, onlineDateStr=2026-03-17, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773740912382, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773740912382, creator=13701087609, updateTime=1773740912382, updator=13701087609, issue=Issue{id=1240722566957027366, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='19', pageStart='3457', pageEnd='3648', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=0, createTime=1773740911472, creator=13701087609, updateTime=1773740981732, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240722861736906836, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240722566957027366, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240722861736906837, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240722566957027366, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3543, endPage=3547, ext={EN=ArticleExt(id=1240722571222642884, articleId=1240722570773852333, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between intergenerational continuity of adverse childhood experiences and cognitive impairment in rural preschoolers, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the association between intergenerational continuity of adverse childhood experiences (ACEs) and preschoolers’ cognitive performance to provide evidence for promoting healthy cognitive development in preschoolers. Methods A total of 450 children aged 3-6 years from 9 kindergartens in the rural area of Wuhu, Anhui Province were selected to enter the survey on cognitive development. The Childhood Trauma Questionnaire Short Form (CTQ-SF) and an investigator-designed questionnaire were employed to measure maternal ACEs and children ACEs, respectively. The Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth edition (WPPSI-IV) was conducted to assess participants’cognitive performance. Results The detection rate was 26.7% for neither maternal nor child ACEs exposure, 18.9% for only maternal ACEs exposure, 31.6% for only child ACEs exposure, and 22.9% for both maternal and child ACEs exposure (intergenerational continuity of ACEs). Compared to children in neither maternal nor child ACEs exposure group, cognitive performance was significantly worse in children with intergenerational continuity of ACEs (103.92±10.00 vs 100.94±10.01, P=0.001). After adjusting for covariates, linear regression models showed that intergenerational continuation of ACEs was significantly associated with a 3.34-point reduction in offspring cognitive performance (95% CI: -6.54~-0.14, P=0.04). Conclusion Intergenerational continuity of ACEs is associated with cognitive impairment in preschoolers.

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目的 探讨童年期不良经历（adverse childhood experiences，ACEs）代际延续与学龄前儿童认知水平的关联，为促进学龄前儿童认知健康发展提供理论依据。方法 在安徽省芜湖市某农村地区9所托幼机构共招募450名3～6岁儿童进行认知水平专项调查。采用《简化童年创伤问卷》（Childhood Trauma Questionnaire, Short Form，CTQ-SF）评估母亲ACEs，采用课题组自制问卷评估儿童的ACEs。通过中文版《韦氏幼儿智力量表-第四版》（Wechsler Preschool and Primary Scale of Intelligence，Fourth edition，WPPSI-IV）评估学龄前儿童的认知水平。结果 母亲和儿童均无ACEs暴露、仅母亲ACEs暴露、仅儿童ACEs暴露、母亲和儿童均ACEs暴露（ACEs代际延续）的检出率分别为26.7%、18.9%、31.6%、22.9%。相较于母子均无ACEs暴露的儿童，ACEs代际延续儿童的认知水平得分较低［（103.92±10.00）vs.（100.94±10.01），P=0.001］。调整协变量后的线性回归模型显示，ACEs代际延续与儿童认知水平降低3.34分，显著相关（95%CI：-6.54～-0.14，P=0.04）。结论 ACEs代际延续与儿童认知水平损伤相关。

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孙莹，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=s/L6gwkG7zYGlIiZEcBOmQ==, magXml=xv6kOiY8+2s//ZRV7UeiHA==, pdfUrl=null, pdf=iM0kSFSDHPfcdCaJhoPUYg==, pdfFileSize=565291, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Z96w915dJ/1PZrY5YRsRtQ==, mapNumber=null, authorCompany=null, fund=null, authors=

张安慧（1978—），女，硕士，副主任医师，研究方向：儿童保健工作

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张安慧（1978—），女，硕士，副主任医师，研究方向：儿童保健工作

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Distribution of demographic information among preschoolers with different adverse childhood experiences ［n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总样本（n=450）童年期不良经历代际传递χ2/F值P值
均无暴露仅母亲暴露仅儿童暴露均暴露
性别3.0510.383
男214 (47.6)54 (45.0)39 (45.9)76 (53.5)45 (43.7)
女236 (52.8)66 (55.0)46 (54.1)66 (46.5)58 (56.3)
年龄（岁）4.60±0.564.58±0.574.65±0.574.58±0.564.60±0.540.2810.841
BMI(kg/m2)15.61±1.6815.66±1.6315.58±1.7415.55±1.5315.66±1.900.1320.942
出生体重（kg）3.29±0.563.35±0.483.33±0.743.24±0.573.24±0.481.1850.321
母亲抑郁2.67±3.301.89±2.492.87±3.462.68±3.384.03±3.92***5.9900.001
FSIQ103.92±10.00105.28±10.28104.13±10.27104.81±9.23100.94±10.01***4.2700.006
家庭月收入（元）2.8010.830
<5 000113(25.1)27(22.5)21(24.7)33(23.2)32(31.1)
5 000 ~ 10 000175(38.9)47(39.2)33(38.8)57(40.1)38(36.9)
>10 000162(36.0)46(38.3)31(36.5)52(36.6)33(32.0)
父母最高学历6.8340.342
初中及以下179(39.8)44(36.7)28(32.9)60(42.3)47(45.6)
高中/专科205(45.6)57(47.5)39(45.9)66(46.5)43(41.7)
大学及以上66(14.7)19(15.8)18(21.2)16(11.3)3(12.6)
), ArticleFig(id=1240933511809519934, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722570773852333, language=CN, label=表1, caption=

不同代际逆境经历的学龄前儿童基本信息比较［n（%）（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总样本（n=450）童年期不良经历代际传递χ2/F值P值
均无暴露仅母亲暴露仅儿童暴露均暴露
性别3.0510.383
男214 (47.6)54 (45.0)39 (45.9)76 (53.5)45 (43.7)
女236 (52.8)66 (55.0)46 (54.1)66 (46.5)58 (56.3)
年龄（岁）4.60±0.564.58±0.574.65±0.574.58±0.564.60±0.540.2810.841
BMI(kg/m2)15.61±1.6815.66±1.6315.58±1.7415.55±1.5315.66±1.900.1320.942
出生体重（kg）3.29±0.563.35±0.483.33±0.743.24±0.573.24±0.481.1850.321
母亲抑郁2.67±3.301.89±2.492.87±3.462.68±3.384.03±3.92***5.9900.001
FSIQ103.92±10.00105.28±10.28104.13±10.27104.81±9.23100.94±10.01***4.2700.006
家庭月收入（元）2.8010.830
<5 000113(25.1)27(22.5)21(24.7)33(23.2)32(31.1)
5 000 ~ 10 000175(38.9)47(39.2)33(38.8)57(40.1)38(36.9)
>10 000162(36.0)46(38.3)31(36.5)52(36.6)33(32.0)
父母最高学历6.8340.342
初中及以下179(39.8)44(36.7)28(32.9)60(42.3)47(45.6)
高中/专科205(45.6)57(47.5)39(45.9)66(46.5)43(41.7)
大学及以上66(14.7)19(15.8)18(21.2)16(11.3)3(12.6)
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Multivariable linear regression model of FSIQ among preschoolers with different intergenerational continuity in adverse childhood experiences

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组别模型1模型2
β (95% CI)P值β (95% CI)P值
代际童年期不良经历
对照组Ref.Ref.
仅母亲暴露-1.15 (-3.91～1.60）0.410.17 (-3.10～3.46)0.923
仅儿童暴露-0.47 (-2.89～1.94)0.700.14 (-2.32～2.61)0.912
均暴露-4.34(-6.95～-1.73)0.001-3.34(-6.54～-0.14)0.040
), ArticleFig(id=1240933512052789580, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722570773852333, language=CN, label=表2, caption=

不同代际逆境与学龄前儿童FSIQ的线性回归模型

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组别模型1模型2
β (95% CI)P值β (95% CI)P值
代际童年期不良经历
对照组Ref.Ref.
仅母亲暴露-1.15 (-3.91～1.60）0.410.17 (-3.10～3.46)0.923
仅儿童暴露-0.47 (-2.89～1.94)0.700.14 (-2.32～2.61)0.912
均暴露-4.34(-6.95～-1.73)0.001-3.34(-6.54～-0.14)0.040
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童年期不良经历的代际延续与农村学龄前儿童认知水平损伤的关联研究
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张安慧 1 , 汪进城 2 , 汪玉芬 2 , 马凯 3 , 孙莹 3
现代预防医学 | 儿少卫生与妇幼保健 2025,52(19): 3543-3547
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(19): 3543-3547
童年期不良经历的代际延续与农村学龄前儿童认知水平损伤的关联研究
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张安慧1, 汪进城2, 汪玉芬2, 马凯3, 孙莹3
作者信息
  • 1.芜湖市妇幼保健院，安徽 芜湖 241000
  • 2.南陵县妇计中心
  • 3.安徽医科大学公共卫生学院儿少卫生与妇幼保健学系/出生人口健康教育部重点实验室，安徽 合肥 230032

    • 张安慧（1978—），女，硕士，副主任医师，研究方向：儿童保健工作

通讯作者:

孙莹，E-mail:
Association between intergenerational continuity of adverse childhood experiences and cognitive impairment in rural preschoolers
An-hui ZHANG1, Jin-cheng WANG2, Yu-fen WANG2, Kai MA3, Ying SUN3
Affiliations
  • Wuhu Maternal and Child Health Hospital, Wuhu, Anhui 241000, China
出版时间: 2025-10-10 doi: 10.20043/j.cnki.MPM.202406031
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摘要
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目的 探讨童年期不良经历（adverse childhood experiences，ACEs）代际延续与学龄前儿童认知水平的关联，为促进学龄前儿童认知健康发展提供理论依据。方法 在安徽省芜湖市某农村地区9所托幼机构共招募450名3～6岁儿童进行认知水平专项调查。采用《简化童年创伤问卷》（Childhood Trauma Questionnaire, Short Form，CTQ-SF）评估母亲ACEs，采用课题组自制问卷评估儿童的ACEs。通过中文版《韦氏幼儿智力量表-第四版》（Wechsler Preschool and Primary Scale of Intelligence，Fourth edition，WPPSI-IV）评估学龄前儿童的认知水平。结果 母亲和儿童均无ACEs暴露、仅母亲ACEs暴露、仅儿童ACEs暴露、母亲和儿童均ACEs暴露（ACEs代际延续）的检出率分别为26.7%、18.9%、31.6%、22.9%。相较于母子均无ACEs暴露的儿童，ACEs代际延续儿童的认知水平得分较低［（103.92±10.00）vs.（100.94±10.01），P=0.001］。调整协变量后的线性回归模型显示，ACEs代际延续与儿童认知水平降低3.34分，显著相关（95%CI：-6.54～-0.14，P=0.04）。结论 ACEs代际延续与儿童认知水平损伤相关。

学龄前儿童  /  代际延续  /  童年期不良经历  /  认知

Objective To explore the association between intergenerational continuity of adverse childhood experiences (ACEs) and preschoolers’ cognitive performance to provide evidence for promoting healthy cognitive development in preschoolers. Methods A total of 450 children aged 3-6 years from 9 kindergartens in the rural area of Wuhu, Anhui Province were selected to enter the survey on cognitive development. The Childhood Trauma Questionnaire Short Form (CTQ-SF) and an investigator-designed questionnaire were employed to measure maternal ACEs and children ACEs, respectively. The Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth edition (WPPSI-IV) was conducted to assess participants’cognitive performance. Results The detection rate was 26.7% for neither maternal nor child ACEs exposure, 18.9% for only maternal ACEs exposure, 31.6% for only child ACEs exposure, and 22.9% for both maternal and child ACEs exposure (intergenerational continuity of ACEs). Compared to children in neither maternal nor child ACEs exposure group, cognitive performance was significantly worse in children with intergenerational continuity of ACEs (103.92±10.00 vs 100.94±10.01, P=0.001). After adjusting for covariates, linear regression models showed that intergenerational continuation of ACEs was significantly associated with a 3.34-point reduction in offspring cognitive performance (95% CI: -6.54~-0.14, P=0.04). Conclusion Intergenerational continuity of ACEs is associated with cognitive impairment in preschoolers.

Preschooler  /  Intergenerational continuity  /  Adverse childhood experiences  /  Cognition
张安慧, 汪进城, 汪玉芬, 马凯, 孙莹. 童年期不良经历的代际延续与农村学龄前儿童认知水平损伤的关联研究. 现代预防医学, 2025 , 52 (19) : 3543 -3547 . DOI: 10.20043/j.cnki.MPM.202406031
An-hui ZHANG, Jin-cheng WANG, Yu-fen WANG, Kai MA, Ying SUN. Association between intergenerational continuity of adverse childhood experiences and cognitive impairment in rural preschoolers[J]. Modern Preventive Medicine, 2025 , 52 (19) : 3543 -3547 . DOI: 10.20043/j.cnki.MPM.202406031
正文
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童年期不良经历（adverse childhood experiences，ACEs）是指个体18岁前，即成年之前经历的，会对身心健康产生不良影响的创伤性事件，包括但不限于情感虐待、躯体虐待、性虐待、情感忽视、躯体忽视等[1]。父母ACEs可增加儿童生长发育不良和躯体健康问题的发生风险。Zhao等[2]和Wang等[3]研究发现，ACEs可能会对儿童认知水平发展产生不良影响，如数学认知测试表现较差和认知相关脑区的异常自发活动等；不良经历的儿童所处于的剥夺性环境也会增加儿童发生语言、运动、社会情感行为方面发育迟缓的的概率[4]。
近年来，研究者们从最初关注ACEs对自身健康的影响，发展到关注ACEs的代际健康效应，ACEs对子代健康的作用已成为当下关注的热点。劣势累积理论[5]（cumulative disadvantage theory）认为，父辈在童年时期经历的不良事件，通过心理、行为、社会或生物学机制，间接或直接地影响下一代子女的身心健康、行为模式或家庭环境，导致类似不良经历重复出现代际延续的现象。以往研究主要集中在不良经历的直接暴露或代际暴露对儿童认知水平的影响[6-7]，较少关注探讨逆境的“双重打击”对儿童认知水平的健康危害效应。为探讨童年期不良经历代际延续对子代认知水平的影响，本研究于2021年对芜湖市某农村地区多家托幼机构的学龄前儿童开展认知水平专项调查，可进一步丰富早期逆境的研究维度，针对性提供开展早期干预以打破虐待经历和健康问题的代际延续。
1　对象与方法
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1.1　对象
2021年5月采用整群抽样方法，在安徽省芜湖市某农村地区招募9所幼儿园建立幼儿发育评估队列，共计2 729名大、中、小班学龄前儿童参与了基线调查。根据知情同意原则，开展父母问卷（问卷星）、主要抚育人问卷调查（纸质问卷）及儿童体格检查。参考基线问卷调查结果，选择中、小班249名自身或母亲有亲子分离经历的儿童，按照性别、年龄（±0.5岁）进行匹配选取自身及母亲均无亲子分离经历的对照儿童235名，共计484名儿童进行认知水平专项评估，中途有34人退出本次调查（因转学、病/事请假、疑似严重智力障碍缺陷或拒绝参与测试等原因），最终评估450名儿童，将其纳入认知发育研究。本研究已通过安徽医科大学伦理委员会审查（批号：20180082）。
1.2　方法
1.2.1　一般人口学特征
包括儿童年龄、性别、出生日期、出生体重、是否早产、家庭结构、家庭经济水平（平均月收入：2 000元/月以下、2 000～4 999元/月、5 000～9 999元/月、10 000元/月及以上）、父母年龄、父母文化程度（初中及以下、高中和本科及以上）等。通过体格检查评估儿童身高、体重并计算身体质量指数（body mass index，BMI），BMI=体重（kg）/身高的二次方（m2）。
1.2.2　母亲童年期不良经历
母亲电子问卷调查，根据《简化童年创伤问卷》[8]（Childhood Trauma Questionnaire, Short Form，CTQ-SF）自我报告ACEs，包括情感虐待、躯体虐待、性虐待、情感忽视、躯体忽视五个维度。该问卷具有良好的信效度，克隆巴赫系数为0.855。每种ACEs被编码为二分类变量（0=否、1=是），将各维度的得分相加得到ACEs总分（得分范围：0～5分），ACEs总分≥ 1分界定为暴露、再将ACEs总分编码为二分类变量（0=无暴露、1=暴露）。
1.2.3　儿童ACEs
由主要抚育人报告学龄前儿童的ACEs。通过自制问卷报告同伴欺凌、躯体虐待、情感虐待、躯体忽视、情感忽视、家庭不良事件、学校不良事件和个人不良事件这八种逆境，问卷具有良好的信效度，克隆巴赫系数为0.632[9]。每种ACEs被编码为二分类变量（0=否、1=是），将所有ACEs的得分相加得到ACEs总分，ACEs总分≥ 1分界定为暴露，再将ACEs总分编码为二分类变量（0=无暴露、1=暴露）。
1.2.4　ACEs的代际传递
根据母亲和儿童的ACEs暴露情况，将学龄前儿童分为四组：母亲和儿童均无ACEs暴露组、仅母亲ACEs暴露组、仅儿童ACEs暴露组、母亲和儿童均有ACEs暴露组。
1.2.5　儿童认知水平评估
由三名受过专业韦氏认知评估训练并通过了实习考核的工作人员使用中文版《韦氏幼儿智力量表-第四版》（Wechsler Preschool and Primary Scale of Intelligence，Fourth edition，WPPSI-IV）评估学龄前儿童的认知水平[10]。WPPSI-IV是当前世界范围内最广泛使用的认知功能衡量标准量表之一，具有较高的信度和效度。WPPSI-IV共包括13个分测验，由于本研究样本量较大，结合3～6岁儿童特征，因此选取常识、类同、图片记忆、积木、找虫、矩阵推理这六个核心分测验作为儿童认知水平评估的测试内容，利用以上测试的粗分及得分标准转换，计算得到总智商得分（full scale intelligent quotient，FSIQ），得分越高意味着受试儿童的认知水平越高。
1.2.6　协变量
儿童性别、年龄、BMI、出生体重、分娩方式（顺产、剖宫产）、是否早产、独生子女、体格生长发育水平、父母年龄、父母最高受教育水平、家庭经济水平、母亲抑郁症状（Patient Health Questionnaire-9，PHQ-9）[11]。
1.3　质量控制
1.3.1　问卷调查
本次调查选择电子问卷和传统问卷共同收集信息。纸质问卷当场填写收集并检查，问卷收集者发现明显错误或缺漏项时会要求填写人改正或补充，电子问卷出现填写质量不合格时调查人员电话联系填写者修改完善。
1.3.2　认知发育评估
三名认知评估人员接受专门培训，并开展预测验。考察合格的主试使用WPPSI-IV配套工具箱进行一对一测试。由托幼机构提供专门的安静且独立的房间，施测时仅有施测人员和受试儿童在场。受试儿童被要求尽可能一次性完成所有6个测试，整个评估过程约50 min。每天评估结束后，评估人员根据操作手册对记分册进行核算粗分，并对有疑问的答案进行讨论，然后登陆评分系统，录入相关信息，得到儿童的认知发育标准得分。
1.4　统计分析
使用Epidata 3.1软件对数据进行录入，使用SPSS 26.0进行数据整理和统计分析。采用方差分析和χ2检验比较不同母子ACEs暴露组别的儿童的年龄、性别、出生体重、BMI、母亲抑郁症状得分、家庭收入、父母受教育水平、认知水平情况等的差异。使用多元线性回归模型评价不同代际ACEs暴露组别与子代认知水平的关联。协变量包括年龄、性别、出生体重、BMI、父母教育水平、家庭收入、母亲抑郁症状得分、是否早产等个体和家庭因素，检验水准α=0.05。
2　结果
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2.1　南陵县学龄前儿童ACEs代际延续现况
450名入组儿童平均年龄为（4.60±0.56）岁，其中男生214人（47.6%），女生236人（52.8%）。母亲ACEs总暴露率为41.8%（188/450），儿童ACEs总暴露率为54.4%（245/450）。ACEs暴露代际延续检出率为22.9%（103/450），仅儿童ACEs暴露检出率为31.6%（142/450），仅母亲ACEs暴露检出率为18.9%（85/450），母子均无ACEs暴露检出率为26.7%（120/450）。未发现ACEs代际延续在儿童性别与年龄存在差异（性别：χ2=3.05，P=0.38；年龄：F=0.28，χ2= 0.84；χ2/F值分别为3.05和0.28，P值均>0.05）。见表1。
2.2　学龄前儿童ACEs不同暴露组别的认知发育比较
母子均无ACEs暴露组、仅母亲ACEs暴露组、仅儿童ACEs暴露组、母子均有ACEs暴露组的儿童的FSIQ得分分别为（105.28±10.28）、（104.13±10.27）、（104.81±9.23）和（100.94±10.01）分，组间差异具有统计学意义（F=4.27，P=0.006）。相较于母子均无ACEs暴露的儿童，母子均有ACEs暴露组的儿童的FSIQ得分显著较低（P=0.001）；在仅母亲ACEs暴露组、仅儿童ACEs暴露组中，未发现统计学差异（P值均>0.05）。见表1。
2.3　不同ACEs代际传递组与学龄前儿童认知发育的关联
在未校正模型中（模型1），不同的代际逆境组别相较于仅母亲有ACEs暴露、仅儿童有ACEs暴露，母子均有ACEs暴露的儿童FSIQ得分降低4.34分（95%CI：-6.95～-1.73，P=0.001）。在调整儿童性别、年龄、BMI、父母年龄、父母最高受教育水平、家庭经济水平、母亲抑郁症状得分等协变量后（模型2），这种关联仍具有统计学意义（β=-3.34，95%CI：-6.54～-0.14，P=0.04）。母子均无ACEs、仅母亲有ACEs、仅儿童有ACEs暴露的三组学龄前儿童认知得分无显著性差异（P>0.05）。见表2。
3　讨论
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当前，受到广泛关注的ACEs代际延续主要类型是童年期虐待与忽视，会导致多种不良结健康结局。本次研究发现，母亲经历一种或一种以上ACEs检出率达41.8%，略低于安徽省合肥市的52%[12]。儿童经历一种或一种以上ACEs的检出率为54.4%，显著高于Giovanelli A等人[13]的研究（32.8%），差异可能与地域及文化背景等相关。现有报道显示，生命早期逆境的危害效应不仅局限于个体层面，还可能传递给子代[14]。本次研究发现，ACEs代际延续对学龄前儿童认知水平产生重要影响。ACEs代际延续会使学龄前儿童认知水平受损，FSIQ下降3.34分，提示发生认知发育迟缓风险较高，这一结果有既往证据支持[15]。有几种潜在的机制可以解释本研究的结果。一方面，在生命早期，尤其是童年期和青春期，是最为重要的生长发育时期，在此期间，应激暴露会塑造母亲应激相关生理系统的反应能力，进而影响其子代健康[16]。另一方面，从生物学角度，生命早期应激暴露会使母亲生殖系统发生表观遗传学改变，在孕期保留下来并传递给子代[17]。对大屠杀幸存群体的研究发现，大屠杀幸存者和他们的后代在FKBP5内含子的相同部位均出现甲基化变异[18]。此外，本研究发现的结果也可能是因为ACEs暴露母亲的敌意养育有关，即ACEs暴露的母亲对儿童的反应能力和对儿童需求做出适当回应的能力降低，从而导致子代神经发育偏离的风险增加[19-20]。
尽管本次研究未发现ACEs代际中断对儿童认知水平的损伤效应，即与母亲和自身均无ACEs的儿童相比，仅母亲ACEs暴露、仅儿童ACEs暴露的三组学龄前儿童认知水平得分无统计学差异。这与一项141 000名儿童的研究结果相类似，数据显示，亲子分离儿童在数学、中文及英语的化测试中的得分和与父母双方居住在一起的儿童得分无差异[21]。表明有ACEs儿童可能并非如想象中的脆弱，母亲生命早期ACEs不良效应的代际延续并非是不可逆的。提示笔者未来需进一步深入开展 ACEs与儿童身心健康关联的机制研究，了解ACEs代际延续和健康效应，以指导围产期研究和临床实践。但本研究结果与产前编程框架和创伤代际传递理论相呼应[22-24]，即母亲ACEs暴露的不良效应可能会延伸至子代。本研究的发现具有重要的公共卫生意义，为探讨ACEs与儿童早期发育的关联提供了新的视角——代际。鉴于收集母亲及其子代的ACEs信息相对方便可行，笔者建议在孕检或儿童保健门诊常规体检中收集相关信息，以便风险分层，做到早发现、早干预，促进儿童早期发展。
本研究基于农村地区建立的亲子队列，根据研究样本年龄段特征，通过父母电子版问卷、主要抚育人纸质版问卷，以及韦氏智力测试等调查方法，且调整了家庭经济地位、儿童体格发育情况和父母受教育水平等重要协变量，较好的保证了研究结果的可靠性。这项研究为ACEs的代际延续研究提供了新的视角。本研究也存在一定局限性：（1）由于为横断面研究，研究结果可能会受到回忆偏倚的影响，或在因果推断上的无法排除反省因果。（2）ACEs代际延续的个体样本量较小，调查样本为安徽省芜湖市某农村地区的学龄前儿童，因此结论的普遍性可能较为局限。（3）本研究缺乏关于父亲的ACEs数据的收集，将在后续研究中完善，对ACEs的代际连续性/非连续性提出更全面的见解。
基金
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  • 2022年度出生人口健康教育部重点实验室开放课题(JKZD20222)
文献
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doi: 10.20043/j.cnki.MPM.202406031
  • 接收时间：2024-06-03
  • 首发时间：2026-03-17
  • 出版时间：2025-10-10
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  • 收稿日期：2024-06-03
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2022年度出生人口健康教育部重点实验室开放课题(JKZD20222)
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    1.芜湖市妇幼保健院，安徽 芜湖 241000
    2.南陵县妇计中心
    3.安徽医科大学公共卫生学院儿少卫生与妇幼保健学系/出生人口健康教育部重点实验室，安徽 合肥 230032

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