目的 评估学龄期儿童尿液中抗生素的暴露水平及其影响因素,以期为防控儿童抗生素暴露提供依据。方法 选取2019年10—12月曲阜市8所城区学校和4所郊区/农村学校、中山市6所市区学校和3所郊区/农村学校中的820名6~9岁儿童为研究对象。收集患儿的人口及社会经济情况、饮食情况、尿液中抗生素浓度等资料。将尿液中抗生素是否检出作为结局,采用二元logistic回归方法分析影响因素。结果 820名学龄期儿童尿液中人类专用抗生素(HAs)检出率为63.0%、兽类专用抗生素(VAs)检出率为34.3%、人兽共用但常用于人类抗生素(PHAs)检出率为46.3%、人兽共用但常用于兽类抗生素(PVAs)检出率为61.3%、HAs_PHAs(HAs和PHAs之和)检出率为76.5%、VAs_PVAs(VAs和PVAs之和)检出率为70.5%、32种抗生素总检出率为92.9%。单因素logistic回归显示,年龄大的儿童尿液中HAs检出率低(OR=0.744);北方儿童较南方儿童HAs、PHAs、HAs_PHAs及所有抗生素检出率高(OR=2.494、6.930、5.250、4.757);城市儿童较郊区/农村儿童VAs检出率高(OR=1.703);父母教育水平高的儿童PHAs、HAs_PHAs检出率低(OR=0.314、0.627);家庭月收入高的儿童PHAs、HAs_PHAs、所有抗生素检出率低(OR=0.386、0.572、0.400)。多因素logistic回归分析显示,水果食用频率低(0~3次/周)是HAs和HAs_PHAs暴露的危险因素(OR=1.384、1.491);水果食用频率较高(>8次/周)是VAs暴露的危险因素(OR=1.784);禽类食用频率高(≥4次/周)是PVAs暴露的危险因素(OR=1.466);软饮料食用频率高(≥1次/周)是VAs_PVAs及所有抗生素暴露的危险因素(OR=1.394、1.816)。结论 广东省中山市及山东省曲阜市学龄期儿童广泛暴露于抗生素,且年龄、家庭月收入、父母教育水平、城乡差异、南北差异、特定食物食用频率是学龄期儿童抗生素暴露的影响因素。
Abstract
Objective To assess the exposure levels of antibiotics in the urine of school-age children, and to identify influencing factors, in order to provide evidence for the prevention and control of antibiotics exposure in children. Methods A total of 820 children aged 6 - 9 years were recruited from 8 urban and 4 suburban/rural schools in Qufu City and 6 urban and 3 suburban/rural schools in Zhongshan City between October and December 2019. Data on demographic and socioeconomic characteristics, dietary habits, and urinary antibiotic concentrations were collected. The detection of antibiotics in urine was used as the outcome, and binary logistic regression was employed to analyze influencing factors. Results The detection rates of antibiotics in the urine of the 820 school-age children were as follows: human antibiotics (HAs) 63.0%, veterinary antibiotics (VAs) 34.3%, antibiotics primarily used in humans but also shared with animals (PHAs) 46.3%, antibiotics primarily used in animals but also shared with humans (PVAs) 61.3%, combined HAs and PHAs (HAs_PHAs) 76.5%, combined VAs and PVAs (VAs_PVAs) 70.5%, and the total detection rate of 32 antibiotics was 92.9%. Univariate logistic regression revealed that older children had a lower detection rate of HAs (OR=0.744). Children from northern regions had higher detection rates of HAs, PHAs, HAs_PHAs, and total antibiotics compared to those from southern regions (OR=2.494, 6.930, 5.250, 4.757). Urban children had a higher detection rate of VAs than suburban/rural children (OR=1.703). Children with higher parental education levels had lower detection rates of PHAs and HAs_PHAs (OR=0.314, 0.627). Children from households with higher monthly incomes had lower detection rates of PHAs, HAs_PHAs, and total antibiotics (OR=0.386, 0.572, 0.400). Multivariate logistic regression analysis indicated that low fruit consumption frequency (0 - 3 times/week)was a risk factor for HAs and HAs_PHAs exposure (OR=1.384, 1.491), while high fruit consumption frequency (>8 times/week) was a risk factor for VAs exposure (OR=1.784). High poultry consumption frequency (≥4 times/week) was a risk factor for PVAs exposure (OR=1.466), and high soft drink consumption frequency (at least once a week) was a risk factor for VAs_PVAs and total antibiotic exposure (OR=1.394, 1.816). Conclusions School-age children in Zhongshan City, Guangdong Province, and Qufu City, Shandong Province, are widely exposed to antibiotics. Factors such as age, household monthly income, parental education level, urban-rural differences, north-south regional differences, and specific dietary habits influence antibiotic exposure in this population.
关键词
学龄期儿童 /
抗生素 /
饮食 /
软饮料 /
暴露
Key words
school-age children /
antibiotics /
diet /
soft drink /
exposure
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基金
国家重点研究计划重点专项(2022YFC2705203);上海交通大学医学院儿科学院注意缺陷多动障碍临床研究中心(ELYZX202207)
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