铅对儿童甲状腺功能影响的研究

【目的】本文主要探讨铅中毒对儿童甲状腺功能的影响。【方法】入选对象为0~6岁的儿童,血铅采用钨舟原子吸收光谱法测定,并根据血铅的水平<100μg/L,100~200μg/L,200~499μg/L将儿童分为正常血铅组、轻度铅中毒组和中度铅中毒组。对三组对象均采用化学发光免疫技术,分别测其TT3、TT4、FT3、FT4、TSH共5项甲状腺功能指标,并计算出FT4/TSH的比值,将三组甲状腺功能指标和FT4/TSH的比值进行方差分析。【结果】正常血铅组、轻度铅中毒组和中度铅中毒组TT3、TT4、FT3、FT4值差异均无显著性,而三组的TSH值,FT4/TSH比值存在显著性差异。【结论】虽然未达到甲状腺功能低下的程度,但是轻中度铅中毒对儿童甲状腺功能已存在影响;并且随着血中铅浓度的增高,甲状腺功能损害的程度也会加重。     

The effects of elevated blood lead levels and succimer chelation therapy on physical growth in developing rhesus monkeys

Seventy-two female rhesus monkeys were randomly assigned to three lead exposure conditions (none, birth to 1 year, birth to 2 years). In a completely crossed design, the lead-exposed and control monkeys were randomized to placebo or chelation therapy which began at 1 year of age. Dosing was conducted daily beginning on day 8 postpartum. The lead dose levels were adjusted biweekly to gradually elevate the blood lead level of each monkey to a target of 1.69-1.93 micromol/L (35-40 microg/dL). Succimer (or placebo) was administered orally (30 mg/kg/day for 5 days and 20 mg/kg/day for 14 additional days) for a total 19-day treatment regimen. There were two separate chelation regimes at 53 and 65 weeks of age. Succimer therapy in combination with lead abatement reduced blood lead levels significantly faster than lead abatement alone; however, that advantage disappeared once succimer therapy was discontinued. Weight, crown-rump length, and head circumference were measured regularly. Growth in weight, length, and head circumference did not vary significantly as a function of blood lead levels. Succimer chelation therapy did not significantly affect weight, length, or head circumference through 2 years of age.     

二巯基丁二酸治疗慢性中度铅中毒的实验研究

目的 探讨二巯基丁二酸(又名二巯琥珀酸,DMSA)治疗慢性中度铅中毒幼兔的驱铅效果.方法 24 只离乳(45 d)雄性健康新西兰幼兔,数字表法随机分为治疗组、阳性对照组和阴性对照组,每组8只,经消化道染铅(醋酸铅,每天5 mg/kg) 6周复制中度铅中毒动物模型,然后给予DMSA 驱铅治疗,第1周每天给DMSA 1050 mg/m2 体表面积,然后改为每天700 mg/m2 体表面积连续2周,停药3周,每周采集血液和尿液,12周后杀死并取海马、睾丸、心脏、肝脏、肾脏和脾脏.用原子吸收分光光谱仪测定血铅,电感耦合等离子体质谱仪测尿铅和组织脏器铅,光学显微镜(简称光镜)下观察组织脏器的组织结构.结果 与阳性对照组(PG)相比,DMSA 治疗组(TG)的幼兔展尿铅浓度增加显著,从治疗前的(40.97±1.77)μg/L 显著增加至达到峰值 (1246.96±157.91)μg/L,然后逐步减少,第1周两组相比差异有统计学意义(F=2934.35,P＜0.01),三组间相比较差异均具有统计学意义(P值均＜0.01);同时血铅水平(blood lead levels,BLLs)在用药后由治疗前的(429.63±10.82)μg/L,锐减到第3周停药时的(238.50±11.82)μg/L,停药后出现一过性反弹,然后再次降低;而PG的BLLs在同时期中呈现缓慢下降过程,到停药3周后为(149.88 4±11.39)μg/L,基本接近于TG的(135.50±7.09)μg/L.TG新西兰兔的组织脏器铅含量显著降低,体重增长明显加快,光镜下观察睾丸和肝脏的病理损伤有一定程度的改善.结论 DMSA 治疗慢性中度铅中毒幼兔,可以快速有效降低血铅和软组织铅,在短时间内减轻铅对组织脏器的毒性作用,使组织脏器的损伤随着机体铅负荷的降低而有所减轻,对铅毒性作用导致的生长发育落后有一定的改善作用.     

学生家长对中学卫生保健服务认可情况的调查

开放改革 2 0年多来 ,在学校卫生专业工作者的指导下 ,学校给学生开展了丰富多样的卫生保健服务和健康教育等工作 ,而这些服务和教育的效果与需求如何 ,学生家长是较有发言权的。随着开放改革的深入 ,外来文化自然会渗透到每个角落 ,甚至国人自古讳莫如深的性问题 ,在学校中也普遍存在[1] 。为了解学生家长对新形势下学校提供的医疗卫生保健服务和健康教育的认可情况 ,我们开展了本调查 ,为制定学校卫生保健工作计划 ,积极有效地开展、完善或改进学校卫生保健和健康教育等工作 ,提供科学的依据。1　材料和方法在广州市区选择邻近大学的完全…     

2141名学龄前儿童血铅水平调查研究

目的:了解丰台区目前学龄前儿童血铅水平,为制定积极有效的干预措施提供科学依据。方法:采取整群分层随机抽样的方法,选择北京市丰台区6所城区幼儿园和6所农村幼儿园在园2～6岁儿童2 141名,采用阳极溶出分析法测定血铅水平。结果:丰台区学龄前儿童血铅水平均数为73.90μg/L,其中铅中毒发生率为10.46%;儿童血铅水平存在显著的性别差异,男童铅中毒发生率高于女童,且具有统计意义;血铅水平以2岁组儿童血铅水平最高;儿童血铅水平无显著的地域差异,城市儿童血铅水平和血铅≥100μg/L的发生率与农村儿童无差别(P>0.05)。结论:目前丰台区儿童铅中毒绝大多数处于轻中度铅中毒水平,应采取积极、多样的健康宣教等干预措施防治儿童铅中毒。     

顺德大良地区学龄前儿童血铅水平调查

目的通过调查顺德大良地区2 285例3~6岁儿童末梢血铅水平,为制定相关公共卫生政策提供依据。方法采集大良2 285例3~6岁儿童末梢血,用电感耦合高频等离子发射光谱法进行血铅检测,并对检测结果进行统计学处理。结果 2 285例学龄前儿童血铅水平为(44.77±17.73)μg/L,铅中毒率1.8%,以轻度铅中毒为主。统计分析显示不同性别儿童铅中毒率比较及城乡间儿童铅中毒率比较,差异均有统计学意义(P0.05)。男童铅中毒率高于女童(P0.05);农村儿童铅中毒率高于城镇儿童(P0.01)。结论重点关注农村地区儿童的铅中毒防治;提高居民环保意识,保障儿童健康成长。     

儿童血铅含量调查分析

目的 筛查儿童血铅水平,能及早发现儿童铅中毒,可达到预防、提早干预和治疗的目的 ,提高本地区儿童的健康水平.方法 对2168名12岁以内儿童的血铅筛查资料进行了归纳、分析.结果 2168例儿童当中血铅≥200 μg/L(0.97 μmol/L)的儿童共159名,占总检查人数的7.33%,均为轻到中度中毒,且多表现不典型.多数患儿能找出铅接触危险因素,中毒程度与多重危险因素相关.惠儿均给予去除铅接触危险因素、营养指导等处理,2～3个月后复查血铅,其血铅水平均有不同程度下降.结论 儿童铅中毒是完全可以预防的,通过环境干预、开展健康教育、有重点的筛查和监测等措施,可以预防和早发现、早干预儿童铅中毒.     

Decreased stature associated with moderate blood lead concentrations in Mexican-American children

The relationship of blood lead concentration to stature was evaluated by examining data from a sample of 1454 Mexican-American children aged 5-12 y, derived from the data sets of the Hispanic Health and Nutrition Examination Survey (HHANES) conducted in 1982-1984. The results indicate that there is an inverse relationship between blood lead concentration in the range 0.14-1.92 mumol/L with stature. The present finding suggests that growth retardation may be associated even with moderate concentrations of blood lead. Therefore, permissible exposure levels of lead for children deserve reexamination in light of the present analysis.     

学龄前儿童血铅水平与体液免疫关系分析

目的探讨血铅水平对学龄前儿童体液免疫影响。方法用石墨炉原子吸收光谱法对917名学龄前儿童进行血铅测定,根据血铅水平设立高铅组和低铅组(对照组),分别对两组儿童用免疫比浊法进行免疫球蛋白5项(IgA、IgG、IgM、C3和C4)测定,高铅组及对照组均给予补钙剂(排铅方法之一),3个月后两组儿童再次进行免疫球蛋白5项测定,高铅组重新进行血铅水平测定。结果3个月后,高铅组血铅水平由原来的(143.5±12.1)μg/L下降到(92.6±8.9)μg/L(P<0.05),免疫球蛋白IgA、IgG及C3水平分别由治疗前的(0.64±0.15)g/L、(6.21±1.38)g/L和(1.02±0.26)g/L升高到(0.95±0.31)g/L、(9.56±2.16)g/L和(1.12±0.28)g/L(P<0.05);对照组免疫球蛋白IgA、IgG及C3水平与补钙前比较差异无统计学意义(P>0.05)。结论高血铅对学龄前儿童体液免疫功能有一定的影响,且补钙是一种安全有效的排铅方法之一。     

Community blood lead survey with emphasis on preschool children following lead dust pollution in Esperance, Western Australia

Objective: To assess the impact of airborne lead dust on blood lead levels in residents of Esperance, a regional Western Australian town, with particular reference to preschool children. Methods: Following identification of significant airborne lead contamination, residents were notified that a blood lead clinic was available to all, with testing of preschool children encouraged. About 40% (333 children) of the preschool group and about 20% of the remaining population were tested. The main measures were blood lead levels, prevalence of elevated results and comparisons to other Western Australian surveys. Results: In preschoolers, 2.1% (seven children) had blood lead levels exceeding the current 10 μg/dL level of concern. This was not significantly different to two previous community‐based surveys elsewhere in Western Australia. However, at a lower cut‐off of 5 μg/dL, the prevalence of elevated lead levels was 24.6%, significantly higher than children tested in a previous Western Australian survey. The prevalence of blood lead levels of 10 μg/dL or greater in adults was 1.3% (26 adults), not significantly different from a previous Western Australian survey. Conclusions: The prevalence of preschool children with blood lead levels exceeding the current level of concern was not significantly increased. However, the increased prevalence of children with lead levels at or above 5 μg/dL demonstrates exposure to lead dust pollution. Implications: This episode of lead dust contamination highlights the need for strict adherence to environmental controls and effective monitoring processes to ensure the prevention of future events.     

韶关市2～6岁1 139名儿童血铅水平及影响因素的分析

【目的】了解韶关市2～6岁儿童血铅水平分布特点及影响因素，以期为做好儿童保健工作提供依据。【方法】根据韶关市布局特点，随机抽取居民、近郊、交通繁忙及厂矿区8个幼儿园1139名2～6岁儿童为调查对象,采指端末梢血20μl，用钨舟原子吸收光谱法．测定血铅水平，并进行问卷调查。【结果】2～6岁1130名儿童血铅水平均值为0．47μmol／L，铅中毒率30．955％，以轻度铅中毒者居多（38.02％）；男、女童血铅水平及铅中毒率差异无显著性;随年龄的增加．铅中毒率逐渐增高。5岁组血铅水平、铅中毒率最高;近郊及厂矿区血铅水平,铅中毒率较高;不良卫生习惯、铅作业家庭成员、被动吸烟是影响血铅的高危因素，常用乳类食品则是保护因素。【结论】韶关市近郊及厂矿区儿童是高危人群15岁左右可能是铅暴露的关键时期;不良卫生习惯和环境因素增加铅吸收风险。     

Declining blood lead levels in Victorian children

Abstract: To investigate the distribution of blood lead levels in a sample of Victorian children, and to compare current levels with those from a similar survey in 1979, blood was tested for lead in 252 children (123 under five years) attending Royal Children's Hospital as outpatients and having venepuncture blood samples for medical reasons. Blood lead levels were determined by graphite furnace atomic absorption spectrophotometer. The mean blood lead level was 0.26 μmol/L (5.4 μg/dL). In the under-five age group, the mean was 0.28 μmol/L (5.7 μg/dL). Only 1.6 per cent of this group exceeded the National Health and Medical Research Council action level of 0.72 μmol/L (15 μg/dL). Levels in this age group have declined significantly since 1979, when the mean was 0.54 μmol/L (11.1 μg/dL) and 12.9 per cent exceeded 0.72 μmol/L (15 μg/dL). Average blood lead levels have halved since 1979, with likely contributing factors being reduced exposure from lead in diet, reduced access to lead in paint and reduced lead in ambient air. Children with elevated levels had identifiable risk factors such as pica or exposure to lead-based paint, suggesting the need for ongoing public health action to prevent exposure in these groups.     

学龄前儿童末稍血中5种营养素水平分析

目的:检测学龄前儿童末稍血中钙、铁、锌、镁、铜元素的水平,为预防疾病提供科学依据。方法:采用MP-2型溶出分析法检测。结果:各种元素构成比正常;<2岁组、2～5岁组、>5岁组儿童钙、铁、锌、铜构成比比较差异无统计学意义(P>0.05);镁元素在3个年龄组儿童构成比比较差异有统计学意义,>5岁组与≤5岁组比较差异有统计学意义,镁元素缺乏率高。结论:营养素钙、铁、锌、铜在学龄前儿童体内的分布合理;镁元素的缺乏在学龄前儿童中占有一定的比例,机体可存在长期缺镁而无低镁血症现象,建议将营养素的检测纳入学龄前儿童保健常规检查项目。     

学龄前儿童发铅水平及其对健康影响的调查

目的了解广州市儿童发铅水平及其对健康的影响。方法采用多阶段随机抽样方法抽取广州市学龄前儿童作为调查对象,采用WFS-130型原子吸收分光光度法测量儿童的发铅含量,并对其健康状况和相关因素进行问卷调查。结果调查对象的平均发铅含量为8.642±2.509ug/g,发铅含量超标率为35.1%,儿童发铅含量随着年龄增加而降低。发铅含量超标的儿童经常使用彩色笔颜料和经常使用彩色餐饮具的比例分别为39.3%和29.0%,高于发铅含量正常的儿童。在工厂区生活的儿童的发铅含量超标率为40.5%,高于生活在其他环境的儿童。发铅含量超标儿童患多动症者、记忆和思考能力差的发生率分别为20.8%、7.63%,高于发铅正常儿童。结论儿童行为习惯和生活环境与其发铅含量有关,儿童发铅含量高对其健康状况有影响,应引起重视。     

鞍山市学龄前儿童血铅及脂质过氧化水平检测

目的 探讨环境铅暴露对学龄前儿童血铅及脂质过氧化水平的影响.方法 采用分层整群抽样法,抽取辽宁省鞍山市5所托幼机构的408名学龄前儿童,其中男童217名,女童192名.检测血铅、全血δ-氨基γ-戊二酸脱水酶(ALAD)、超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)、谷胱甘肽过氧化物酶(GSH-Px)和血清丙二醛(MDA).结果 鞍山市儿童铅中毒发生率为27.4%;血铅≥100 μg/L的儿童ALAD活性为(644.50±146.17)u/(g·Hb),与血铅<100μg/L的儿童比较明显降低,MDA水平达(5.875±0.818)nmol/ml,与血铅<100μg/L的儿童比较明显升高;被调查儿童的SOD、GSH-Px、GSH水平与血铅升高无关联.结论 ALAD和MDA是反映铅致氧化损伤的敏感指标.     

芜湖市市区561例学龄前儿童血铅水平调查分析

目的了解芜湖市市区学龄前儿童血铅水平,为提出针对性干预措施提供科学依据。方法对561名3~6岁儿童采左手无名指末梢血,采用电极溶出法进行血铅测定,并进行相关因素问卷调查。结果 561名儿童血铅值在0.15~194.44ug/l之间,平均54.43±39.82ug/l,儿童铅中毒检出率为14.08%,男女检出率差异无统计学意义（P〉0.05）,各年龄组儿童铅水平差异有统计学意义（P〈0.05）,检出率随年龄增长而升高。儿童铅中毒可引起儿童注意力不集中、攻击性、挑食、情绪不稳等。结论芜湖市市区学龄前儿童存在铅中毒,应加强血铅防控工作。     

Effect of interventions on children's blood lead levels.

Trail, Canada, has been the site of an active lead/zinc smelter for nearly a century. Since 1991, the Trail Community Lead Task Force has carried out blood lead screening, case management, education programs targeted at early childhood groups and the general community, community dust abatement, exposure pathways studies, and remedial trials. From 1989 through 1996, average blood lead levels of children tested for the first time declined at an average rate of 0.6 microg/dl/year, while blood lead levels in Canadian children not living near point sources appeared to be leveling off following the phase-out of leaded gasoline. Since there was no concurrent improvement in local environmental conditions during this time, it is possible that the continuing decline in Trail blood lead levels has been at least partly due to community-wide intervention programs. One year follow-up of children whose families received in-home educational visits, as well as assistance with home-based dust control measures, found that these specific interventions produced average blood lead changes of +0.5- -4.0 microg/dl, with statistically significant declines in 3 years out of 5. Education and dust control, particularly actions targeted toward higher risk children, appear to have served as effective and appropriate interim remedial measures while major source control measures have been implemented at the smelter site.     

1755例儿童血铅水平分析

目的:了解长沙市儿童血铅水平。方法:采用日本日立公司Z-2700石墨炉原子吸收光谱仪对1755例0～12岁健康体检儿童进行血铅检测。结果:1755名儿童中高铅血症检出率为10.6%,血铅平均值66.6μg/L,其中男童检出率为11.0%,女童检出率为10.2%;城市儿童检出率为8.0%,农村儿童检出率为13.9%,农村明显高于城市,差异有统计学意义(P<0.05);各年龄组中幼儿组高铅血症检出率最高14.2%,学龄前组次之12.5%,学龄组8.4%及婴儿组7.2%检出率相对较低。结论:应加强铅中毒危害知识的宣传教育,尤其应针对农村地区及婴幼儿的家长开展相关健康宣教,预防儿童铅中毒发生。