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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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母亲使用乙氨基和儿童神经发育

Pei-Chen Lee1, Yu-Hsuan Chuang1, Ya-Hui Hu1

  • 1Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

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怀孕期间母亲使用乙氨基显示出与后代ADHD和ASD在一个大队列中的关联. 然而,兄弟分析显示没有联系,这表明未解决的偏见可能会影响对乙氨基和神经发育结果的发现.

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科学领域:

  • 神经发育障碍 神经发育障碍
  • 围产期药理学 围产期药理学
  • 流行病学 流行病学

背景情况:

  • 孕妇在怀孕期间使用乙氨基是常见的,但与其与ADHD和ASD等后代神经发育结果的关联仍然存在争议.
  • 之前的研究已经产生了相互矛盾的结果,强调了需要强大的研究设计来解决混因素.

研究的目的:

  • 调查母亲产前乙氨基处方与后代注意力缺陷/多动障碍 (ADHD) 和自闭症谱系障碍 (ASD) 风险之间的关联.
  • 用完整的队列和兄弟匹配分析来评估这些关联,以控制遗传和环境因素.

主要方法:

  • 台湾的一项大型队列研究分析了2,092,926个单独出生 (2004-2015年),其中1,231,819个子集至少有一个兄弟姐妹.
  • 从国家健康保险研究数据库中提取了母亲的乙氨基处方,将使用定义为怀孕期间至少两个处方记录.
  • 确定后代的ADHD和ASD诊断,并计算危险比率 (HRs),调整混因子并进行兄弟匹配和双向分析.

主要成果:

  • 在整个队列中,产前对乙氨基的处方与后代多动症和自闭症的风险增加有关,特别是在更高的频率或剂量时.
  • 然而,与兄弟姐妹匹配的分析显示,产前乙氨基暴露与这些神经发育障碍之间没有关联.
  • 双向兄弟姐妹分析显示出差异,只有较大的兄弟姐妹暴露时出现积极关联,只有较小的兄弟姐妹暴露时出现负面关联.

结论:

  • 虽然完整的队列分析表明,母亲使用乙氨基和后代ADHD/ASD之间存在联系,但与兄弟姐妹匹配的分析并不支持这种联系.
  • 兄弟分析中的不同发现表明潜在的未解决的偏见来源,使得最终的结论变得复杂.
  • 需要进一步的研究来澄清产前乙氨基暴露与后代神经发育结果之间的复杂关系.