镉、铅暴露对妊娠结局和儿童发育的影响
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摘要
为了分析镉、铅暴露对新生儿身高、体重和学龄前期发育(包括体格发育和智商发育)的影响,并探讨镉、铅及其与营养元素间的交互作用,课题的研究现场选在环境镉、铅污染较重的湖北省黄石市有色、罗桥乡及相对污染轻的四棵乡。2002年11月至2003年11月共109名孕妇被随机选入我们的研究,2007年随访这些孕妇所生子女,随访时这些孩子平均月龄为54±3个月,最终有3个儿童失访,一个离开原居住地,另外两个分别死于白血病和溺水,随访率97.25%。通过问卷调查和体格检查分别了解上述儿童的一般状况、生长发育情况。用韦克斯勒氏学龄前儿童智商测量量表测定儿童智商,并采集学龄前儿童头发,使用电感耦合等离子体质谱法(ICP-MS)和火焰原子吸收分光光度法(F-AAS),检测其中钙、铁、锌、硒、铜和镉、铅元素含量。元素检测的质量控制措施包括使用标准参考物质和测定双份平行样。在统计分析时,用到了以前对这些孩子的母亲开展的流行病学调查资料和元素水平测定数据。
使用Microsoft Excel 2003软件录入资料,采用SPSS16.0软件进行统计分析。运用t检验、协方差分析和多因素线性回归等分析方法,分析镉、铅暴露是否影响出生时儿童的身高、体重及学龄前期儿童体格发育和智商发育,探讨毒性元素镉、铅之间是否存在交互作用,并研究营养元素与毒性元素之间的交互作用。
所有新生儿脐血镉水平均低于母血镉,脐血镉与孕妇血镉呈正相关。脐血铅与孕妇血铅呈正相关。母血钙水平的增加对铅的胎盘转运有拮抗作用。母血镉和母血铅在胎盘转运中有交互加强作用。
脐血镉与新生儿身高、体重呈负相关,与学龄前期儿童身高也呈负相关;脐血铅与出生时和学龄前期儿童身高、体重无统计学关联。母血硒、锌、铜水平的升高能拮抗镉对新生儿身高、体重的影响。
在控制了混杂因素后发现,脐血镉水平与韦氏量表总智商评分和操作智商评分呈负相关;脐血铅水平与韦氏量表智商总评分呈负相关,主要影响学龄前期儿童的操作智商评分。随着发镉水平的增加,学龄前期儿童身高、总智商评分和操作智商评分降低。随着发铅的增加,学龄前期儿童总智商评分和操作智商评分下降,发钙拮抗发铅的对智商的影响。脐血镉*脐血铅、发镉*发铅交互项对儿童总智商评分和操作智商评分的影响有统计学意义,说明镉、铅对智商的影响存在交互加强作用。
本项研究较系统的分析了妊娠期和学龄前期镉、铅暴露对儿童体格发育和智商发育的影响,并探讨了毒性元素与营养元素的交互作用及毒性元素间的交互作用。结果表明,妊娠期和学龄前期镉暴露对出生时儿童身高、体重和学龄前期儿童身高、智商发育有显著的影响。妊娠期和学龄前期铅暴露对学龄前期儿童智商发育有显著的影响。在对儿童生长发育的影响方面,毒性元素镉、铅之间,以及营养元素锌、硒、铜、钙与毒性元素镉、铅之间,存在着复杂的交互作用。
通过随访,首次探讨了镉、铅在胎盘转运中的交互作用,分析了妊娠期镉、铅暴露对出生时和学龄前期儿童发育的影响,并探讨毒性元素镉、铅之间的交互作用,加强了对营养元素钙、铁、锌、硒、铜与毒性元素镉、铅交互作用的认识,为采取干预措施预防镉、铅危害提供了依据。
The objective of the present study was to evaluate the potential effects of cadmium and lead exposure during gestation period and preschool age on the fetus and preschool age children development(including physical development and intelligence quotient) and study the interaction between cadmium,lead and nutritional elements.The Follow-Up Studies was conducted among the neonates who entered the cohort from November 2002 to November 2003.Follow-up information about their children's development was obtained when the children were on average 54±3 months of age.Three children were excluded,one of them changed residence,the other two died from leukemia and drowning respectively.106 children were followed-up and all these children lived in their birthplace.The follow-up questionnaire and interview provided the necessary information about the children's general state of health and general state of growth development and so on.The performance,Verbal and Full IQ scores from the WPPSI-R administered were used to evaluate IQ development of these children.Preschool age hair samples were collected.Cadmium,lead,calcium,iron,zinc,selenium and copper were determined by ICP-MS and F-AAS.Certified Reference Materials and parallel samples analysis were used for quality control.The maternal epidemiological study data and maternal elements level data were used when we did statistical analysis.
Microsoft Excel 2003 was used for the import of all the data,and SPSS16.0 was applied for statistical analysis.Analysis of correlation analysis,t-test,analysis of covariance and multiple linear regression analysis were conducted to analysis effects of cadmium and lead exposure on pregnancy outcome and development in the offspring during the period of pregnancy and preschool age.These analysis methods were also used to evaluate the interaction between toxic elements cadmium and lead,the interaction between nutritional elements and toxic elements.
Cadmium concentrations in cord blood were lower than that in maternal blood. Simple correlation was showed between cord blood cadmium and maternal blood, between cord blood lead and maternal blood lead.The increase of maternal calcium has antagonistic action on the placental lead transport.There was synergistic action between maternal cadmium and maternal lead during placental transport.
Multiple linear regression analysis indicated that cord blood cadmium level was significantly negatively correlated with fetus development.No significant correlations were found between cord blood lead level and fetus development and later preschool age development.Maternal selenium,maternal zinc and maternal copper have antagonistic action on cadmium toxic effect on neonatal length and height.
Significantly negative correlation was found between cord blood cadmium exposure and WPPSI-R IQ full score,performance score after controlling for confounding variables.Significantly negative correlation was found between cord blood lead exposure and WPPSI-R IQ full score after controlling for confounding variables.Cord blood lead has effects on the performance score.With the increasing of hair cadmium level,the height and WPPSI-R IQ full score of preschool children decreased.Similarly,with the increasing of hair lead level,the performance score and WPPSI-R IQ full score decreased. Hair calcium level has antagonistic action on lead toxic of decreasing the performance score effect.Cord blood cadmium ~*cord blood lead,hair cadmium~*hair lead has effects on full score and performance score,cadmium and lead has synergistic reaction.
In summary,the study explored the effects of cadmium and lead exposure during pregnancy period and preschool age on the fetus and preschool age children development, and study the interaction between toxic elements and nutrition elements,between toxic elements cadmium and lead.It was concluded that cord blood cadmium concentration was a factor influenced fetus growth and later IQ development.Cord blood lead level was a factor influenced children IQ development.There were complex interactions among zinc,selenium,copper and lead,cadmium.
Through follow-up study,the interaction of cadmium and lead was studied for the first time.The potential effects of cadmium and lead exposure during gestation period and preschool age on the fetus and preschool age children development were studied. Increase the understanding of the interaction between nutrient elements and toxic elements cadmium,lead.It will provide effectually intervention study to prevent the side-effect on people.
使用Microsoft Excel 2003软件录入资料,采用SPSS16.0软件进行统计分析。运用t检验、协方差分析和多因素线性回归等分析方法,分析镉、铅暴露是否影响出生时儿童的身高、体重及学龄前期儿童体格发育和智商发育,探讨毒性元素镉、铅之间是否存在交互作用,并研究营养元素与毒性元素之间的交互作用。
所有新生儿脐血镉水平均低于母血镉,脐血镉与孕妇血镉呈正相关。脐血铅与孕妇血铅呈正相关。母血钙水平的增加对铅的胎盘转运有拮抗作用。母血镉和母血铅在胎盘转运中有交互加强作用。
脐血镉与新生儿身高、体重呈负相关,与学龄前期儿童身高也呈负相关;脐血铅与出生时和学龄前期儿童身高、体重无统计学关联。母血硒、锌、铜水平的升高能拮抗镉对新生儿身高、体重的影响。
在控制了混杂因素后发现,脐血镉水平与韦氏量表总智商评分和操作智商评分呈负相关;脐血铅水平与韦氏量表智商总评分呈负相关,主要影响学龄前期儿童的操作智商评分。随着发镉水平的增加,学龄前期儿童身高、总智商评分和操作智商评分降低。随着发铅的增加,学龄前期儿童总智商评分和操作智商评分下降,发钙拮抗发铅的对智商的影响。脐血镉*脐血铅、发镉*发铅交互项对儿童总智商评分和操作智商评分的影响有统计学意义,说明镉、铅对智商的影响存在交互加强作用。
本项研究较系统的分析了妊娠期和学龄前期镉、铅暴露对儿童体格发育和智商发育的影响,并探讨了毒性元素与营养元素的交互作用及毒性元素间的交互作用。结果表明,妊娠期和学龄前期镉暴露对出生时儿童身高、体重和学龄前期儿童身高、智商发育有显著的影响。妊娠期和学龄前期铅暴露对学龄前期儿童智商发育有显著的影响。在对儿童生长发育的影响方面,毒性元素镉、铅之间,以及营养元素锌、硒、铜、钙与毒性元素镉、铅之间,存在着复杂的交互作用。
通过随访,首次探讨了镉、铅在胎盘转运中的交互作用,分析了妊娠期镉、铅暴露对出生时和学龄前期儿童发育的影响,并探讨毒性元素镉、铅之间的交互作用,加强了对营养元素钙、铁、锌、硒、铜与毒性元素镉、铅交互作用的认识,为采取干预措施预防镉、铅危害提供了依据。
The objective of the present study was to evaluate the potential effects of cadmium and lead exposure during gestation period and preschool age on the fetus and preschool age children development(including physical development and intelligence quotient) and study the interaction between cadmium,lead and nutritional elements.The Follow-Up Studies was conducted among the neonates who entered the cohort from November 2002 to November 2003.Follow-up information about their children's development was obtained when the children were on average 54±3 months of age.Three children were excluded,one of them changed residence,the other two died from leukemia and drowning respectively.106 children were followed-up and all these children lived in their birthplace.The follow-up questionnaire and interview provided the necessary information about the children's general state of health and general state of growth development and so on.The performance,Verbal and Full IQ scores from the WPPSI-R administered were used to evaluate IQ development of these children.Preschool age hair samples were collected.Cadmium,lead,calcium,iron,zinc,selenium and copper were determined by ICP-MS and F-AAS.Certified Reference Materials and parallel samples analysis were used for quality control.The maternal epidemiological study data and maternal elements level data were used when we did statistical analysis.
Microsoft Excel 2003 was used for the import of all the data,and SPSS16.0 was applied for statistical analysis.Analysis of correlation analysis,t-test,analysis of covariance and multiple linear regression analysis were conducted to analysis effects of cadmium and lead exposure on pregnancy outcome and development in the offspring during the period of pregnancy and preschool age.These analysis methods were also used to evaluate the interaction between toxic elements cadmium and lead,the interaction between nutritional elements and toxic elements.
Cadmium concentrations in cord blood were lower than that in maternal blood. Simple correlation was showed between cord blood cadmium and maternal blood, between cord blood lead and maternal blood lead.The increase of maternal calcium has antagonistic action on the placental lead transport.There was synergistic action between maternal cadmium and maternal lead during placental transport.
Multiple linear regression analysis indicated that cord blood cadmium level was significantly negatively correlated with fetus development.No significant correlations were found between cord blood lead level and fetus development and later preschool age development.Maternal selenium,maternal zinc and maternal copper have antagonistic action on cadmium toxic effect on neonatal length and height.
Significantly negative correlation was found between cord blood cadmium exposure and WPPSI-R IQ full score,performance score after controlling for confounding variables.Significantly negative correlation was found between cord blood lead exposure and WPPSI-R IQ full score after controlling for confounding variables.Cord blood lead has effects on the performance score.With the increasing of hair cadmium level,the height and WPPSI-R IQ full score of preschool children decreased.Similarly,with the increasing of hair lead level,the performance score and WPPSI-R IQ full score decreased. Hair calcium level has antagonistic action on lead toxic of decreasing the performance score effect.Cord blood cadmium ~*cord blood lead,hair cadmium~*hair lead has effects on full score and performance score,cadmium and lead has synergistic reaction.
In summary,the study explored the effects of cadmium and lead exposure during pregnancy period and preschool age on the fetus and preschool age children development, and study the interaction between toxic elements and nutrition elements,between toxic elements cadmium and lead.It was concluded that cord blood cadmium concentration was a factor influenced fetus growth and later IQ development.Cord blood lead level was a factor influenced children IQ development.There were complex interactions among zinc,selenium,copper and lead,cadmium.
Through follow-up study,the interaction of cadmium and lead was studied for the first time.The potential effects of cadmium and lead exposure during gestation period and preschool age on the fetus and preschool age children development were studied. Increase the understanding of the interaction between nutrient elements and toxic elements cadmium,lead.It will provide effectually intervention study to prevent the side-effect on people.
引文
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