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Article(id=1324078277308064186, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509014, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1756656000000, receivedDateStr=2025-09-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614461495, onlineDateStr=2026-11-02, pubDate=1769270400000, pubDateStr=2026-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614461495, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614461495, creator=13701087609, updateTime=1793614461495, updator=13701087609, issue=Issue{id=1324078175000605624, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='1769270400000', pubDateStr='2026-01-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614437103, creator='13701087609', updateTime=1793614526046, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078548130082942, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078548130082943, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=322, endPage=326, ext={EN=ArticleExt(id=1324078277635219899, articleId=1324078277308064186, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=An association study of adverse childhood experiences and cognitive function in middle-aged and older adults based on latent class analysis, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the separate associations of cumulative ACEs exposure and specific ACEs patterns with cognitive function among middle-aged and older adults.

Methods

Using data from the China Health and Retirement Longitudinal Study (2011-2020), 12 ACE indicators were included. Linear mixed-effects model was employed to analyze the longitudinal effects of the cumulative number of ACEs and ACE patterns on cognitive function, with ACEs patterns identified using latent class analysis.

Results

Compared with those who did not experience ACEs, those who experienced ≥4 ACEs had a faster decline in cognitive function (β=-0.029, 95% CI: -0.045--0.012). Latent class analysis identified four ACE patterns: low ACEs, domestic abuse and bullying, emotional and physical neglect, and parental mental illness and death. Among these, the “parental mental illness and death” subgroup experienced faster cognitive decline than the low ACEs group (β=-0.018, 95% CI: -0.027--0.008).

Conclusion

Both cumulative ACEs exposure and specific adversity patterns are associated with accelerated cognitive decline in middle-aged and older adults. Individuals who have experienced ≥4 ACEs and parental mental illness and death require particular attention.

, authors=Rui MA, Xiao-yue JIANG, Meng-qi ZHOU, Si-ran CHEN, Yu-ling DU, Zi-yi YANG, Yan-fang YANG, authorsList=Rui MA, Xiao-yue JIANG, Meng-qi ZHOU, Si-ran CHEN, Yu-ling DU, Zi-yi YANG, Yan-fang YANG, authorCompany=null, correspAuthors=Yan-fang YANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078278381806016, articleId=1324078277308064186, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于潜在类别分析的童年不良经历和中老年人认知功能的关联研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

分析童年不良经历（Adverse Childhood Experiences，ACEs）累计事件数及经历模式对中老年人认知功能的影响。

方法

利用2011—2020年中国健康与养老追踪调查数据，纳入12种ACEs，采用线性混合效应模型，分别分析累计事件数和ACEs模式对认知功能的纵向影响，ACEs模式通过潜在类别分析方法进行识别。

结果

与未经历ACEs者相比，经历≥4种ACEs的中老年人认知功能下降更快（β=-0.029，95% CI：-0.045~-0.012）。潜在类别分析识别出4类ACEs模式：低逆境、家暴和霸凌、情感和身体忽视以及父母精神疾病和死亡，其中父母精神疾病及死亡组认知功能下降比低逆境组更快（β=-0.018，95% CI：-0.027~-0.008）。

结论

经历4种及以上ACEs及特定的ACEs模式与中老年认知功能下降有关，提示尤其要重点关注父母患精神疾病和死亡经历者的认知功能。

, authors=马蕊, 蒋晓悦, 周梦琦, 陈思燃, 杜昱玲, 杨子乙, 杨艳芳, authorsList=马蕊, 蒋晓悦, 周梦琦, 陈思燃, 杜昱玲, 杨子乙, 杨艳芳, authorCompany=null, correspAuthors=杨艳芳, authorNote=

马蕊（2000—），女，硕士在读，研究方向：慢性病流行病学

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杨艳芳，E-mail:
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JAMA Pediatrics, 2024, 178(7): 678-687., articleTitle=Patterns of adverse childhood experiences and neurocognitive development, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324078278654435777, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, xref=null, ext=[AuthorCompanyExt(id=1324078278675407298, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, companyId=1324078278654435777, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1324078278687990211, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, companyId=1324078278654435777, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院／四川大学华西第四医院流行病与卫生统计学系，四川 成都 610041)])], figs=[ArticleFig(id=1324078283633074669, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, language=EN, label=Fig.1, caption=Probability of each adverse experience for each class, figureFileSmall=+e4Itv6P2/w93HYygfxM0Q==, figureFileBig=SYmvWe8qH/YVZy+vyN1k2A==, tableContent=null), ArticleFig(id=1324078283737932270, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, language=CN, label=图1, caption=每种经历模式中各种不良事件的发生概率, figureFileSmall=+e4Itv6P2/w93HYygfxM0Q==, figureFileBig=SYmvWe8qH/YVZy+vyN1k2A==, tableContent=null), ArticleFig(id=1324078284010562031, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, language=EN, label=Table 1, caption=

Baseline characteristics of participants with different ACEs patterns

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特征低逆境
(n=7 395)		家暴和霸凌
(n=195)		情感和身体忽视
(n=251)		父母精神疾病和死亡(n=396)χ2值P值
性别[n(%)]2.3860.496
男性3 579(48.4)99(50.8)114(45.4)202(51.0)
女性3 816(51.6)96(49.2)137(54.6)194(49.0)
年龄[岁，n(%)]37.643<0.001
45~594 341(58.7)140(71.8)139(55.4)186(47.0)
60~742 672(36.1)50(25.6)96(38.2)184(46.5)
≥75382(5.2)5(2.6)16(6.4)26(6.6)
受教育程度[n(%)]101.372<0.001
小学及以下2 913(39.4)90(46.2)116(46.2)253(63.9)
初高中4 348(58.8)99(50.8)132(52.6)138(34.8)
大学及以上134(1.8)6(3.1)3(1.2)5(1.3)
婚姻状况[n(%)]16.0420.014
结婚或同居6 653(90.0)180(92.3)214(85.3)341(86.1)
离婚或分居或守寡694(9.4)15(7.7)35(13.9)49(12.4)
未婚48(0.6)0(0.0)2(0.8)6(1.5)
童年社会经济状况[n(%)]14.5330.024
低3 551(53.7)91(50.3)115(54.0)217(63.6)
中2 667(40.3)79(43.6)85(39.9)111(32.6)
高395(6.0)11(6.1)13(6.1)13(3.8)
), ArticleFig(id=1324078284178334192, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, language=CN, label=表1, caption=

不同ACEs模式研究对象的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征低逆境
(n=7 395)		家暴和霸凌
(n=195)		情感和身体忽视
(n=251)		父母精神疾病和死亡(n=396)χ2值P值
性别[n(%)]2.3860.496
男性3 579(48.4)99(50.8)114(45.4)202(51.0)
女性3 816(51.6)96(49.2)137(54.6)194(49.0)
年龄[岁，n(%)]37.643<0.001
45~594 341(58.7)140(71.8)139(55.4)186(47.0)
60~742 672(36.1)50(25.6)96(38.2)184(46.5)
≥75382(5.2)5(2.6)16(6.4)26(6.6)
受教育程度[n(%)]101.372<0.001
小学及以下2 913(39.4)90(46.2)116(46.2)253(63.9)
初高中4 348(58.8)99(50.8)132(52.6)138(34.8)
大学及以上134(1.8)6(3.1)3(1.2)5(1.3)
婚姻状况[n(%)]16.0420.014
结婚或同居6 653(90.0)180(92.3)214(85.3)341(86.1)
离婚或分居或守寡694(9.4)15(7.7)35(13.9)49(12.4)
未婚48(0.6)0(0.0)2(0.8)6(1.5)
童年社会经济状况[n(%)]14.5330.024
低3 551(53.7)91(50.3)115(54.0)217(63.6)
中2 667(40.3)79(43.6)85(39.9)111(32.6)
高395(6.0)11(6.1)13(6.1)13(3.8)
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Association between cumulative number of ACEs and cognitive function

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ACEs事件数β系数 (95%CI)
模型1模型2
0[参照组][参照组]
1-0.147(-0.193~-0.102)-0.023(-0.061~0.016)
2-0.187(-0.251~-0.123)-0.053(-0.106~0.001)
3-0.319(-0.424~-0.213)-0.051(-0.140~0.038)
≥4-0.191(-0.349~-0.033)0.081(-0.053~0.216)
时间-0.029(-0.031~-0.026)-0.029(-0.032~-0.026)
0a 时间[参照组][参照组]
1a 时间-0.004(-0.008~0.001)-0.004(-0.008~0.001)
2a 时间-0.007(-0.014~-0.001)-0.003(-0.010~0.003)
3a 时间-0.006(-0.017~0.004)-0.010(-0.021~0.001)
≥4a 时间-0.026(-0.041~-0.011)-0.029(-0.045~-0.012)
), ArticleFig(id=1324078284379660786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, language=CN, label=表2, caption=

ACEs事件数和认知功能的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
ACEs事件数β系数 (95%CI)
模型1模型2
0[参照组][参照组]
1-0.147(-0.193~-0.102)-0.023(-0.061~0.016)
2-0.187(-0.251~-0.123)-0.053(-0.106~0.001)
3-0.319(-0.424~-0.213)-0.051(-0.140~0.038)
≥4-0.191(-0.349~-0.033)0.081(-0.053~0.216)
时间-0.029(-0.031~-0.026)-0.029(-0.032~-0.026)
0a 时间[参照组][参照组]
1a 时间-0.004(-0.008~0.001)-0.004(-0.008~0.001)
2a 时间-0.007(-0.014~-0.001)-0.003(-0.010~0.003)
3a 时间-0.006(-0.017~0.004)-0.010(-0.021~0.001)
≥4a 时间-0.026(-0.041~-0.011)-0.029(-0.045~-0.012)
), ArticleFig(id=1324078286074159603, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, language=EN, label=Table 3, caption=

Association of ACEs patterns with cognitive function

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ACEs事件数β系数 (95%CI)
模型1模型2
低逆境[参照组][参照组]
家暴和霸凌0.009(-0.123~0.141)0.010(-0.098~0.118)
情感和身体忽视-0.158(-0.276~-0.041)-0.052(-0.152~0.047)
父母精神疾病和死亡-0.262(-0.356~-0.168)0.008(-0.072~0.088)
时间-0.030(-0.032~-0.028)-0.030(-0.032~-0.028)
低逆境a 时间[参照组][参照组]
家暴和霸凌a 时间0.000 3(-0.012~0.013)-0.003(-0.016~0.01)
情感和身体忽视a 时间-0.004(-0.016~0.007)-0.002(-0.014~0.01)
父母精神疾病和死亡a 时间-0.018(-0.027~-0.008)-0.018(-0.027~-0.008)
), ArticleFig(id=1324078286195794420, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078277308064186, language=CN, label=表3, caption=

不同ACEs模式和认知功能的关联

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ACEs事件数β系数 (95%CI)
模型1模型2
低逆境[参照组][参照组]
家暴和霸凌0.009(-0.123~0.141)0.010(-0.098~0.118)
情感和身体忽视-0.158(-0.276~-0.041)-0.052(-0.152~0.047)
父母精神疾病和死亡-0.262(-0.356~-0.168)0.008(-0.072~0.088)
时间-0.030(-0.032~-0.028)-0.030(-0.032~-0.028)
低逆境a 时间[参照组][参照组]
家暴和霸凌a 时间0.000 3(-0.012~0.013)-0.003(-0.016~0.01)
情感和身体忽视a 时间-0.004(-0.016~0.007)-0.002(-0.014~0.01)
父母精神疾病和死亡a 时间-0.018(-0.027~-0.008)-0.018(-0.027~-0.008)
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基于潜在类别分析的童年不良经历和中老年人认知功能的关联研究
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马蕊 , 蒋晓悦 , 周梦琦 , 陈思燃 , 杜昱玲 , 杨子乙 , 杨艳芳
现代预防医学 | 健康与社会行为 2026,53(2): 322-326
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现代预防医学 |健康与社会行为 2026 , 53 (2) : 322 -326
基于潜在类别分析的童年不良经历和中老年人认知功能的关联研究
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马蕊, 蒋晓悦, 周梦琦, 陈思燃, 杜昱玲, 杨子乙, 杨艳芳
作者信息
  • 四川大学华西公共卫生学院／四川大学华西第四医院流行病与卫生统计学系，四川 成都 610041
通讯作者:
杨艳芳，E-mail:
作者简介:

马蕊（2000—），女，硕士在读，研究方向：慢性病流行病学

An association study of adverse childhood experiences and cognitive function in middle-aged and older adults based on latent class analysis
Rui MA, Xiao-yue JIANG, Meng-qi ZHOU, Si-ran CHEN, Yu-ling DU, Zi-yi YANG, Yan-fang YANG
Affiliations
  • Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-01-25 doi: 10.20043/j.cnki.MPM.202509014
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摘要
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目的

分析童年不良经历（Adverse Childhood Experiences，ACEs）累计事件数及经历模式对中老年人认知功能的影响。

方法

利用2011—2020年中国健康与养老追踪调查数据，纳入12种ACEs，采用线性混合效应模型，分别分析累计事件数和ACEs模式对认知功能的纵向影响，ACEs模式通过潜在类别分析方法进行识别。

结果

与未经历ACEs者相比，经历≥4种ACEs的中老年人认知功能下降更快（β=-0.029，95% CI：-0.045~-0.012）。潜在类别分析识别出4类ACEs模式：低逆境、家暴和霸凌、情感和身体忽视以及父母精神疾病和死亡，其中父母精神疾病及死亡组认知功能下降比低逆境组更快（β=-0.018，95% CI：-0.027~-0.008）。

结论

经历4种及以上ACEs及特定的ACEs模式与中老年认知功能下降有关，提示尤其要重点关注父母患精神疾病和死亡经历者的认知功能。

童年不良经历  /  认知功能  /  潜在类别分析
Objective

To investigate the separate associations of cumulative ACEs exposure and specific ACEs patterns with cognitive function among middle-aged and older adults.

Methods

Using data from the China Health and Retirement Longitudinal Study (2011-2020), 12 ACE indicators were included. Linear mixed-effects model was employed to analyze the longitudinal effects of the cumulative number of ACEs and ACE patterns on cognitive function, with ACEs patterns identified using latent class analysis.

Results

Compared with those who did not experience ACEs, those who experienced ≥4 ACEs had a faster decline in cognitive function (β=-0.029, 95% CI: -0.045--0.012). Latent class analysis identified four ACE patterns: low ACEs, domestic abuse and bullying, emotional and physical neglect, and parental mental illness and death. Among these, the “parental mental illness and death” subgroup experienced faster cognitive decline than the low ACEs group (β=-0.018, 95% CI: -0.027--0.008).

Conclusion

Both cumulative ACEs exposure and specific adversity patterns are associated with accelerated cognitive decline in middle-aged and older adults. Individuals who have experienced ≥4 ACEs and parental mental illness and death require particular attention.

Adverse childhood experiences  /  Cognitive function  /  Latent class analysis
马蕊, 蒋晓悦, 周梦琦, 陈思燃, 杜昱玲, 杨子乙, 杨艳芳. 基于潜在类别分析的童年不良经历和中老年人认知功能的关联研究. 现代预防医学, 2026 , 53 (2) : 322 -326 . DOI: 10.20043/j.cnki.MPM.202509014
Rui MA, Xiao-yue JIANG, Meng-qi ZHOU, Si-ran CHEN, Yu-ling DU, Zi-yi YANG, Yan-fang YANG. An association study of adverse childhood experiences and cognitive function in middle-aged and older adults based on latent class analysis[J]. Modern Preventive Medicine, 2026 , 53 (2) : 322 -326 . DOI: 10.20043/j.cnki.MPM.202509014
正文
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人口老龄化使得年龄相关疾病成为了重要的公共卫生问题，在中国有超过20%的老年人被诊断为轻度认知障碍，给家庭和社会带来了沉重负担[1]。现有研究显示认知功能受到社会、心理、生理等多方面的复杂影响，全生命周期危险因素识别及控制的策略受到了越来越多关注[2]。
生命早期是大脑发育的关键时期，童年时期的不良经历（Adverse Childhood Experiences, ACEs）可能会对个体成年后的认知功能产生影响[3]。已有研究发现，ACEs与成年期认知能力下降及发生痴呆风险之间存在关联[4-6]，这可能是因为早期生活经历会塑造大脑的结构和功能，从而影响大脑在晚年时的神经可塑性和认知能力[7]。但多数研究采用累计经历不良事件的数目来衡量童年逆境的暴露，这种方法假设所有ACEs事件对认知功能的影响相等，可能会忽视特定经历的影响[8]。近年来，研究者开始将潜类别分析（Latent Class Analysis, LCA）应用于ACEs相关研究中，LCA是一种数据驱动的方法，旨在识别经历相似逆境模式的潜在亚群，相比于传统研究方法，这种方法有助于更精确地描述童年逆境的发生模式，从而为ACEs的预防和干预提供更具针对性和更有效的策略[9]。
本研究利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）数据，旨在从ACEs累计事件数和特定ACEs暴露模式两方面，探究ACEs与认知功能的纵向关联，为中老年人认知功能障碍的防控提供科学依据。
1　资料与方法
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1.1　研究对象
CHARLS是一项针对中老年人的全国代表性综合队列研究，涵盖中国28个省（自治区、直辖市）、150个县（区），每两年进行一次常规随访。本研究使用2011年基线调查，2014年生命历程调查（包括童年经历），以及2013年、2015年、2018年、2020年的随访调查数据进行分析。纳入标准：①基线年龄≥45岁；②除基线调查外，至少进行了一次随访。排除标准包括：①基线认知功能测量不完整；②ACEs相关测量缺失；③有中风或精神疾病史或基线认知z分数低于P5。最终纳入5 168名研究对象。CHARLS项目经北京大学伦理委员会审查，研究对象均签署知情同意书（批准文号：IRB00001052-11015）。
1.2　主要分析指标和定义
1.2.1　童年不良经历
通过问卷调查获取，包括参与者17岁前经历的12项紧张和创伤事件，具体为6个家庭功能失调事件（父母药物滥用、父母精神疾病、父母间暴力、父母犯罪、父母离婚或分居、父母死亡），3个忽视和虐待事件（身体忽视、情感忽视、身体虐待），3个其他事件（遭遇饥荒、不安全居住环境、霸凌）。每个指标被二分类并编码为0（不存在）和1（存在）。
1.2.2　认知功能
使用认知状态电话访谈量表[10]的改编版本，测量定向力、计算力、视空间能力、情景记忆几个方面以评估认知功能，得分为0~21分，分数越高表示认知功能越好。分析中将原始得分转换为z分数。
1.2.3　协变量
基于研究假设，参考既往研究选择混杂变量，包括基线时的性别、年龄、受教育水平、婚姻状况、童年社会经济状况。其中童年社会经济状况结合父母受教育程度和参与者童年户口判断[11]。
1.3　统计学分析
1.3.1　描述性分析
连续性变量用表示，分类变量用频数（构成比）表示，使用student t检验和χ2检验作组间差异性分析，双侧检验，检验水准α=0.05。
1.3.2　潜在类别分析
为了识别不同ACEs模式，本研究对不良经历指标进行LCA分析。通过赤池信息准则（AIC）和贝叶斯信息准则（BIC）对潜在类别模型的拟合效果进行评价；Vuong-Lo-Mendell-Rubin调整似然比检验（VLMR-LRT）和基于Bootstrap的似然比检验（BLRT）用于检验模型中类别数量的显著性；此外信息熵（Entroph）用于评估分类的质量。综合考虑以上参数及模型的可解释性，选出最优分类数。
1.3.3　关联性分析
使用线性混合效应模型分别评估ACEs事件数和ACEs模式与认知功能的关联，并纳入ACEs与随访时间的交互项，着重评估其与认知功能下降速率的关联。构建未调整的模型1（仅纳入ACEs、时间、时间与ACEs的交互项）、完全调整的模型2（调整年龄、性别、童年社会经济状况、受教育水平、婚姻状况）进行分析，并进一步按性别进行分层分析。模型的固定效应包括时间、ACEs、协变量、时间与ACEs的交互项，同时通过纳入个体水平的随机截距来解释个体间差异。使用R 4.3.1软件进行统计学分析。
2　结果
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2.1　研究对象基本情况及ACEs模式识别
本研究共纳入8 237人，基线平均年龄为（58.46±8.92）岁，平均随访年限为7.42年。纳入人群中有50.6%没有经历过任何ACEs，31.7%经历过1种，12.2%经历过2种，3.9%经历过3种，1.7%经历过4种及以上。LCA分析综合各项指标选择4类ACEs模式作为最终模型，其AIC和BIC为各模型中最小，信息熵为0.77是各模型中最大，VLMR-LRT和BLRT的P值均<0.05。图1展示了4类ACEs模式中每种ACE的条件概率，根据主要的ACEs来标记4种类别：第1类经历任何ACE的概率都低，标记为“低逆境”；第2类身体虐待、父母间暴力和霸凌的概率较高，标记为“家暴和霸凌”；第3类父母对子女的情感和身体忽视概率较高，标记为“情感和身体忽视”；第4类父母精神疾病和父母死亡的概率较高，标记为“父母精神疾病和死亡”。基线基本人口学特征在4种潜在类别间的分布见表1。
2.2　童年不良经历与认知功能的关联
按ACEs的累计事件数分析其与认知功能下降的关联，各组在基线时认知功能无差异。与未经历过ACE相比，经历≥4种ACEs的参与者在随访期间认知功能下降更快（β=-0.029, 95% CI:-0.045~-0.012），在男性和女性中均是如此。
按ACEs的潜在类别分析，各组在基线时认知功能无差异。在随访中与“低逆境”组相比，仅有“父母精神疾病和死亡”组显示出更快的认知功能下降（β=-0.018 , 95% CI:-0.027~-0.008），性别分层分析与主分析结果一致。未观察到其他ACEs模式与“低逆境”组认知功能下降速率的差异。
3　讨论
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本研究结果显示经历≥4种ACEs的人群及暴露于“父母精神疾病和死亡”的人群，认知功能下降更快，且在不同性别间结论一致。这一结果支持了童年逆境事件数的累积效应，同时表明不同类型的ACEs模式可能对认知功能产生不同影响。
ACEs累计事件数和神经及精神疾病的关系已被广泛报道[5-6,12-13]，本研究再次证实了与未经历ACEs的群体相比，经历过≥4种ACEs的群体中老年时认知功能下降更快。ACEs和认知功能的关联可能由多种机制介导：生物学层面，ACEs可能导致下丘脑-垂体-肾上腺轴失调及循环皮质醇水平异常，从而影响认知障碍和阿尔兹海默症发生，此外ACEs还可能导致肠道微生物组改变、少突胶质细胞功能障碍和髓鞘形成不足和异常的成人海马神经发生，这些病理过程可能相互作用，导致不良神经结局[14]。心理社会层面，ACEs可通过影响成年后的社交情况、健康行为及躯体健康状况间接作用于认知功能[5,11]。尽管本研究结果与多数ACEs相关研究一致，但也有部分研究得出了相反的结论，例如“英国老龄化纵向研究”和“KHANDLE研究”等队列研究未发现关联或仅发现ACEs与部分认知功能下降的关联[15-16]。这些差异可能源于：①研究人群社会经济背景差异；②ACE定义差异：本研究纳入了更符合中国背景的指标（如遭遇饥荒、不良邻里关系、霸凌），这些事件在中国文化背景下影响可能更深远[17]。此外，经历1~3种ACEs的人群未观察到认知功能下降，这提示ACEs的影响可能存在效应阈值，在精神病学相关研究中通常用风险累积效应来解释[18]。但仅以ACEs事件数量衡量风险，假设所有事件的影响等效，可能存在一定偏倚，关注特定事件及其组合也是十分重要的。
本研究通过LCA进一步识别了“父母精神疾病和死亡”组为认知下降的高风险人群，该亚组属于对塑造认知发展尤为重要的剥夺维度，既往研究显示剥夺相关ACEs与更差的认知相关，独立于威胁维度的经历[11,19-20]。然而，部分西方研究未发现父母精神疾病或死亡对认知的负面影响[4]，提示文化背景的调节作用：中国文化中家庭结构与亲属支持的重要性可能放大此类不良事件的心理健康长期影响；而发达国家对孤儿更完善的社会保障可能缓冲其不利后果。
本研究存在一些局限性，首先ACEs的测量可能存在回忆偏倚和测量不全（如，未涉及性虐待这一敏感问题；未调查发生ACEs的具体时间和频次）；且在长达多年的随访过程中，部分参与者失访所引起的数据缺失，也可能引入选择偏倚。其次LCA分析所得“家暴和霸凌”类别仅195人（2.4%），可能影响该类别结果的稳定性；此外由于随机斜率模型无法收敛，我们使用随机截距模型进行了分析，忽略了个体间随时间变化速率的潜在差异；最后，尽管本研究已对重要混杂因素进行了调整，但不能完全排除未知或未测量的残余混杂因素对结果的可能影响。综上所述，本研究揭示了ACEs与中老年人认知功能衰退的长期关联，尤其是通过LCA识别出“父母精神疾病和死亡组”这一高风险暴露模式，提示不仅ACEs事件数重要，特定的事件类型也很重要。研究结果强调减少ACEs发生，并针对高风险的ACEs模式进行干预，可能更好的预防和缓解认知衰老。

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doi: 10.20043/j.cnki.MPM.202509014
  • 接收时间：2025-09-01
  • 首发时间：2026-11-02
  • 出版时间：2026-01-25
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    四川大学华西公共卫生学院／四川大学华西第四医院流行病与卫生统计学系，四川 成都 610041

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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