Hutton Jill
Department of Obstetrics and Gynecology, The Woman's Hospital of Texas , Houston, TX , USA.
Front Hum Neurosci. 2016 Feb 1;10:25. doi: 10.3389/fnhum.2016.00025. eCollection 2016.
In the 1970s, Stella Chess found a high prevalence of autism in children with congenital rubella syndrome (CRS), 200 times that of the general population at the time. Many researchers quote this fact to add proof to the current theory that maternal infection with immune system activation in pregnancy leads to autism in the offspring. This rubella and autism association is presented with the notion that rubella has been eliminated in today's world. CRS cases are no longer typically seen; yet, autistic children often share findings of CRS including deafness, congenital heart defects, and to a lesser extent visual changes. Autistic children commonly have hyperactivity and spasticity, as do CRS children. Both autistic and CRS individuals may develop type 1 diabetes as young adults. Neuropathology of CRS infants may reveal cerebral vasculitis with narrowed lumens and cerebral necrosis. Neuroradiological findings of children with CRS show calcifications, periventricular leukomalacia, and dilated perivascular spaces. Neuroradiology of autism has also demonstrated hyperintensities, leukomalacia, and prominent perivascular spaces. PET studies of autistic individuals exhibit decreased perfusion to areas of the brain similarly affected by rubella. In both autism and CRS, certain changes in the brain have implicated the immune system. Several children with autism lack antibodies to rubella, as do children with CRS. These numerous similarities increase the probability of an association between rubella virus and autism. Rubella and autism cross many ethnicities in many countries. Contrary to current belief, rubella has not been eradicated and globally affects up to 5% of pregnant women. Susceptibility continues as vaccines are not given worldwide and are not fully protective. Rubella might still cause autism, even in vaccinated populations.
20世纪70年代，斯特拉·切斯发现先天性风疹综合征（CRS）患儿中自闭症的患病率很高，是当时普通人群的200倍。许多研究人员引用这一事实来为当前的理论提供证据，即孕期母体感染且免疫系统激活会导致后代患自闭症。这种风疹与自闭症的关联是在当今世界风疹已被消灭的观念背景下提出的。如今已不再常见CRS病例；然而，自闭症儿童常常有CRS的表现，包括耳聋、先天性心脏缺陷，以及程度较轻的视力变化。自闭症儿童通常有多动和痉挛症状，CRS儿童也是如此。自闭症患者和CRS患者在年轻时都可能患1型糖尿病。CRS婴儿的神经病理学检查可能显示脑动脉炎伴管腔狭窄和脑坏死。CRS儿童的神经放射学检查结果显示有钙化、脑室周围白质软化和血管周围间隙增宽。自闭症的神经放射学检查也显示有高信号、白质软化和明显的血管周围间隙。对自闭症患者的PET研究表明，大脑中受风疹影响的区域灌注减少。在自闭症和CRS中，大脑的某些变化都与免疫系统有关。一些自闭症儿童缺乏风疹抗体，CRS儿童也是如此。这些众多的相似之处增加了风疹病毒与自闭症之间存在关联的可能性。风疹和自闭症在许多国家的多个种族中都有出现。与当前的看法相反，风疹并未被根除，全球仍有高达5%的孕妇受到影响。由于疫苗未在全球范围内接种且并非完全具有保护性，易感性依然存在。即使在接种过疫苗的人群中，风疹仍可能导致自闭症。
