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］     

神经系统疾病儿童免疫接种策略

儿童神经系统疾病种类繁多、病情复杂,神经系统疾病儿童的免疫接种困难问题突出.文章从神经系统疾病儿童免疫接种现状、免疫接种相关的神经系统反应免疫接种风险及预后、免疫接种的禁忌证以及不同神经系统疾病儿童免疫接种策略五方面进行阐述,强调指出处于稳定期的神经系统疾病儿童可以接种各类疫苗,疫苗相关的神经系统反应极其罕见.     

航空工业区1272名儿童血铅水平调查

目的　了解航空工业区儿童血铅水平。方法　采用外周血石墨炉原子吸收光谱法对社区 12 72名儿童检测血铅水平(BPb) ,对家长进行询问调查相关因素。结果　BPb≤ 0 .483 μmol/L 62 9例 (4 9.44 % ) ,>0 .483 μmol/L64 3例 (5 0 .5 5 % ) ,平均BPb为 0 .62 μmol/L。男女之间有高度显著性差异 (χ2 =16.78　P <0 .0 0 1) ;各年龄组铅水平比较有显著差异 (χ2 =42 .182　P <0 .0 0 1)。可提供高危因素 2 3 0例 ,原因不清 413例。结论　航空工业区儿童血铅水平明显升高 ,达 5 0 .5 5 % ,有明显铅污染存在。     

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。     

降低儿童血铅水平的干预研究

目的　通过 3年来对厦门儿童血铅水平的监测和干预 ,总结血铅检测和降低儿童血铅的方法。方法　采用间接血锌原卟啉 (ZPP)和直接石墨炉原子吸收仪检测血铅水平 ,以及部分计数嗜碱性点彩红细胞。每年对托幼机构的儿童保健人员进行培训和到托幼机构进行指导 ,对家长进行防铅宣教。结果　 1999年、2 0 0 0年、2 0 0 2年高ZPP组的筛查率分别为 11 2 7%、9 0 2 %和 6 5 2 % ,呈逐年下降 ;中度以上铅中毒儿童的血铅与嗜碱性点彩红细胞铅中毒有显著的相关关系。结论　在无显著铅污染的环境下 ,对于普通儿童 ,切实做好防铅保健 ,及时定期监测血铅水平 ,可以达到显著降低儿童血铅水平的目的。在无原子吸收仪的医院 ,嗜碱性点彩红细胞对于儿童中度以上铅中毒诊断有一定的参考价值。     

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］     

血浆置换治疗儿童神经系统疾病六例临床分析

目的 观察血浆置换治疗儿童神经系统疾病的临床疗效及安全性.方法 对4例吉兰-巴雷综合征、1例急性播散性脑脊髓炎和1例慢性炎症性脱髓鞘性多发性神经病患儿分别应用全血浆置换和双重血浆置换,同时给予抗感染、营养支持等综合治疗.结果 6例患儿临床症状均明显改善,吉兰-巴雷综合征患儿恢复时间为8～13 d,急性播散性脑脊髓炎患儿恢复时间为24 d,慢性炎症性脱髓鞘性多发性神经病患儿恢复时间为5 d.肌力可恢复至Ⅲ～Ⅴ级.未见严重不良反应出现.结论 血浆置换治疗儿童神经系统自身免疫性疾病安全、有效.     

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。     

小儿遗传性神经系统疾病的研究近况

小儿遗传性神经系统疾病的研究近况吴希如戚豫近１０年来，有关遗传性神经系统疾病的研究进展很快，迄今已有１００多种单基因遗传的神经系统疾病的致病基因在染色体定位，其中５０多种的致病基因被克隆，基因蛋白产物的生化性质已被鉴定。这些基因所编码的蛋白质包括各种...     

Cochrane图书馆中关于儿童神经系统疾病的证据分析

Cochrane系统评价是循证医学证据级别最高的证据,是特定医疗干预措施疗效评价的最佳证据来源。该文介绍Cochrane图书馆中关于儿童神经系统疾病的系统评价现状,并结合实例进行阐述,以期使读者认识和了解儿童神经系统疾病的高级别临床证据,为临床医师利用Cochrane系统评价指导临床实践和科研提供参考。     

Blood lead and cadmium levels in children: A study conducted in Changchun,Jilin Province,China

OBJECTIVES:

Exposure to lead and cadmium in developing countries is considered to be a public health emergency. The present study was designed to investigate children’s exposure to lead and cadmium in Changchun, China.

METHODS:

A total of 1619 blood samples were collected at random from 1426 children between one and 14 years of age, and 204 adults from Changchun, China. Blood lead and cadmium levels were determined using atomic absorption spectrophotometry.

RESULTS:

The average blood lead level in children was 60.29 μg/L, with boys exhibiting higher blood lead levels than girls. The average blood cadmium level in children was 1.26 μg/L, and differences were not observed between boys and girls.

CONCLUSIONS:

Children from Changchun exhibited relatively low blood lead and cadmium levels compared with children from other cities, and higher lead and lower cadmium levels than adults. This may be related to leaded gasoline environmental pollution and children’s hand-to-mouth activities.     

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.     

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.     

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.     

甲基丙二酸血症患儿血浆microRNA表达变化的初步研究

目的 筛选甲基丙二酸血症（MMA）患儿血浆中表达差异的microRNA（miRNA）,并检测miR-9-1 在MMA 患儿血浆中的表达变化,初步探讨miR-9-1 作为MMA 潜在的生物标记物的意义。方法 收集17 例MMA 患儿血浆样本,其中MMA 合并高同型半胱氨酸血症12 例（MMA+HHcy 组）、不伴高同型半胱氨酸血症的MMA 5 例（MMA 组）;另收集10 例非MMA 的高同型半胱氨酸血症（HHcy 组）和10 例健康对照者的血浆样本。采用miRNA 微阵列基因芯片法筛选具表达差异的miRNA,选择具有表达差异的miR-9-1 行RTPCR法检测血浆中miR-9-1 的表达。选择经维生素B12 治疗的MMA 患儿检测治疗后血浆miR-9-1 表达的变化。结果 miRNA 微阵列基因芯片共筛选出26 个具有表达差异的miRNA,其中下调2 倍以上的miRNA 16 个（包括miR-9-1）,上调2 倍以上的10 个。MMA+HHcy 组、MMA 组及HHcy 组 miR-9-1 的表达量较健康对照组均显著下调（P结论 miR-9-1 在MMA 患儿血浆中显著下调,维生素B12 治疗后显著上调,可作为监控MMA 病情变化的指标。     

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.     

Cerebral diffusion tensor images in children with tuberous sclerosis: a preliminary report

Background In tuberous sclerosis (TS), tubers usually involve the white matter. Diffusion tensor (DT) images are used to demonstrate white-matter tracts.Objective To determine the changes in DT indices in supratentorial tubers and associated changes in the white-matter tracts adjacent to tubers in patients with TS.Materials and methods The DT imaging indices, including first, second and third eigenvalues (EVs), apparent diffusion coefficients (ADCs), and fractional anisotropy (FA) in the white-matter lesions of tubers, were assessed in seven patients with TS exhibiting developmental delay and compared with controls.Results EV1, EV2, EV3, ADC and FA of the white-matter lesions of tubers were significantly different from contralateral unremarkable regions of the brain and from controls (P<0.05). The number of frontal and parietal tubers was significantly negatively correlated with EV1 of the superior longitudinal fasciculi of TS patients (r=–0.60, P =0.04). In addition, TS patients had significantly larger ADCs in the corona radiata and sagittal stratum than the control subjects. EV3s of the inferior longitudinal fasciculus and sagittal stratum were significantly more increased in the TS patients than in the control subjects.Conclusions EV1, EV2, EV3, ADC and FA maps are potential tools for demonstrating cerebral white-matter changes owing to TS.     

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.