Interaction between anemia and blood levels of iron,zinc, copper,cadmium and lead in children

Objective Anemia is a widespread problem among infants and children in many parts of the world, and it is often associated with some trace elements (iron, zinc, copper) and heavy metals (cadmium and lead). Aim of this study was to investigate the relationship between anemia and these elements. Methods This research was performed on 256 children (mean age 6.8 ± 0.2) living in Denizli city center. We observed iron deficiency anemia (IDA) in 23 children, iron deficiency without anemia (ID) in 36 children and only anemia (ferritin level normal) (OA) in 18 children, and 179 children were found healthy and they were regarded as controls (C). Blood samples were taken from subjects and the concentrations of zinc, copper, iron, cadmium and lead in serum were measured with atomic absorption spectrophotometer. Results The levels of copper, cadmium and lead in serum were significantly higher in children with IDA than those of controls (p<0.05, p<0.05, p<0.01, respectively). The other elements in the serum of ID were not different from controls.     

神经系统疾病儿童的血铅水平调查：单中心初步研究

目的：儿童铅中毒具有很大的潜在危害。慢性低水平铅暴露会导致学习障碍及行为问题,如腹痛,失眠,多动,生长发育落后,听力损失,上肢无力。该研究旨在调查神经系统疾病儿童的血铅水平,并与健康儿童作比较。方法：100名患有神经系统疾病的1~10岁儿童作为研究对象。100名年龄和性别匹配的健康儿童作为对照。采用火焰原子吸收光谱法检测血铅含量。结果：神经系统疾病组儿童的平均血铅含量显著高于对照组,差异有显著性 (113.2±47.5 μg/L vs 84.7±38.0 μg/L; P<0.01)。神经系统疾病组和对照组分别有44%和19%的儿童血铅超标（>100 μg/L）。结论：儿童血铅水平增高可能与神经系统疾病有关。建议对患神经系统疾病的儿童常规作血铅测定。［中国当代儿科杂志,2009,11（11）：873-876］     

神经系统疾病儿童的血铅水平调查:单中心初步研究(英文)

目的儿童铅中毒具有很大的潜在危害。慢性低水平铅暴露会导致学习障碍及行为问题,如腹痛,失眠,多动,生长发育落后,听力损失,上肢无力。该研究旨在调查神经系统疾病儿童的血铅水平,并与健康儿童作比较。方法100名患有神经系统疾病的1～10岁儿童作为研究对象。100名年龄和性别匹配的健康儿童作为对照。采用火焰原子吸收光谱法检测血铅含量。结果神经系统疾病组儿童的平均血铅含量显著高于对照组,差异有显著性(113.2±47.5μg/Lvs84.7±38.0μg/L;P<0.01)。神经系统疾病组和对照组分别有44%和19%的儿童血铅超标(>100μg/L)。结论儿童血铅水平增高可能与神经系统疾病有关。建议对患神经系统疾病的儿童常规作血铅测定。     

Lead levels in Canadian children: Do we have to review the standard?

Research indicates that the blood lead levels that were once considered safe can adversely affect the neurodevelopment of children. The purpose of the present article is to review issues surrounding lead exposure in Canadian children, including sources, chronic low levels of exposure, and recommendations for prevention. Information was obtained through searches of MEDLINE and Web of Science using a combination of: “Canada” or “Canadian” plus “child” or “paediatrics” plus “lead” or “lead poisoning” or “blood lead”. Centers for Disease Control and Prevention data and American peer-reviewed literature were also used. On-line Health Canada advisories (available since 1995), as well as relevant reports from nongovernmental organization and the media, were reviewed. The present review found that there has been limited surveillance of blood lead levels of Canadian children and, mainly, among high-risk groups. Harmful health effects may occur below the current standards and the threat of lead in consumer products remains. The current regulation seems to be inadequate to protect Canadian children.     

儿童血铅水平与智商的相关性研究

目的　研究儿童血铅水平与智商的关系。方法　对160例3～6岁儿童进行血铅测定,采用中国比奈全国智力量表进行智商测定,并对两者进行相关性分析。结果　儿童血铅与智商呈显著负相关,血铅每升高100μg/L,智商下降6.67分。结论　低铅暴露影响儿童神经发育与智商,值得广泛重视。     

Blood lead levels of children with pica and surma use

Blood lead levels of 253 Delhi children were estimated by dithizone method. In 82 (controls) children with no symptoms mean blood lead level was 9.6 μg/dl (±SD 6.8: median 10 μg); only 6 had high levels between 30–33 μg/dl. In 88 children with pica, the mean blood lead level was 23.0 μg/dl (±SD 13.82; median 17 μg) which was significantly higher than the control; 26 had high levels between 30–92 μg/dl. Sixteen children with pica and surma- use and 46 children suspected of lead poisoning showed lead level patterns like the pica group. However, 21 surma-using children without pica resembled the control group. Children with pica were significantly more anemic than the controls and showed higher prevalence of abdominal-neurological symptoms. Because, in India, blood lead cannot be estimated in most of the hospitals, it is suggested that children with severe pica, anemia, abdominal-neurological symptoms and exposure to surma or lead, be suspected of lead poisoning, kept in lead-free environment with corrected nutrition, and be given a short cautious therapeutic trial with oral penicillamine.     

Blood lead and efythrocyte protoporphyrin levels in Kazakhstan

A pilot study was conducted to examine the extent of lead exposure and prevalence of iron deficiency in 3 major cities of Kazakhstan. Blood lead (B-Pb.) and erythrocyte protoporphyrin (ZnPP) levels of 475 children, age range 6 months to 7 yeas were measured. The mean B-Pb. levels in the different cities ranged from 4–7 ug/dl (minimum 1 to max 29 ug/dl) and similarly the mean ZnPP levels ranged from 26–32 ug/dl (minimum 12 and maximum 95 ug/dl), thus confirming low level lead poisoning of children at some sites. One to four year olds had greater than 10 ng/dl B-Pb in 18–27% cases compared with 3–7% cases in five to seven year olds. Prevalence of iron deficiency in 6 months to 4 year old children was the highest ranging from 28–86% compared with 4 to 15% in 4–7 year olds. However, there was remarkably low prevalence (4%) of iron deficiency in a group of 5–6 years olds. This study suggests that a targeted B-Pb and ZnPP monitoring together with an iron supplementation programme in the 3 cities of Kazakhstan is essential. Environmental education appears to have had a positive impact in lowering B-Pb at one site and should thus be expanded nationwide.     

北京市儿童血铅水平及相关因素的调查研究

目的为了解北京市儿童血铅水平及相关因素。方法对本市９所幼儿园２４６名１～６岁儿童进行静脉血铅测定并做危险因素问卷调查，同时测定部分幼儿园的水、空气、食品、灰尘、玩具、幼儿手上灰尘中铅含量。结果本次调查儿童血铅≥１００μｇ／Ｌ者占６８．７％，（１μｇ／Ｌ＝０．００４８３μｍｏｌ／Ｌ），矿区儿童血铅水平显著高于近效区，Ｐ＜０．０１。结论儿童高血铅与空气中铅含量及某些生活行为有密切关系。     

中国部分城市儿童血铅状况及其影响因素

目的 了解我国学前儿童血铅状况及其影响因素.方法 2004年起连续5年采用分层整群随机抽样法抽取银川、西安、成都、武汉、合肥、北京、长沙、哈尔滨、郑州、呼和浩特、石家庄、海口、大连、青岛、广州、南宁各城市相同城区固定幼儿园及社区的69 968名0～6岁儿童进行问卷调查,原子吸收法测定其血铅含量.结果 (1)5年儿童血铅含量≥100μg/L平均检出率为7.57%,血铅平均水平为(45.00±2.05)μg/L,均低于我国既往调查.2004-2008年儿童血铅含量≥100 μg/L检出率分别为10.03%、7.85%、7.40%、6.91%、4.78%(x2=297.36,P＜0.0001).2004-2008年儿童血铅平均含量≥100μg/L检出率海口12.15%、郑州10.49%、广州10.37%、石家庄9.69%、长沙9.53%、西安9.46%、武汉9.40%、合肥8.50%、成都7.99%、银川7.98%、哈尔滨7.51%、北京6.10%、大连3.25%、呼和浩特2.89%、南宁2.46%、青岛2.39%(x2=768.21,P＜0.0001).(2)Logistic回归分析:母亲文化程度低、儿童年龄大、常咬文具/玩具、男性、在交通繁忙地带散步/玩耍时间较长、进食前不洗手、常食爆米花、常服中草药、常吸吮手指啃指甲、住房楼层低、室内墙皮脱落、常玩橡皮泥、住所周围有油漆/蓄电池/炼钢铁/炼油/印刷厂、离主干道较近是其血铅含量≥100μg/L的危险因素.散居、常服钙、铁、锌制剂、常食乳类及乳制品、母亲年龄较大是保护因素(P＜0.05).结论 儿童血铅含量≥100 μg/L检出率高于发达国家,铅暴露是我国儿童的公共卫生问题.儿童血铅状况受外环境和自身多因素影响.政府及社会应以环境干预切断污染源为手段,以营养干预健康教育为方法,减少儿童铅暴露及其危害.

Abstract：

Objective To investigate the blood lead status and influencing factors among preschool children in the sampling city. Method Stratified-clustered-random sampling was used. Standardized questionnaire and peripheral blood samples were obtained from 69 968 children aged 0-6 years in fixed kindergartens and communities of Yinchuan, Xi'an, Chengdu, Wuhan, Hefei, Beijing, Harbin,Zhengzhou,Huhhot,Shijiazhuang,Haikou,Dalian,Qingdao,Guangzhou,Nanning and Changsha from 2004 to 2008,respectively.Tungsten atomic absorbtion spectrophotometry was employed to determine the blood lead level of children. Result The proportion of children with blood lead level ≥ 100 μg/L was 7.57%(among which the proportion of high blood lead level,mild lead poisoning,moderate lead poisoning,severe lead poisoning were 91.0% ,2.76% ,3.32% ,2.93%,respectively)and the blood leadlevel was lower than those of the past studies.The proportion of high blood lead level has steadily declined from 2004 to 2008 [the proportions were 10.03%,7.85%,7.40%,6.91% and 4.78%,respectively (x2 =297.36,P＜ 0.0001)].The proportion of children with blood lead level ≥ 100 μg/L in Haikou,Zhengzhou,Guangzhou,Shijiazhuang,Changsha ,Xi'an,Wuhan,Hefei,Chengdu,Yinchuan,Harbin,Beijing,Dalian,Huhhot,Nanning and Qingdao were 12.15%,10.49%,10.37%,9.69%,9.53%,9.46%,9.40%,8.50%,7.99%,7.98%,7.51%,6.10%,3.25%,2.89%,2.46% and 2.39%,respectively(x2 =768.21,P＜ 0.0001).By multiple regression method,the risk factors which influenced blood lead status of children were education status of mother,older children,behavior and dietary habit of children,boy,stay for long time in traffic busy areas,the type of housing,taking traditional Chinese and herbal medicine.The protective factors against lead poisoning in children mainly included scattered living,the nutritional status of calcium,iron,zinc,frequent intake of milk,and older mother.Conclusion The blood lead level of children has decreased,but is still higher than those in developed countries. Lead exposure remains a public health issue which affects children most. The blood lead level of children is affected by multiple factors. Government and the whole society should pay attention to interrupt the lead pollutant and to promote nutritional health education.With all these efforts,it is possible to stop the progress of lead exposure and reduce its hazardous effects on the growth and development of children.     

健康教育对轻中度铅中毒儿童干预作用的随机临床对照研究

目的评价健康教育对轻、中度儿童铅中毒的干预效果.方法血铅水平在100 μg/L以上的儿童200名,随机分为2组实验组107名,对照组93名.研究开始阶段,两组均要求儿童父母填写一份KABP问卷和家庭社会环境与健康问卷,随后对实验组采取健康教育进行干预,而对照组不采取任何措施.干预的时间为3个月,随后对2组的全部儿童进行血铅水平复测.结果实验组干预后父母的铅中毒知识均有所提高,前后比较差异均有高度统计学意义;而对照组对儿童铅中毒的概念和预防知识也有部分提高.实验组在健康教育后,儿童及父母多种接触铅高危行为也有显著改善;而对照组只有少数改善.两组儿童血铅水平均有所下降,血铅下降值分别为55 μg/L和33 μg/L,具有统计学意义(t=4.979, 3.398, P<0.01);但实验组比对照组多下降22 μg/L(t=3.531, P<0.01).采用多元逐步回归分析排除可能的混杂因素后,有14个变量最终进入血铅水平变化的逐步回归方程,这些变量有父母预防儿童铅中毒知识的提高、对儿童铅中毒态度的转变及儿童吃零食习惯的改变等.结论对父母进行健康教育可明显提高家长对儿童铅中毒预防知识的了解,有效降低轻中度铅中毒儿童的血铅水平.健康教育可作为轻中度儿童铅中毒临床处理的常规手段之一.     

儿童急性中毒的血液净化治疗

本文综述了抢救儿童急性中毒常用的血液净化模式的机制、特点和效果及血液净化治疗的时机和注意事项.熟知血液净化的适应证、禁忌证,恰当地选择治疗模式,熟练掌握操作过程,可减少不良反应的发生,提高儿童急性中毒抢救成功率.

Abstract：

This article summarizes the mechanisms, and the effects of clinical application of more common mode of blood purification in rescuing the acute poisoning in children. The timing of blood purification and the considerations are reviewed as well. It also proposes that acquaintancing the indications and contraindications of blood purification, proper selection of treatment modalities and mastering the operation can reduce the adverse reaction and improve the survival rate in children with acute poisoning.     

Effect of living in lead mining area on growth

Objective Blood lead level BLL and growth parameters including weight and height, in children, living in lead mining area was surveyed. Methods Two groups of 7–11 yr old children, including 45 from a lead mining area (Angooran-Zanjan Province-Iran) and 36 from control area (similar area to the study area, but not lead mining: Ijrood-the same province), were selected to assess BLL (by atomic absorption spectrometry) and growth parameters. Results In the children of the study and control areas, mean BLLs were 36.97±24.67 (μg/dL; mean ± SD) and 15.57 ± 13.35 (μg/dL; mean±SD), respectively (P=0.0005). No significant correlation was found between BLL in children and their fathers’ occupation. In addition, there was no significant difference in growth parameters, including weight and height, in the children of two groups. Conclusion Regarding the results of this study, environmental exposure due to living in lead mining area can lead to increased BLL in children. In addition, our results suggest there is no significant effect of BLL on growth parameters in children in lead mining area. Since some clinical and sub clinical problems are strongly probable when BLL is increased, special attention of the relevant organizations, and more research about the problem and its outcome, is recommended.     

学龄前儿童血铅水平与5种微量元素相互关系的研究

目的　探讨学龄前儿童铅中毒现状及血铅水平与微量元素锌、铁、铜、钙、锰间的相互关系。方法　采用电感耦合高频等离子体原子发射光谱法 ,广东省佛山市妇幼保健院于 2 0 0 3年对 5 175名 3～ 6岁学龄前儿童进行血铅、锌、铁、铜、钙、锰含量的测定及血铅与其他 5种微量元素的相关分析。结果　 (1) 5 175名儿童中 ,血铅含量最低值为 0 0 2 4mg/L ,最高值为 0 2 9mg/L ,几何均值为 0 10 1mg/L ,铅中毒发生率为 4 3 7%。 (2 )线性回归分析显示血锌、铜标准回归系数最大 ,分别为 0 0 5 1和 0 0 4 1,与儿童血铅水平差异有显著性 (P <0 0 1)。 (3)双因素方差分析显示血铅与血锌、血铜呈负相关关系。结论　儿童铅中毒可导致血锌、血铜水平下降。     

Association of blood pressure, obesity and serum homocysteine levels in healthy children

AIM: Obesity, hypertension and total serum homocysteine levels are well-known risk factors for cardiovascular disease in adults. However, there is limited data on the relation of these risk factors in children. METHODS: Five hundred twenty-four healthy school children aged 6-15 years participated in the study. BMI were used to categorize our subjects in normal overweight and obese groups based on Internationally Obesity Task Force criteria. RESULTS: The prevalence of overweight and obesity was 21.1% and 8.4% for boys and 17.6% and 7.3% for girls, respectively. Diastolic blood pressure (DBP), systolic blood pressure (SBP) and waist circumference (WC) were significantly higher in overweight and obese group compared to normal ones, whereas for homocysteine levels no difference was observed. Based on the results derived from the multiple regression analysis, BMI was positively related to energy intake (beta=0.247, p<0.001) and WC (beta=0.014, p<0.001). Both SBP and DBP were positively related to age ([beta=0.251, p<0.001] and [beta=0.301, p<0.001, respectively]), and BMI ([beta=0.096, p<0.001] and [beta=0.022, p<0.001], respectively). CONCLUSION: The current study revealed an association of blood pressure and WC with overweight and obesity in children, and even though these children may not have increased homocysteine levels, they still have enough reasons to reduce weight in order to avoid cardiovascular disease in their life later on.     

湖南省城镇学龄前儿童血铅水平流行病学调查

目的：调查湖南省城镇学龄前儿童血铅水平及影响因素,为儿童铅中毒的防治提供科学依据。方法：2008年9月至2009年6月整群随机抽取湖南省12个地区城镇学龄前儿童2 044名,男1 108名,女936名,年龄2～6岁,平均4.4±1.1岁。采用原子吸收光谱法测定末梢血血铅水平, 并采用《中国部分城市儿童铅中毒防治项目调查表》进行问卷调查。Logistic回归分析血铅水平的影响因素。结果：湖南省学龄前儿童平均血铅值为81.9±34.5 μg/L。血铅水平≥100 μg/L者482例,占23.58%。其中血铅水平100～199 μg/L(高铅血症)472例,占23.09%,血铅水平≥200 μg/L（铅中毒）10例,占0.49%。不同年龄组间血铅异常(血铅水平≥100 μg/L)率差异有统计学意义(P<0.01)。男童的血铅异常率为28.99%,高于女童的 21.98% （P<0.01）。不同地区儿童血铅异常率差异亦有统计学意义 (P<0.01)。回归分析显示,男性(OR=1.449, P<0.01)、父亲从事铅暴露职业(OR=1.314, P<0.01)及母亲常用染发剂（OR=1.678,P<0.05）为儿童血铅异常的危险因素。结论：湖南省城镇学龄前儿童血铅异常率较高。该省城镇学龄前儿童血铅异常率与儿童所在地区和年龄有关。男性、父亲从事铅暴露职业及母亲常用染发剂为儿童血铅异常的危险因素。［中国当代儿科杂志,2010,12（8）：645-649］     

Blood pressure levels in childhood: probing the relative importance of birth weight and current size

Several studies have reported data supporting the idea that an impaired intrauterine environment that deprives the fetus of optimal nutrient delivery results in the predisposition of the fetus to experience cardiovascular and metabolic dysfunction in later life. However, contradictory data still exist. Our purpose was to investigate the effects of both birth weight and weight gain on the risk for high blood pressure levels in 6- to 10-year-old children. This cross-sectional study included 739 children divided into quartiles of birth weight. The mean values of both systolic and diastolic pressure were significantly different between quartiles of birth weight, with increasing blood pressure values as the birth weight decreased (P < 0.001). Covariance analysis adjusting for gender, prematurity, and body mass index (BMI) showed that both systolic and diastolic pressure remained greater in the lowest than in the highest birth weight quartile. Separating those with low and normal birth weight demonstrated that the risk of childhood hypertension was significantly higher among children with low birth weight and current obesity (odds ratio [OR]: 5.0, confidence interval [CI]: 3.3 to 16.1; P = 0.023). The inverse association between birth weight and blood pressure levels appears to be programmed during fetal life, while weight gain during childhood adds to this risk.     

新疆伊犁地区2438例哈萨克族儿童血压现况分析

目的：了解新疆伊犁地区哈萨克族儿童血压水平和高血压的发生状况及影响因素。方法：2009年5~6月采用随机整群抽样方法,抽取新疆伊犁地区哈萨克族学龄儿童2438例,进行身高、体重、腰围、臀围、皮褶厚度、血压测量,并计算体质指数（BMI）。结果：2438名儿童收缩压（SBP）平均水平为94±13 mm Hg,舒张压（DBP）平均水平为60±9 mm Hg,低于国内同年龄段汉族平均水平;检出高血压儿童138名,患病率5.66%（138/2438）,其中男童患病率4.38% （54/1232）,女童患病率6.97%（84/1206）,女童患病率高于男童（P<0.05）;血压及高血压患病率与BMI、腰围、臀围、皮褶厚度、性别、年龄均呈正相关。结论新疆伊犁地区哈萨克族儿童血压平均水平较国内儿童低;女童高血压患病率高于男童;肥胖与哈萨克族儿童高血压患病率密切相关。