多发性抽动症患儿血铅水平测定的意义

目的研究多发性抽动症儿童血铅水平及铅接触的相关因素。方法对76例多发性抽动症患儿父母进行问卷调查铅接触相关因素,采用原子吸收光谱仪进行血铅测定。结果对多发性抽动症患儿76例进行血铅水平测定,结果36例血铅≥100μg/L,铅中毒发生率为47.37%(36/76),其中学龄前组铅中毒发生率为45.16%(14/31),学龄组为48.84%(22/45)。结论血铅增高与儿童多发性抽动症有一定关系,治疗多发性抽动症的同时应关注患儿血铅水平。     

季节变化对健康体检儿童血铅水平的影响

目的探讨季节变化对儿童血铅水平的影响。方法采用阳极溶出伏安法对健康查体儿童进行血铅检测,将入组儿童分婴幼儿组(1个月~3岁)、学龄前组(3~6岁)、学龄组(6~12岁)和青少年组(12~18岁),分析不同季节儿童血铅水平及铅中毒状况。结果共检测儿童13 233例。年龄1个月~18岁;男8315例,女4918例。平均血铅质量浓度60μg/L,第5和第95百分位数为19、138μg/L,儿童铅中毒检出率为14.8%,检出率随年龄增长而上升,以轻度铅中毒为主(χ2=116.3125 P<0.0001)。按照冬、春、秋、夏季顺序,血铅质量浓度分别为48、60、61、66μg/L;铅中毒检出率分别为9.5%、12.6%、15.5%、18.4%。夏、秋季节儿童铅质量浓度及铅中毒检出率有明显季节差异(χ2=128.0371 P<0.0001),多元Logistic回归结果分析显示男童、年龄越大越易发生铅中毒,秋、春、夏季发生铅中毒危险性较冬季大。结论儿童血铅水平与季节有关。北京地区秋季儿童铅中毒危险性最大。     

儿童铅中毒诊治进展

理想的血铅水平应是零,但由于环境污染体内血铅常 常并不为零.美国国家疾病控制中心(CDC)1991年将血 铅质量浓度≥100μg/L定义为儿童铅中毒(childhood lead poisoning).近来开始重视血铅≥100μg/L是一个群体流 行病学的概念,而并非临床医学上的诊断标准.2006年我 国调整了儿童铅中毒的诊断标准,提出了高铅血症概念,制 定了铅中毒的干预和治疗方案(试行)[1].     

Relationship Between Low-Level Lead Exposure and Neurobehaviors of Preschool Children

目的　探讨低水平铅暴露对儿童神经行为的影响。方法　整群随机抽取某市幼儿园 4～ 6岁 2 11名儿童为研究对象 ,采指端末梢血 2 0 μl,原子吸收石墨炉法测定血铅 ,以血铅水平 10 0 μg/L为界 ,分为高血铅组(≥ 10 0 μg/L)和低血铅组 (<10 0 μg/L) ,采用Achenbach儿童行为量表 (CBCL)及自拟调查表进行问卷调查 ,其结果运用t ,χ2 检验 ,简相关及多元逐步回归等方法进行统计分析。结果　高血铅组外向行为得分及行为异常率(13.2 8± 6 .2 6 ,18.2 6 % )显著高于低血铅组 (9.98± 5 .4 6 ,7.2 9% ) (t =4 .0 6 77,χ2 =5 .4 70 ,均P <0 .0 5 ) ,血铅值与外向行为中多动、攻击、违纪因子分显著正相关 (r =0 .316 4 ,0 .2 82 8,0 .1886 ,P <0 .0 5 ) ,血铅值≥ 15 0 μg/L时 ,行为异常率显著增加 (χ2 =13.6 95 ,P <0 .0 5 )。结论　低水平铅暴露对儿童外向行为具有负性影响。     

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.     

厦门市儿童血铅水平及其相关因素

目的了解厦门市儿童血铅水平及相关因素。方法对该市不同区的5所幼儿园478名2～7岁儿童以及5家卫生院所辖的538名1～36个月婴幼儿 ,进行纸片法血铅水平抽样检查 ,并做相关因素问卷调查。结果儿童血铅几何均数为72.90μg/L ,标准差为1.47μg/L ,血铅水平≥100μg/L者占20.5% ;市区儿童血铅水平高于偏僻乡区 ,差异显著 (P<0.01) ;拥有较多乡镇企业的乡村儿童血铅水平高于新市区 ,差异有显著性 (P<0.01)。结论儿童血铅水平与汽车尾气及某些生活行为有密切关系。     

儿童铅中毒高危因素分析

目的探讨儿童铅中毒发生的高危因素,以便能更好地进行预防。方法选择1055例门诊患儿。年龄5个月~16岁,平均(7.2±3.5)岁。应用3010-B血铅分析仪对患儿进行血铅测定;同时对每位患儿进行铅中毒影响因素问卷调查。结果儿童血铅水平(110.1±41.9)μg/L,铅中毒(血铅≥100μg/L)检出率为43.51%,各年龄组血铅水平无显著差异。多因素逐步回归分析显示,对儿童血铅水平发生显著影响因素依次是不勤洗手、经常吃膨化食品、偏(挑)食、不常补钙和锌及经常居室装修。结论不良的饮食和生活习惯是儿童铅中毒发生的高危因素。     

珠海市铅中毒儿童贫血发生率的调查

目的　了解珠海市铅中毒对儿童贫血发生率的影响。方法　根据 5 4 0名儿童血铅 (BPb)测定水平 ,将其分成非铅中毒组 (BPb <10 0 μg/L)和铅中毒组 (BPb≥ 10 0 μg/L) ,同时进行两组血细胞分析 ,测定红细胞 (RBC)、血红蛋白 (Hb)、红细胞平均容积 (MCV)、红细胞平均血红蛋白 (MCH)、红细胞平均血红蛋白浓度(MCHC)水平。结果　两组RBC、Hb、MCV、MCH、MCHC水平差异无显著性 (P均 >0 .0 5 )。结论　较低水平铅中毒患儿贫血发生率无显著升高。     

儿童低水平铅暴露与神经行为关系的研究

目的：探讨低水平铅暴露对儿童神经行为的影响。方法：整群随机抽取某市幼儿园4～6岁211名儿童为研究对象,采指端末梢血20 μl,原子吸收石墨炉法测定血铅,以血铅水平100 μg/L为界,分为高血铅组(≥100 μg/L)和低血铅组(<100 μg/L),采用Achenbach儿童行为量表(CBCL)及自拟调查表进行问卷调查,其结果运用t,χ2检验,简相关及多元逐步回归等方法进行统计分析。结果：高血铅组外向行为得分及行为异常率(13.28±6.26,18.26%)显著高于低血铅组(9.98±5.46,7.29%)(t=4.0677, χ2＝5.470, 均P<0.05), 血铅值与外向行为中多动、攻击、违纪因子分显著正相关(r=0.3164,0.2828,0.1886, P<0.05),血铅值≥150 μg/L 时,行为异常率显著增加(χ2=13.695,P<0.05)。结论：低水平铅暴露对儿童外向行为具有负性影响。     

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］     

Lead poisoning among Burmese refugee children--Indiana, 2009

Recent routine screening revealed multiple cases of unexplained lead poisoning among children of Burmese refugees living in Fort Wayne, Indiana. A cross-sectional study was conducted to determine (a) the prevalence of elevated blood lead levels (BLLs) among Burmese children and (b) potential sources of lead exposure. A case was defined as an elevated venous BLL (≥10 μg/dL); prevalence was compared with all Indiana children screened during 2008. Environmental and product samples were tested for lead. In all, 14 of 197 (7.1%) children had elevated BLLs (prevalence ratio: 10.7) that ranged from 10.2 to 29.0 μg/dL. Six cases were newly identified; 4 were among US-born children. Laboratory testing identified a traditional ethnic digestive remedy, Daw Tway, containing a median 520 ppm lead. A multilevel linear regression model identified daily use of thanakha, an ethnic cosmetic, and Daw Tway use were related to elevated BLLs (P < .05). Routine monitoring of BLLs among this population should remain a priority.     

Surveillance of childhood blood lead levels in 11 cities of China

Background

Exposure to lead can be deleterious to children’s health. Surveillance for blood lead levels (BLLs) is reported every year in the USA and some other countries. However, such reports are lacking in China which has the world’s largest population of children. In this study, we provided the latest nationally representative data on BLLs among Chinese children living in cities, described the change in BLLs since 2004, and explored the risk factors for elevated BLLs (EBLLs) among children.

Methods

We studied 12 693 children aged 0–6 years in 2004 and 11 255 children aged 0–6 years in 2010. We evaluated the average BLLs and the prevalence of EBLLs, and a multivariate logistic regression model was used to estimate predictors of EBLLs.

Results

The geometric mean BLLs of children aged 0–6 years dropped by 16% (from 46.38±2.10 μg/L in 2004 to 38.95±1.83 μg/L in 2010), while the prevalence of EBLLs dropped by 87% (from 9.78% in 2004 to 1.32% in 2010). In a multivariate analysis, the following factors were associated with EBLLs: (1) children being cared for at home or at a boarding nursery (compared to children being cared for in a day nursery), (2) children having fathers with a lower education level, and (3) children often eating popcorn and chewing fingernails or sucking fingers were associated with EBLLs.

Conclusions

The results of this study demonstrated a substantial decline in BLLs from 2004 to 2010 among Chinese children 0–6 years living in cities. However, these levels were higher than levels in countries, such as the USA, Canada, Japan and Sweden. These data demonstrate that Chinese children’s lead exposure remains a public health problem that requires additional effort and resources.     

手足口病合并病毒性脑炎患儿血清铁蛋白及神经元特异性烯醇化酶水平的变化及意义

目的：探讨手足口病（HFMD）合并病毒性脑炎患儿血清铁蛋白和神经元特异性烯醇化酶（NSE）水平的变化及意义。方法：采用酶联免疫吸附（ELISA）与电化学发光法对20 例HFMD合并病毒性脑炎（脑炎组）和20 例单纯HFMD患儿(单纯HFMD组)进行血清铁蛋白和NSE水平测定,并与20 例正常健康儿(对照组)进行比较。结果：脑炎组血清铁蛋白含量为 212±71 μg /L,明显高于单纯HFMD组（85±18 μg /L）及对照组（70±15 μg/L）（均P＜0.01）;脑炎组血清NSE含量（8.6±2.6 μg/L）亦明显高于单纯HFMD组（6.0±1.3 μg/L）及对照组（5.6±1.8 μg/L）,（均P＜0.01）。治疗后脑炎组血清铁蛋白及NSE分别下降至126±37 μg /L、6.8±1.9 μg/L,较治疗前差异有统计学意义（P<0.01）。结论：HFMD合并病毒性脑炎患儿血清铁蛋白和NSE含量显著升高,对血清铁蛋白和NSE含量的检测有利于HFMD合并病毒性脑炎的早期诊断。     

2002-2005年湖南省儿童白血病临床资料分析

目的：小儿白血病发病形势严峻，中国大陆近5年仅有少量文献涉及小儿白血病的发病情况，该文对2002~2005年湖南省县市以上各医院新发小儿白血病临床资料进行分析，以期对湖南省小儿白血病的发病调查起到抛砖引玉的作用。方法：将收集到的2002-2005年湖南省各县市以上医院新发小儿白血病资料进行统计分析。结果：2002-2005年湖南省县市以上各医院小儿白血病新发病例803例，其中急性淋巴细胞性白血病占绝大部分（74.35%），男性与女性在白血病临床分型的分布及新发病例率上差异无显著性；城市新发病例高于农村（2.02/105 ∶1.50/105），接受治疗的比例也高于农村（41.79% ∶22.80%），差异有显著性，P<0.05。结论：小儿白血病的发病情况呈逐年上升趋势，进行湖南省小儿白血病的发病情况调查迫在眉睫。［中国当代儿科杂志，2007，9（3）：198-200］     

Examining Links Between Diet and Lead Exposure in Young Children: 2009 to 2014 National Health and Nutrition Examination Survey

ObjectiveDespite recommendations to consume iron-, calcium-, and vitamin C-rich foods for managing blood lead levels (BLLs), limited evidence exists on how specific foods affect children's BLLs. Using data from 12- to 36-month olds (n = 992) from the 2009 to 2014 National Health and Nutrition Examination Survey, we assessed how foods rich in these nutrients associate with BLLs, and with potential inadvertent exposures to cadmium and mercury.MethodsFood intake was assessed from one 24-hour dietary recall. Foods were categorized into 10 energy-adjusted groups, with intake categorized as none (reference) and tertiles. BLLs were natural log-transformed. Linear regressions tested associations between food groups and BLLs. Logistic regressions were conducted for blood cadmium and mercury.ResultsMedian (5%, 95% range) BLLs were 1.01 (0.39, 3.21) µg/dL. Majority of food groups (7 of 10) showed little association with BLLs. Compared to no intake, cereal (tertile 3: β [95% confidence interval] = ?0.22 [?0.41, ?0.02]) and milk (P_trend < 0.002; nonsignificant tertiles) consumption was associated with lower BLLs. Meat (tertile 2: 0.23 [0.01, 0.45]) and fruit drink (tertile 2: 0.20 [0.03, 0.38]; tertile 3: 0.25 [0.02, 0.49]) intake was associated with higher BLLs. Fruit drink consumption was associated with lower likelihood of having blood cadmium >0.11 µg/dL (tertile 3: odds ratio: 0.05 [0.01, 0.36]). No associations were observed with blood mercury.ConclusionsAmong young children, consumption of iron-, calcium-, and vitamin C-rich foods showed weak or no association with BLLs. Few associations were observed for blood cadmium or mercury. Food-based approaches to BLL management may have limited utility when exposure is low.     

Prevalence of clinical and sub-clinical vitamin a deficiency among rural preschool children of West Bengal,India

A community based cross-sectional study was carried out in rural areas of West Bengal with the aim to assess the prevalence of vitamin A deficiency (VAD) among rural preschool children. Clinical examination was carried out on 9,228 children for the signs and symptoms of VAD and a sub-sample of 590 children were covered for the estimation of blood vitamin A levels using dried blood spot (DBS) method. The prevalence of Bitot’s spots was 0.6% (95% CI=0.44, 0.76), which is more than the public health significance, and it increased with increase in age. The prevalence was significantly higher (P<0.001) among boys (0.8%) as compared to girls (0.4%). The proportion of children with subclinical vitamin A deficiency (blood vitamin A < 20μg/dL) was 61% (95% CI: 52.3–65.1), and it was significantly (P<0.01) higher among the children of lower socioeconomic communities.     

湖南省听力障碍儿童慢性肾脏病流行病学调查

目的 调查湖南省听力障碍儿童慢性肾脏病（CKD）的患病情况。方法 运用横断面研究,采用多阶段整群抽样方法共抽取1 500名儿童作为研究样本,现场进行问卷调查、体格检查、实验室检查。结果 1 500名儿童中,纳入资料完整的儿童1 459名。CKD患病43例,患病率为2.95%,其中 < 7岁组患病率（5.8%,35/604）显著高于7~14岁组（0.9%,8/855）（P < 0.05）。43例CKD患儿中,表现为蛋白尿31例（72%）,表现为血尿27例（63%）,表现肾小球滤过率下降11例（26%）。43例CKD患儿中,CKD 1、2、3a、3b、4、5期患病例数分别为13、19、5、3、3、0例,分别占30%、44%、12%、7%、7%、0%。CKD患病率随听力障碍程度加重而升高（P < 0.01）。结论 湖南省听力障碍儿童中CKD的患病率较高,大部分处于CKD早期,学龄前期儿童多见。听力障碍程度与CKD的患病率相关。     

出生体重与学龄前儿童血压关系的研究

目的 分析出生体重与学龄前儿童收缩压(SBP)、舒张压(DBP)的关系。方法 选择在上海市闵行妇幼保健院产科出生,于2006年3月至2010年11月接受常规健康体检的2～6岁儿童,采用电子血压计测量SBP、DBP和心率,并测量身高和体重。血压评价参照1997年“日本学龄前儿童正常血压和高血压参考值”,以SBP或DBP≥其性别、年龄相对应的P95诊断为高血压。采用多元线性回归分析出生体重与血压的关系,多因素Logistic回归模型分析儿童期患高血压风险的危险因素。结果 4 642名学龄前儿童进入分析,其中男性2 458例（53%）;低出生体重儿占3.2 %(148/4 642),巨大儿占5.4%（251/4 642）。男童SBP水平和高血压患病率均高于女童（P分别为<0.001和0.002）。低出生体重儿SBP、DBP与正常出生体重儿童无明显差异（P分别为0.492和0.398）;巨大儿DBP低于正常出生体重儿童（P=0.003）。多因素Logistic回归显示低出生体重儿、巨大儿与发生儿童高血压无统计学关联,而心率高于平均水平发生高血压的危险增高,OR= 2.55,95%CI＝1.96～3.31。结论 在学龄前儿童中,男童SBP高于女童。未发现低出生体重、巨大儿与儿童期患高血压有统计学关联;心率、体重对血压水平的影响较为明显。     

糖皮质激素对肾病综合征患儿成骨细胞功能的影响

目的　糖皮质激素是治疗肾病综合征的首选药物。但糖皮质激素可抑制成骨细胞功能,导致骨质疏松。该研究通过检测成骨细胞不同分化阶段的生化指标:I型前胶原羧基端前肽(PICP)、骨钙素(BGP)和总碱性磷酸酶(AKP),探讨糖皮质激素对肾病综合征(NS)患儿成骨细胞功能的影响。方法　测定正常对照组(n=30),未治NS患儿(n=30)和激素治疗后NS患儿(每日泼尼松2mg/kg治疗4 ~8周,n=30)血清PICP、BGP及AKP水平。结果　未治NS患儿血清PICP165 ±56μg/L,BGP15 ±9ng/L水平明显低于正常对照组205 ±81μg/L, 19 ±12ng/L(均P<0. 05),而血清总AKP198 ±71U/L与正常对照组202 ±46U/L比较差异无显著性。激素治疗后NS患儿血清PICP85 ±56μg/L、BGP8±5ng/L、AKP104 ±59 U/L均明显低于未治NS患儿(P<0. 01)。结论　NS患儿本身存在骨合成障碍,大剂量糖皮质激素治疗可进一步抑制NS患儿的成骨细胞合成功能。