Sreedharan Raman, Mehta Devendra I
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatrics. 2004 Apr;113(4 Suppl):1044-50.
The developing gastrointestinal tract from conception to adolescence is in constant direct interaction with an increasingly complex environment. This sets up the potential for unrecognized acute as well as chronic disorders, some of which may be difficult to pinpoint in a developing infant and child, given the wide variations that exist. It is startling to note how early some environmental toxins can come into contact with the developing human, where vulnerability may be heightened and maturation of detoxifying pathways may be incomplete. Although the complex process of recognizing, detoxifying, and avoiding the toxic substance by the body has presumably evolved over a substantial period of time, in this rapidly changing world, the array of novel toxins that make their way into the gastrointestinal tract is increasing. There remain many gaps in understanding the effects of environmental toxins on all of the developmental stages from conception to adolescence. Although threshold levels have typically been derived from adult or animal data, factors such as size, relative differences in consumption in proportion to size especially in infancy, and variable physiologic maturation of metabolic pathways are not well understood. The vulnerability may be further accentuated by physical factors that alter with maturity, such as permeability and critical times during organogenesis or organ maturation. Also of concern is how little is known about low-dose, long-term exposure, as well as any interplay with common illnesses. This article focuses on environmental toxins that have been shown to have toxic effects on the gastrointestinal tract.
从受孕到青春期,发育中的胃肠道始终与日益复杂的环境直接相互作用。这就产生了出现未被识别的急性和慢性疾病的可能性,鉴于存在的广泛差异,其中一些疾病可能难以在发育中的婴幼儿身上准确查明。值得注意的是,一些环境毒素在人类发育早期就可能与之接触,此时人体的易感性可能会增加,解毒途径的成熟可能也不完全。尽管人体识别、解毒和避免有毒物质的复杂过程可能在很长一段时间内不断进化,但在这个快速变化的世界里,进入胃肠道的新型毒素种类正在增加。在理解环境毒素对从受孕到青春期所有发育阶段的影响方面,仍存在许多空白。尽管阈值水平通常来自成人或动物数据,但诸如体型、尤其是婴儿期按体型比例计算的摄入量相对差异以及代谢途径的可变生理成熟度等因素,目前还没有得到很好的理解。随着成熟度而改变的身体因素,如通透性以及器官发生或器官成熟过程中的关键时期,可能会进一步加剧这种易感性。同样令人担忧的是,对于低剂量、长期接触以及与常见疾病的任何相互作用,我们知之甚少。本文重点关注已被证明对胃肠道有毒性作用的环境毒素。