【目的】 探讨出生前100 μg/L以下剂量铅暴露对婴儿6月龄时智力和行为发育的影响。 【方法】 以出生前孕早期和晚期孕妇血铅低于100 μg/L的婴儿为研究对象,在其6月龄时用Bayley婴幼儿发育量表评价智力发育和精神运动发育。根据孕早期和晚期血铅的P25、P50和P75为界值,将婴儿分为相对高、中、低铅组,比较不同组间智力(mental development index, MDI)和行为发育指数(psychomotor development index, PDI)差异。 【结果】 婴儿6月龄时MDI和PDI均随出生前血铅水平的升高呈现下降趋势。以P25和P50为界值分组时,相对高铅组婴儿PDI均低于相对低铅组,且差异具有统计学意义(P<0.05);以P75为界值时,组间婴儿PDI未见明显差异。各分组间婴儿MDI差异均无统计学意义(P>0.05)。纳入孕妇年龄、文化因素分析发现,孕早期和晚期血铅在P50(31.15 μg/L和37.58 μg/L)以上的婴儿其PDI较其他婴儿PDI低4.48分;孕早期和晚期血铅水平在P25(24.0 μg/L和29.8 μg/L)以上的婴儿,其PDI较其他婴儿PDI低6.51分,差异均有统计学意义。 【结论】 出生前100 μg/L剂量以下铅暴露对婴儿发育有影响,特别是对婴儿6月龄时PDI影响更为显著。
Abstract
【Objective】 To determine the effects of prenatal lead exposure(lower than 100 μg/L) on six-month-old infant's growth and development. 【Methods】 The study subjects were 6-month-old infants whose mothers' blood lead were lower than 100 μg/L both during the 1st and 3rd trimester of gestation in a cohort study. Bayley infant development scale was used to evaluate the infants' development. The differences in mental development index(MDI) and psychomotor development index(PDI) of infant were compared across different prenatal blood exposure levels, using the P25, P50 and P75 of the blood lead during pregnancy as the dividing value of groups, respectively. 【Results】 The MDI and PDI of 6-month-old infants tended to decrease as the increase of prenatal blood lead exposure level. The PDI of 6-month-old infants in the relative high lead level group was lower than that in the relative low lead group as the dividing value of groups was P25 and P50 of blood lead, and the difference were statistically significant(P<0.05). There were no significant differences in the MDI of 6-month-old infants across groups. Besides, multivariate analysis indicated that the PDI of the infants whose prenatal lead concentration higher than P50 was 4.48 point lower than that of infants below P50. Similarly, the PDI of the infants whose prenatal lead concentration higher than P25 was 6.51 point lower than that of infants below P25. The differences were statistically significant. 【Conclusion】 Low level prenatal lead exposure may exert an influence on infants' behavior development and such effect might be more significant at the low level of lead exposure, which merits further research.
关键词
血铅 /
出生前 /
婴儿 /
发育
Key words
blood lead /
prenatal exposure /
infant /
development
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参考文献
[1] Miranda ML, Kim D, Galeano MA, et al. The relationship between early childhood blood lead levels and performance on end-of-grade tests[J]. Environ Health Perspect,2007,115(8):1242-1247.
[2] Pocock SJ, Smith M, Baghurst P. Environmental lead and children's intelligence: a systematic review of the epidemiological evidence[J]. BMJ,1994,309(6963):1189-1197.
[3] Schwartz J. Low-level lead exposure and children's IQ: a meta-analysis and search for a threshold[J]. Environ Res,1994,65(1):42-55.
[4] Jusko TA, Henderson CR, Lanphear BP, et al. Blood Lead Concentrations <10 mg/dL and Child Intelligence at 6 Years of Age[J]. Environ Health Perspect,2008,116(2):243-248.
[5] Surkan PJ, Zhang A, Trachtenberg F, et al. Neuropsychological function in children with blood lead levels <10 microg/dL[J]. Neurotoxicology,2007,28(6):1170-1177.
[6] Schnaas L, Rothenberg SJ, Flores MF, et al. Reduced intellectual development in children with prenatal lead exposure[J]. Environ Health Perspect,2006,114(5):791-797.
[7] Ronchetti R, Van Hazel P, Schoeters G, et al. Lead neurotoxicity in children: is prenatal exposure more important than postnatal exposure?[J]. Acta Paediatr Suppl,2006,95(453):45-49.
[8] 周爱芬,曹江霞,覃凌智.416名孕妇血铅水平及相关因素分析[J].中国妇幼保健,2007,22(12):1670-1672.
[9] 吴清,岑赛宁,官大伙,等.产妇及新生儿血铅水平调查[J].中国妇幼保健,2004,19(8): 109-110.
[10] 黄惠萍.680例孕妇血铅水平及其对胎儿、婴儿的影响[J].国际医药卫生导报,2004,10(8):68-69.
[11] Baghurst PA, McMichael AJ, Wigg NR, et al. Environmental exposure to lead and children's intelligence at the age of seven years. The Port Pirie Cohort Study[J]. N Engl J Med,1992,327(18):1279-1284.
[12] Kaufman AS. How dangerous are low(not moderate or high) doses of lead for children's intellectual development?[J]. Arch Clin Neuropsychol,2001,16(4):403-431.
[13] Wasserman GA, Liu X, Popovac D, et al. The Yugoslavia Prospective Lead Study: contributions of prenatal and postnatal lead exposure to early intelligence[J]. Neurotoxicol Teratol,2000,22(6):811-818.
[14] Nigg JT, Knottnerus GM, Martel MM, et al. Low blood lead levels associated with clinically diagnosed attention-deficit/hyperactivity disorder and mediated by weak cognitive control[J]. Biol Psychiatry,2008,63(3):325-331.
[15] Canfield RL, Kreher DA, Cornwell C, et al. Low-level lead exposure, executive functioning, and learning in early childhood[J]. Child Neuropsychol,2003,9(1):35-53.
[16] Kamel NM, Ramadan AM, Kamel MI, et al. Impact of lead exposure on health status and scholastic achievement of school pupils in Alexandria[J]. J Egypt Public Health Assoc,2003,78(1-2):1-28.
[17] Lanphear BP, Hornung R, Khoury J, et al. Low-level environmental lead exposure and children's intellectual function: an international pooled analysis[J]. Environ Health Perspect,2005,113(7):894-899.
[18] 顾伟栋,叶细标,冯献湘,等.某工业城市儿童铅暴露所致MMR的疾病负担估算[J].环境与职业医学,2007,24(2):183-185.
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