广西某地学龄儿童血铅水平及铅暴露对某矿区学龄儿童健康的影响

发布时间：2018-06-07 21:21

本文选题：铅 + 血铅　；参考：《广西医科大学》2016年博士论文

【摘要】：目的通过调查广西某地7-12岁学龄儿童的血铅水平和铅中毒流行状况,探讨血铅暴露对锌、铜、铁、钙、镁水平的影响,为儿童铅中毒防治提供科学依据。对象和方法近三年共2629名(男童1781人,女童848人)来自某医院儿童保健门诊的7-12岁学龄儿童自愿参与实验室检测,清晨采儿童空腹静脉血lml用于测全血血铅和锌、铜、铁、钙、镁等元素的含量。用石墨炉-原子吸收分光光谱法(GFAAS)测定血铅含量,火焰原子吸收分光光度法测定血锌、铜、铁、钙、镁等元素的含量。用SPSS16.0统计软件对儿童血铅、锌、铜、铁、钙、镁的水平和铅中毒检出率进行描述；用卡方检验法对不同亚群学龄儿童铅中毒检出率进行比较分析；用Pearson相关分析和Spearman相关分析法分析铅、锌、铜、铁、钙、镁六种元素之间的关系。结果全样本2629名7-12岁学龄儿童的血铅中位数为54.6μ g/L；男童、女童的血铅中位数分别为56.9μg/L.51.2μg/L,男童血铅水平高于女童,P0.05。9-12岁男童血铅水平均高于同龄女童,差异有统计学意义,P0.05；学龄儿童的血铅水平无年龄间的差别,P0.05。近三年学龄儿童的血铅中位数分别为64.0μg/L.50.1μg/L和49.5μg/L,后者学龄儿童的血铅水平分别低于前两组,P值均0.05。第一年的7-8岁和12岁男童、第二年的9岁男童、第三年的11岁男童的血铅水平高于同龄女童,差异有统计学意义,P0.05。全样本学龄儿童血铅水平主要位于50-μg/L组段,占50.7%,其次为0-μg/L组段,占41.1%。男童血铅水平位于0-、50-、100-、150-、200及以上μg/L组段的比例分别为37.8%、53.1%、7.2%、1.5%、0.4%；女童的比例为48%、45.8%、4.5%、0.8%和0.9%,两组学龄儿童在血铅水平的构成上差异有统计学意义(X2＝31.534,P=0.000)。第二年和第三年两个年份组学龄儿童血铅水平构成无差别,P0.05；第一年学龄儿童血铅水平构成分别与后两年有差别,P0.05。全样本学龄儿童铅中毒检出率为8.2%；男童和女童分别为9.1%和6.3%,男童大于女童(X2=6.197,P=-0.013)。9岁组男童铅中毒检出率高于同龄女童(X2＝4.247,P=0.039),其余各年龄组的男、女童间铅中毒检出率差异无统计学意义,P0.05。近三年学龄儿童铅中毒检出率分别为10.9%、5.2%、8.4%,有逐年降低的趋势(X2＝3.890,P=-0.049)；男童的铅中毒率亦有逐年降低的趋势(X2＝8.302,P=-0.004)。学龄儿童血锌、铜、铁、钙、镁的含量分别为6.11±1.29μg/ml.1.36 ±0.37μg/ml.433.58±69.25μg/ml.57.77±6.60μg/ml和35.36±4.52μg/ml。铅中毒组与非铅中毒组学龄儿童的血锌、铜、铁、钙、镁含量差异均无统计学意义,P0.05。按年龄分层,9岁非铅中毒组学龄儿童血铁、血镁含量低于铅中毒组,10岁学龄儿童血钙含量高于后者,差异均有统计学意义,P0.05。第二年和第三年组别的非铅中毒组学龄儿童血钙含量高于铅中毒组,P0.05。第一年组别铅中毒等级与血铁、血镁含量呈负相关,r分别为-0.245、-0.224,P0.05。结论广西7-12岁学龄儿童的血铅水平和铅中毒检出率有下降的趋势,但形势仍然不容乐观；男童对铅的易感性更高；铅中毒的发生伴随低血钙、低血铁、低血镁的情况。当地政府部门需重视学龄儿童铅中毒的防治工作,关注儿童体内必需元素的含量,采取措施改善学龄儿童铅中毒的状况。目的调查广西汉族聚居地某铅锌矿区学龄儿童的铅中毒流行状况,分析铅暴露对学龄儿童甲状腺激素、血清氨基酸类神经递质水平、智力水平和生长发育水平的影响,探索铅中毒的影响因素,为开展预防儿童铅中毒的工作提供参考依据。对象和方法选择广西汉族聚居区某铅锌矿区255名7-12岁学龄儿童为观察对象,清晨采儿童空腹静脉血lml用于测全血血铅,另采2m1分离出血清,-80。保存。用石墨炉-原子吸收分光光谱法(GFAAS)测定血铅水平,用化学发光免疫法测定血清促甲状腺激素(TSH)、游离三碘甲状腺氨酸(FT3)和血清游离甲状腺素(FT4)含量,用高效液相色谱(HPLC)荧光检测法测定血清Y-氨基丁酸(GABA)、谷氨酸(Glu)、谷氨酰胺(Gln)含量。在该矿区居民家中随机抽取11份自种大米,用GFAAS检测大米铅含量。对同意参与调研的对象检测身高、体重、胸围等形态发育指标,用瑞文标准推理测验测试智力,填调查表收集家庭环境、生活行为习惯和饮食偏好等信息。血铅水平分析以某综合医院收治的490名学龄儿童为对照,生长发育水平分析以合浦县某乡镇小学308名汉族学龄儿童为对照。采用SPSS16.0统计软件进行数据处理与分析。结果该矿区居民自种大米含铅量的中位数为98.47μg/kg,超标检出率为18.2%。铅锌矿区255名学龄儿童的血铅中位数为84.8μg/L(男童为88.4μg/L,女生为83.2μg/L)；对照组学龄儿童的血铅中位数为54.25μ g/L(男童为58.0μg/L,女童为51.2μg/L),低于铅锌矿区学龄儿童的血铅水平,除12岁男生外,各亚群学龄儿童血铅水平均低于铅锌矿区,P0.05。以血铅大于100μg/L作为判断儿童铅中毒标准,铅锌矿区学龄儿童铅中毒检出率为31.8%(男童为35.7%,女童为27.8%),大于对照组的8.2%(男童为10%,女童为6.3%),差异均有统计学意义(P=0.000)。铅锌矿区8-10岁男童和7、10、12岁女童的铅中毒检出率均高于对照组,差异有统计学意义(P0.05)。铅锌矿区249名7-12岁学龄儿童检测了甲状腺功能和血清氨基酸类神经递质水平。铅中毒组TSH含量低于非铅中毒组,铅中毒组女童GABA水平高于非铅中毒组,差异均有统计学意义(P0.05)。血清TSH含量与血铅水平呈负相关(r=-0.186,P=0.003)。Glu、Gln、GABA水平与血铅水平无相关性。瑞文标准推理测验的Cronbach's a系数标化为0.866。205名学龄儿童的智力水平以三级(中等智力)和四级(智力中下)为主,比例分别为37.6%、25.9%。学龄儿童智商水平为92.32±14.68,智商有随年龄增长而降低的趋势(P均=0.000),7、8岁学生智商水平均高于9-12岁学生,差异有统计学意义(P0.05)；智商水平无性别差异(P0.05)。铅中毒组儿童智商水平为88.7±14.24,比非铅中毒组低3.59；铅中毒组男童的智商水平为88.69±13.90,低于非铅中毒组男童的94.65±15.13,差异有统计学意义,P0.05。学龄儿童的智力等级与血铅水平呈正相关(R=0.147,P0.05)。铅锌矿区234名各亚群汉族学龄儿童的身高、体重均低于对照组,P0.05。除9岁组外,女童的胸围水平明显劣于对照组,差异均有统计学意义,P0.05；男童仅有9岁组胸围低于对照组,差异有统计学意义,P0.05。铅锌矿区学龄儿童的生长发育等级集中在中等和中下水平,体重在这两个等级的构成比高达97%,身高和胸围分别达到88.5%和96.1%。铅锌矿区学龄儿童身高等级、体重等级、胸围等级均差于对照组,差异有统计学意义,P0.05。铅锌矿区学龄儿童消瘦情况突出,男童消瘦的比例达到21.7%,女童达到22.8%。铅中毒组和非铅中毒组学龄儿童在身高等级、体重等级、胸围等级和营养状况的分布上差异无统计学意义,P0.05。7岁女童的身高、8岁女童的体重、9岁女童的胸围与血铅值呈负相关,R分别为-0.432、-0.497、-0.405,P≤0.05。儿童家庭环境与生活行为方式调查问卷的Cronbach's α系数为0.726。母亲偶尔吸烟的学龄儿童发生铅中毒的危险是母亲不吸烟者的3.587倍,经常直接喝生水的学龄儿童发生铅中毒危险是从不喝自来水者的3.716倍；经常食用新鲜水果、蔬菜和经常食用豆制品的学龄儿童不容易发生铅中毒,OR值分别为0.323、0.181,TSH含量高者不容易发生铅中毒,OR值为0.775。结论铅锌矿区环境铅污染问题较突出,铅暴露对学龄儿童的甲状腺功能水平、氨基酸类神经递质、智力水平、生长发育水平可能有一定损害。环境铅暴露对学龄儿童的影响可能存在性别差异,智力方面对男生的影响大于女生,在生长发育方面则相反。补充优质蛋白质和维生素C对儿童铅中毒可能有防治作用。
[Abstract]:Objective to investigate the effects of blood lead exposure on the level of zinc, copper, iron, calcium and magnesium in children of 7-12 year old school-age children in Guangxi, and to provide scientific basis for the prevention and control of lead poisoning in children. In the past three years, 2629 children (1781 boys and 848 girls) were from the 7-12 year old school of children health care clinic in a hospital. Young children volunteered to take part in laboratory testing. LML was used to measure the content of lead and zinc, copper, iron, calcium and magnesium in the whole blood. The content of lead in blood was measured by graphite furnace atomic absorption spectrometry (GFAAS). The content of zinc, copper, iron, calcium and magnesium was measured by flame atomic absorption spectrophotometry. The content of elements such as zinc, copper, iron, calcium and magnesium was measured by flame atomic absorption spectrometry. The content of the elements of blood zinc, copper, iron, calcium and magnesium was measured by SPSS16.0. The level of blood lead, zinc, copper, iron, calcium, magnesium and lead poisoning were described in children. The detection rate of lead poisoning in different subgroups of school-age children was compared with the chi square test. The relationship between six elements of lead, zinc, copper, iron, calcium and magnesium was analyzed by Pearson correlation analysis and Spearman correlation analysis. The results were 2629 7-12. The median of blood lead of school age children was 54.6 mu g/L, the median of blood lead of boys and girls was 56.9 mu g/L.51.2 g/L, and the blood lead level of boys was higher than that of girls. The average blood lead water of P0.05.9-12 years old boys was higher than that of the same age girls. The difference was statistically significant, P0.05; the blood lead level of school age children was no age difference, and P0.05. for nearly three years. The median of blood lead in children was 64 g/L.50.1 mu g/L and 49.5 g/L respectively. The blood lead levels of school age children were lower than those of the first two groups, P values were all 7-8 and 12 years old boys in the first year of 0.05., second years of 9 year old boys, and third years of 11 year old boys were higher than those of the same age girls. The difference was statistically significant, and the whole sample of P0.05. in school age children's blood was statistically significant. Lead level was mainly located in group 50- mu g/L, accounting for 50.7%, followed by 0- mu g/L group, which accounted for 0-, 50-, 100-, 150-, 200 and above g/L group segments in 41.1%. boys, respectively 37.8%, 53.1%, 7.2%, 1.5%, 0.4%; the proportion of girls was 48%, 45.8%, 4.5%, 0.8% and 0.9%, and there was a statistically significant difference in the composition of blood lead levels among school children in two groups. Meaning (X2 = 31.534, P=0.000). There was no difference in blood lead levels in school age children in second and third years. The level of blood lead in school age children in the first year was different from that in the last two years, and the rate of lead poisoning in school age children with P0.05. was 8.2%; boys and girls were 9.1% and 6.3% respectively, and boys were greater than girls (X2=6.197, P=-0). .013) the detection rate of lead poisoning in the.9 year old boys was higher than that of the same age girls (X2 = 4.247, P=0.039). There was no significant difference in the detection rate of lead poisoning among the men and women in the other age groups. The detection rates of lead poisoning in school age children in the last three years were 10.9%, 5.2% and 8.4% respectively (X2 = 3.890, P=-0.049), and the lead poisoning rate of boys was also found. The trend of decreasing year by year (X2 = 8.302, P=-0.004). The content of blood zinc, copper, iron, calcium and magnesium in school age children were 6.11 + 1.29 mu g/ml.1.36 + 0.37 mu g/ml.433.58 + 69.25 mu g/ml.57.77 + 6.60 g/ml and 35.36 + 4.52 u g/ml. lead poisoning group and non lead poisoning group. Age stratification, 9 year old non lead poisoning group of school age children's blood iron, blood magnesium content is lower than the lead poisoning group, 10 year old school children's blood calcium content is higher than the latter, the difference is statistically significant. P0.05. second years and third years of non lead poisoning group of school age children's blood calcium content is higher than the lead poisoning group, P0.05. first year group lead poisoning grade and blood iron, blood magnesium The content was negative correlation, R was -0.245, -0.224, P0.05., conclusion the blood lead level and lead poisoning detection rate of 7-12 year old school-age children in Guangxi have a declining trend, but the situation is still not optimistic; the boy's susceptibility to lead is higher; the occurrence of lead poisoning is accompanied by low blood calcium, low blood iron and low blood magnesium. Local government departments need to pay attention to school age children. The prevention and control of children's lead poisoning, pay attention to the content of essential elements in children and take measures to improve the status of lead poisoning in school-age children. Objective to investigate the prevalence of lead poisoning in school-age children in a lead-zinc mining area of Guangxi, and to analyze the levels of thyroid hormones, serum amino acid neurotransmitters and intelligence levels of children in school age children. And the influence of the growth and development level, the influence factors of lead poisoning were explored to provide reference for the prevention of lead poisoning in children. 255 7-12 year old school-age children in a lead-zinc mining area of Guangxi Han nationality settlement area were selected as the subjects. -80. was preserved. Blood lead levels were measured by graphite furnace atomic absorption spectrometry (GFAAS), serum levels of thyroid stimulating hormone (TSH), free three iodide thyroxine (FT3) and serum free thyroxine (FT4) were measured by chemiluminescence immunoassay. Serum Y- aminobutyric acid (GABA) and glutamic acid (Glu) were measured by high performance liquid chromatography (HPLC) fluorescence detection. The content of glutamine (Gln) was randomly selected from the residents' home in the mining area, and the content of rice lead was detected by GFAAS. The morphological development indexes, such as height, weight, chest circumference, etc., were tested for the subjects who agreed to participate in the investigation, and the intelligence test was tested with raven standard reasoning test, and the family environment, living habits and diet preference were collected and collected. The blood lead level was compared with 490 school-age children in a general hospital. The growth and development level was compared with 308 Han school-age children in a township primary school in Hepu county. Data processing and analysis were carried out by SPSS16.0 software. The results showed that the median of lead content of the self planted rice in the mining area was 98.47 mu g/kg, and the rate of exceeding the standard was found. The median of blood lead of 255 school-age children in 18.2%. lead-zinc mining area was 84.8 g/L (88.4 mu g/L for boys and 83.2 g/L for girls); the median of blood lead in the control group of school age children was 54.25 mu g/L (58 g/L for boys and 51.2 g/L for girls), lower than the blood lead level of school age children in lead-zinc mining area, and the blood lead water of school age children except 12 years old boys. The average lower than lead and zinc mining area, P0.05. with blood lead more than 100 mu g/L to judge the standard of children lead poisoning, lead zinc mining area of school age children lead poisoning detection rate is 31.8% (35.7% for boys, girls 27.8%), greater than the control group of 8.2% (10% for boys, 6.3% for girls), the difference is statistically significant (P=0.000). 8-10 years of age in lead zinc mining area and 7,10,12 year old girl The detection rate of lead poisoning in children was higher than that of the control group, the difference was statistically significant (P0.05). The level of thyroid function and serum amino acid neurotransmitters was detected in 249 7-12 year old school-age children in lead-zinc mining area. The content of TSH in lead poisoning group was lower than that of non lead poisoning group, and the level of GABA in lead poisoning group was higher than that of non lead poisoning group, the difference was statistically significant (P0 .05). The serum TSH content was negatively correlated with the level of blood lead (r=-0.186, P=0.003).Glu, Gln, GABA level and blood lead level. The Cronbach's a coefficient of the Raven standard reasoning test was marked as the intelligence level of the 0.866.205 name school age children with grade three (medium intelligence) and grade four (middle and lower intelligence), with the proportion of 37.6%, 25.9%. school-age children, respectively. The IQ level was 92.32 + 14.68 and the IQ decreased with age (P =0.000). The IQ level of students aged 7,8 was higher than that of 9-12 year old students, the difference was statistically significant (P0.05); the IQ level was no gender difference (P0.05). The IQ level of children in lead poisoning group was 88.7 + 14.24, 3.59 lower than that of non lead poisoning group; the IQ of boys in lead poisoning group was lower than that of non lead poisoning group. The level was 88.69 + 13.90, lower than 94.65 + 15.13 for boys in non lead poisoning group. The difference was statistically significant. The level of intelligence of P0.05. school-age children was positively correlated with the level of blood lead (R=0.147, P0.05). The height and weight of 234 subgroups of Han school age children in the lead-zinc mining area were lower than those in the control group. The chest circumference level of the girls was significantly worse than that of the 9 year old group. In the control group, the difference was statistically significant, P0.05. The chest circumference of only 9 years old boys was lower than that of the control group. The difference was statistically significant. The level of growth and development of school-age children in P0.05. lead-zinc mining area was concentrated at middle and middle levels, and the body weight of the two grades was up to 97%, body height and chest circumference reached 88.5% and 96.1%. lead zinc mine age respectively. The grade, weight grade and chest circumference of children were even worse than the control group. The difference was statistically significant. The weight loss of school-age children in P0.05. lead-zinc mining area was prominent, the proportion of boys' emaciation reached 21.7%. Girls reached the grade of height, weight grade, chest circumference grade and nutritional status in 22.8%. lead poisoning group and non lead poisoning group. The difference was not statistically significant. The height of the girls at the age of P0.05.7, the weight of 8 year old girls, the chest circumference of 9 year old girls were negatively correlated with the blood lead, and the Cronbach's alpha coefficient of the questionnaire on the family environment and life behavior of children with -0.432, -0.497, -0.405 and P < 0.05. respectively was the risk of lead poisoning in the school-age children who were occasionally smoking. 3.587 times as long as the mother did not smoke, the school age children who often drank raw water directly were 3.716 times more likely to lead poisoning than those who never drank water. Regular eating fresh fruits, vegetables and regular bean products were not prone to lead poisoning, OR was 0.323,0.181, and those with high TSH content were not prone to lead poisoning, and the OR value was 0.775. Conclusion the environmental lead pollution in the lead-zinc mining area is more prominent. Lead exposure may have certain damage to the thyroid function level, amino acid neurotransmitter, intelligence level and growth level of school-age children. The influence of environmental lead exposure on school-age children may exist gender differences, intellectual power is more influential to boys than girls, and in growth and development. On the contrary, supplementation of high quality protein and vitamin C may play an important role in the prevention and treatment of lead poisoning in children.
【学位授予单位】：广西医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R179

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