Levy Richard J
Department of Anesthesiology, Columbia University Medical Center, 622 W. 168th Street, New York, NY 10032, United States.
Neurotoxicol Teratol. 2015 May-Jun;49:31-40. doi: 10.1016/j.ntt.2015.03.001. Epub 2015 Mar 13.
Although an association between air pollution and adverse systemic health effects has been known for years, the effect of pollutants on neurodevelopment has been underappreciated. Recent evidence suggests a possible link between air pollution and neurocognitive impairment and behavioral disorders in children, however, the exact nature of this relationship remains poorly understood. Infants and children are uniquely vulnerable due to the potential for exposure in both the fetal and postnatal environments during critical periods in development. Carbon monoxide (CO), a common component of indoor and outdoor air pollution, can cross the placenta to gain access to the fetal circulation and the developing brain. Thus, CO is of particular interest as a known neurotoxin and a potential public health threat. Here we review overt CO toxicity and the policies regulating CO exposure, detail the evidence suggesting a potential link between CO-associated ambient air pollution, tobacco smoke, and learning and behavioral abnormalities in children, describe the effects of subclinical CO exposure on the brain during development, and provide mechanistic insight into a potential connection between CO exposure and neurodevelopmental outcome. CO can disrupt a number of critical processes in the developing brain, providing a better understanding of how this specific neurotoxin may impair neurodevelopment. However, further investigation is needed to better define the effects of perinatal CO exposure on the immature brain. Current policies regarding CO standards were established based on evidence of cardiovascular risk in adults with pre-existing comorbidities. Thus, recent and emerging data highlighted in this review regarding CO exposure in the fetus and developing child may be important to consider when the standards and guidelines are evaluated and revised in the future.
尽管空气污染与全身性健康不良影响之间的关联已为人所知多年，但污染物对神经发育的影响却一直未得到充分重视。最近的证据表明空气污染与儿童神经认知障碍及行为紊乱之间可能存在联系，然而，这种关系的确切性质仍知之甚少。婴儿和儿童由于在发育关键期的胎儿期和出生后环境中都有可能接触污染物，因而特别脆弱。一氧化碳（CO）是室内和室外空气污染的常见成分，它可以穿过胎盘进入胎儿循环和发育中的大脑。因此，作为一种已知的神经毒素和潜在的公共卫生威胁，一氧化碳尤其引人关注。在此，我们回顾明显一氧化碳毒性及规范一氧化碳暴露的政策，详述表明与一氧化碳相关的环境空气污染、烟草烟雾与儿童学习及行为异常之间可能存在联系的证据，描述亚临床一氧化碳暴露在发育过程中对大脑的影响，并对一氧化碳暴露与神经发育结果之间的潜在联系提供机制性见解。一氧化碳会扰乱发育中大脑的许多关键过程，从而能更好地理解这种特定神经毒素可能如何损害神经发育。然而，需要进一步研究以更明确围产期一氧化碳暴露对未成熟大脑的影响。当前关于一氧化碳标准的政策是基于对已有合并症的成年人心血管风险的证据制定的。因此，本综述中强调的关于胎儿和发育中儿童一氧化碳暴露的最新及新出现的数据，在未来评估和修订标准及指南时可能具有重要参考价值。
