發(fā)布時(shí)間：2018-06-07 21:21

  本文選題：鉛 + 血鉛　； 參考：《廣西醫(yī)科大學(xué)》2016年博士論文

【摘要】：目的通過(guò)調(diào)查廣西某地7-12歲學(xué)齡兒童的血鉛水平和鉛中毒流行狀況,探討血鉛暴露對(duì)鋅、銅、鐵、鈣、鎂水平的影響,為兒童鉛中毒防治提供科學(xué)依據(jù)。對(duì)象和方法 近三年共2629名(男童1781人,女童848人)來(lái)自某醫(yī)院兒童保健門(mén)診的7-12歲學(xué)齡兒童自愿參與實(shí)驗(yàn)室檢測(cè),清晨采兒童空腹靜脈血lml用于測(cè)全血血鉛和鋅、銅、鐵、鈣、鎂等元素的含量。用石墨爐-原子吸收分光光譜法(GFAAS)測(cè)定血鉛含量,火焰原子吸收分光光度法測(cè)定血鋅、銅、鐵、鈣、鎂等元素的含量。用SPSS16.0統(tǒng)計(jì)軟件對(duì)兒童血鉛、鋅、銅、鐵、鈣、鎂的水平和鉛中毒檢出率進(jìn)行描述；用卡方檢驗(yàn)法對(duì)不同亞群學(xué)齡兒童鉛中毒檢出率進(jìn)行比較分析；用Pearson相關(guān)分析和Spearman相關(guān)分析法分析鉛、鋅、銅、鐵、鈣、鎂六種元素之間的關(guān)系。結(jié)果全樣本2629名7-12歲學(xué)齡兒童的血鉛中位數(shù)為54.6μ g/L；男童、女童的血鉛中位數(shù)分別為56.9μg/L.51.2μg/L,男童血鉛水平高于女童,P0.05。9-12歲男童血鉛水平均高于同齡女童,差異有統(tǒng)計(jì)學(xué)意義,P0.05；學(xué)齡兒童的血鉛水平無(wú)年齡間的差別,P0.05。近三年學(xué)齡兒童的血鉛中位數(shù)分別為64.0μg/L.50.1μg/L和49.5μg/L,后者學(xué)齡兒童的血鉛水平分別低于前兩組,P值均0.05。第一年的7-8歲和12歲男童、第二年的9歲男童、第三年的11歲男童的血鉛水平高于同齡女童,差異有統(tǒng)計(jì)學(xué)意義,P0.05。全樣本學(xué)齡兒童血鉛水平主要位于50-μg/L組段,占50.7%,其次為0-μg/L組段,占41.1%。男童血鉛水平位于0-、50-、100-、150-、200及以上μg/L組段的比例分別為37.8%、53.1%、7.2%、1.5%、0.4%；女童的比例為48%、45.8%、4.5%、0.8%和0.9%,兩組學(xué)齡兒童在血鉛水平的構(gòu)成上差異有統(tǒng)計(jì)學(xué)意義(X2＝31.534,P=0.000)。第二年和第三年兩個(gè)年份組學(xué)齡兒童血鉛水平構(gòu)成無(wú)差別,P0.05；第一年學(xué)齡兒童血鉛水平構(gòu)成分別與后兩年有差別,P0.05。全樣本學(xué)齡兒童鉛中毒檢出率為8.2%；男童和女童分別為9.1%和6.3%,男童大于女童(X2=6.197,P=-0.013)。9歲組男童鉛中毒檢出率高于同齡女童(X2＝4.247,P=0.039),其余各年齡組的男、女童間鉛中毒檢出率差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。近三年學(xué)齡兒童鉛中毒檢出率分別為10.9%、5.2%、8.4%,有逐年降低的趨勢(shì)(X2＝3.890,P=-0.049)；男童的鉛中毒率亦有逐年降低的趨勢(shì)(X2＝8.302,P=-0.004)。學(xué)齡兒童血鋅、銅、鐵、鈣、鎂的含量分別為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。鉛中毒組與非鉛中毒組學(xué)齡兒童的血鋅、銅、鐵、鈣、鎂含量差異均無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。按年齡分層,9歲非鉛中毒組學(xué)齡兒童血鐵、血鎂含量低于鉛中毒組,10歲學(xué)齡兒童血鈣含量高于后者,差異均有統(tǒng)計(jì)學(xué)意義,P0.05。第二年和第三年組別的非鉛中毒組學(xué)齡兒童血鈣含量高于鉛中毒組,P0.05。第一年組別鉛中毒等級(jí)與血鐵、血鎂含量呈負(fù)相關(guān),r分別為-0.245、-0.224,P0.05。結(jié)論廣西7-12歲學(xué)齡兒童的血鉛水平和鉛中毒檢出率有下降的趨勢(shì),但形勢(shì)仍然不容樂(lè)觀；男童對(duì)鉛的易感性更高；鉛中毒的發(fā)生伴隨低血鈣、低血鐵、低血鎂的情況。當(dāng)?shù)卣块T(mén)需重視學(xué)齡兒童鉛中毒的防治工作,關(guān)注兒童體內(nèi)必需元素的含量,采取措施改善學(xué)齡兒童鉛中毒的狀況。目的調(diào)查廣西漢族聚居地某鉛鋅礦區(qū)學(xué)齡兒童的鉛中毒流行狀況,分析鉛暴露對(duì)學(xué)齡兒童甲狀腺激素、血清氨基酸類(lèi)神經(jīng)遞質(zhì)水平、智力水平和生長(zhǎng)發(fā)育水平的影響,探索鉛中毒的影響因素,為開(kāi)展預(yù)防兒童鉛中毒的工作提供參考依據(jù)。對(duì)象和方法 選擇廣西漢族聚居區(qū)某鉛鋅礦區(qū)255名7-12歲學(xué)齡兒童為觀察對(duì)象,清晨采兒童空腹靜脈血lml用于測(cè)全血血鉛,另采2m1分離出血清,-80。保存。用石墨爐-原子吸收分光光譜法(GFAAS)測(cè)定血鉛水平,用化學(xué)發(fā)光免疫法測(cè)定血清促甲狀腺激素(TSH)、游離三碘甲狀腺氨酸(FT3)和血清游離甲狀腺素(FT4)含量,用高效液相色譜(HPLC)熒光檢測(cè)法測(cè)定血清Y-氨基丁酸(GABA)、谷氨酸(Glu)、谷氨酰胺(Gln)含量。在該礦區(qū)居民家中隨機(jī)抽取11份自種大米,用GFAAS檢測(cè)大米鉛含量。對(duì)同意參與調(diào)研的對(duì)象檢測(cè)身高、體重、胸圍等形態(tài)發(fā)育指標(biāo),用瑞文標(biāo)準(zhǔn)推理測(cè)驗(yàn)測(cè)試智力,填調(diào)查表收集家庭環(huán)境、生活行為習(xí)慣和飲食偏好等信息。血鉛水平分析以某綜合醫(yī)院收治的490名學(xué)齡兒童為對(duì)照,生長(zhǎng)發(fā)育水平分析以合浦縣某鄉(xiāng)鎮(zhèn)小學(xué)308名漢族學(xué)齡兒童為對(duì)照。采用SPSS16.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理與分析。結(jié)果該礦區(qū)居民自種大米含鉛量的中位數(shù)為98.47μg/kg,超標(biāo)檢出率為18.2%。鉛鋅礦區(qū)255名學(xué)齡兒童的血鉛中位數(shù)為84.8μg/L(男童為88.4μg/L,女生為83.2μg/L)；對(duì)照組學(xué)齡兒童的血鉛中位數(shù)為54.25μ g/L(男童為58.0μg/L,女童為51.2μg/L),低于鉛鋅礦區(qū)學(xué)齡兒童的血鉛水平,除12歲男生外,各亞群學(xué)齡兒童血鉛水平均低于鉛鋅礦區(qū),P0.05。以血鉛大于100μg/L作為判斷兒童鉛中毒標(biāo)準(zhǔn),鉛鋅礦區(qū)學(xué)齡兒童鉛中毒檢出率為31.8%(男童為35.7%,女童為27.8%),大于對(duì)照組的8.2%(男童為10%,女童為6.3%),差異均有統(tǒng)計(jì)學(xué)意義(P=0.000)。鉛鋅礦區(qū)8-10歲男童和7、10、12歲女童的鉛中毒檢出率均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。鉛鋅礦區(qū)249名7-12歲學(xué)齡兒童檢測(cè)了甲狀腺功能和血清氨基酸類(lèi)神經(jīng)遞質(zhì)水平。鉛中毒組TSH含量低于非鉛中毒組,鉛中毒組女童GABA水平高于非鉛中毒組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。血清TSH含量與血鉛水平呈負(fù)相關(guān)(r=-0.186,P=0.003)。Glu、Gln、GABA水平與血鉛水平無(wú)相關(guān)性。瑞文標(biāo)準(zhǔn)推理測(cè)驗(yàn)的Cronbach's a系數(shù)標(biāo)化為0.866。205名學(xué)齡兒童的智力水平以三級(jí)(中等智力)和四級(jí)(智力中下)為主,比例分別為37.6%、25.9%。學(xué)齡兒童智商水平為92.32±14.68,智商有隨年齡增長(zhǎng)而降低的趨勢(shì)(P均=0.000),7、8歲學(xué)生智商水平均高于9-12歲學(xué)生,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；智商水平無(wú)性別差異(P0.05)。鉛中毒組兒童智商水平為88.7±14.24,比非鉛中毒組低3.59；鉛中毒組男童的智商水平為88.69±13.90,低于非鉛中毒組男童的94.65±15.13,差異有統(tǒng)計(jì)學(xué)意義,P0.05。學(xué)齡兒童的智力等級(jí)與血鉛水平呈正相關(guān)(R=0.147,P0.05)。鉛鋅礦區(qū)234名各亞群漢族學(xué)齡兒童的身高、體重均低于對(duì)照組,P0.05。除9歲組外,女童的胸圍水平明顯劣于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義,P0.05；男童僅有9歲組胸圍低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義,P0.05。鉛鋅礦區(qū)學(xué)齡兒童的生長(zhǎng)發(fā)育等級(jí)集中在中等和中下水平,體重在這兩個(gè)等級(jí)的構(gòu)成比高達(dá)97%,身高和胸圍分別達(dá)到88.5%和96.1%。鉛鋅礦區(qū)學(xué)齡兒童身高等級(jí)、體重等級(jí)、胸圍等級(jí)均差于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義,P0.05。鉛鋅礦區(qū)學(xué)齡兒童消瘦情況突出,男童消瘦的比例達(dá)到21.7%,女童達(dá)到22.8%。鉛中毒組和非鉛中毒組學(xué)齡兒童在身高等級(jí)、體重等級(jí)、胸圍等級(jí)和營(yíng)養(yǎng)狀況的分布上差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。7歲女童的身高、8歲女童的體重、9歲女童的胸圍與血鉛值呈負(fù)相關(guān),R分別為-0.432、-0.497、-0.405,P≤0.05。兒童家庭環(huán)境與生活行為方式調(diào)查問(wèn)卷的Cronbach's α系數(shù)為0.726。母親偶爾吸煙的學(xué)齡兒童發(fā)生鉛中毒的危險(xiǎn)是母親不吸煙者的3.587倍,經(jīng)常直接喝生水的學(xué)齡兒童發(fā)生鉛中毒危險(xiǎn)是從不喝自來(lái)水者的3.716倍；經(jīng)常食用新鮮水果、蔬菜和經(jīng)常食用豆制品的學(xué)齡兒童不容易發(fā)生鉛中毒,OR值分別為0.323、0.181,TSH含量高者不容易發(fā)生鉛中毒,OR值為0.775。結(jié)論鉛鋅礦區(qū)環(huán)境鉛污染問(wèn)題較突出,鉛暴露對(duì)學(xué)齡兒童的甲狀腺功能水平、氨基酸類(lèi)神經(jīng)遞質(zhì)、智力水平、生長(zhǎng)發(fā)育水平可能有一定損害。環(huán)境鉛暴露對(duì)學(xué)齡兒童的影響可能存在性別差異,智力方面對(duì)男生的影響大于女生,在生長(zhǎng)發(fā)育方面則相反。補(bǔ)充優(yōu)質(zhì)蛋白質(zhì)和維生素C對(duì)兒童鉛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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R179

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 黃靖雯;王佳s，

本文編號(hào)：1992842