DeStefano F, Chen R T
National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia 30341-3724, USA.
CNS Drugs. 2001;15(11):831-7. doi: 10.2165/00023210-200115110-00002.
It has been suggested that vaccination, particularly with measles-mumps-rubella (MMR) vaccine, may be related to the development of autism. The main evidence for a possible association is that the prevalence of autism has been increasing at the same time that infant vaccination coverage has increased, and that in some cases there is an apparent temporal association in which autistic characteristics are first noted shortly after vaccination. Although the prevalence of autism and similar disorders appears to have increased recently, it is not clear if this is an actual increase or the result of increased recognition and changes in diagnostic criteria. The apparent onset of autism in close proximity to vaccination may be a coincidental temporal association. The clinical evidence in support of an association derives from a series of 12 patients with inflammatory bowel conditions and regressive developmental disorders, mostly autism. The possibility that measles vaccine may cause autism through a persistent bowel infection has generated much interest, since it provides a possible biological mechanism. Epidemiological studies, however, have not found an association between MMR vaccination and autism. The epidemiological findings are consistent with current understanding of the pathogenesis of autism, which has a strong genetic component and in which the neurological defects probably occur early in embryonic development. It seems unlikely that a vaccination that is given after birth could cause autism. A minority of cases of autism may have onset after 1 year of age (regressive autism), but the single epidemiological study that included such cases did not find an association with MMR vaccination. Currently, the weight of the available epidemiological and related evidence does not support a causal association between MMR vaccine, or any other vaccine or vaccine constituent, and autism.
有人提出，接种疫苗，尤其是麻疹-腮腺炎-风疹（MMR）疫苗，可能与自闭症的发生有关。可能存在关联的主要证据是，自闭症的患病率在婴儿疫苗接种覆盖率上升的同时也在增加，而且在某些情况下，存在明显的时间关联，即自闭症特征在接种疫苗后不久首次被发现。尽管自闭症和类似疾病的患病率最近似乎有所上升，但尚不清楚这是实际的增加还是由于认识的提高和诊断标准的变化所致。自闭症在接种疫苗后不久明显出现，可能只是一种巧合的时间关联。支持这种关联的临床证据来自一系列12例患有炎症性肠病和退行性发育障碍（主要是自闭症）的患者。麻疹疫苗可能通过持续性肠道感染导致自闭症的可能性引起了广泛关注，因为它提供了一种可能的生物学机制。然而，流行病学研究并未发现MMR疫苗接种与自闭症之间存在关联。流行病学研究结果与目前对自闭症发病机制的理解一致，自闭症具有很强的遗传成分，神经缺陷可能在胚胎发育早期就已出现。出生后接种的疫苗似乎不太可能导致自闭症。少数自闭症病例可能在1岁以后发病（退行性自闭症），但纳入此类病例的唯一一项流行病学研究并未发现与MMR疫苗接种有关联。目前，现有流行病学及相关证据的权重并不支持MMR疫苗或任何其他疫苗及疫苗成分与自闭症之间存在因果关联。
