昆明市四城区儿童血铅水平现状调查

目的了解昆明市四城区儿童血铅水平现状及相关因素调查。方法采取整群随机抽样的方法,对昆明市四城区盘龙、五华、官渡(非工业区)、西山区(工业区)幼儿园、小学27211名3~12岁儿童,采用石墨炉原子吸收法进行静脉血血铅含量测定,并进行相关因素问卷调查。结果昆明市儿童血铅水平总体均值85.7μg/L,铅中毒流行率24.9%。工业区、非工业区儿童血铅水平均值分别为88.9μg/L与82.4μg/L,铅中毒率分别为29.5%与23.2%,存在显著性差异(P<0.01)。男、女儿童血铅含量:100~149μg/L频数组,铅中毒率工业区高于非工业区,存在显著性差异(P<0.01),150~200~μg/L频数组男、女儿童均无显著性差异(P>0.05)。居住距马路<50m、家长铅接触、家长吸烟、吮手习惯、啃铅笔头为儿童高血铅的主要危险因素。结论昆明市儿童血铅水平及铅中毒率与国内报道相近。要高度重视铅污染区儿童铅防护。     

佛山市1～7岁儿童的血铅水平调查及预防

目的 了解目前佛山市1～7儿童的血铅情况。方法 用阳极溶出伏安法对446名1～7岁儿童进行末稍血血铅检测。结果 平均血铅水平为83．1μg／L，血铅≥100μg／L共123名，占调查人数的27．5％。结论 佛山市1～7岁儿童铅中毒不容忽视，同时阐述了铅的危害与预防。     

血铅水平对儿童健康危害的调查及其干预措施

目的对我区0～6岁儿童血铅水平进行筛查,分析儿童高血铅的相关因素。方法对0～6岁2983例儿童进行整群抽样血铅水平检测及钙、铁、锌微量元素测定,并进行相关因素问卷调查。结果 2983例儿童血铅检测值在17~183μg/L之间,平均(76.51±53.37)μg/L,检测出高血铅儿童856例,检出率为28.7%,血铅≥100μg/L组儿童的血清钙、锌、铁水平均显著低于血铅<100μg/L组儿童,差异具有统计学意义(P<0.01);高血铅儿童多见反复呼吸道感染、多汗、多动注意力不集中、偏食厌食等;引起儿童高血铅的相关危险因素有:居住条件、父/母从事铅相关工作、住房近期进行过装修、家庭成员有吸烟习惯、父母学历、儿童饮食习惯等。结论本区高血铅儿童较多,铅中毒对儿童生长发育危害大,应对儿童血铅水平进行定期筛查,对高血铅儿童积极采取相应的干预措施,提高儿童健康水平,促进儿童身心健康发展。     

8121例儿童血铅检测分析

目的 分析2006～2007年来我院门诊体检的儿童血铅水平和铅中毒状况.方法 采用阳极溶出伏安(ASV)法,共检测8121份0～18岁儿童的血铅水平,并对每年龄段的血铅水平进行比较分析.结果 8121例儿童血铅水平中位数为71μg/L(1μmol/L=0.00 483μg/L).血铅中毒为1083例,占13.33%,其中男童743例,占14.85%;女童为340例,占10.91%,两者比较差异有统计学意义(P<0.005).结论 儿童血铅水平和血铅中毒随年龄的增长而增加,学龄期儿童尤为突出,男童铅中毒检出率较女童高,应该引起社会、家长和医务人员的共同关注.     

宜兴市城区3～7岁儿童血铅水平调查分析

目的：了解宜兴市城区3～7岁儿童血铅水平、铅中毒发生率等各项指标。方法：选择宜兴市城区幼儿园作为调查区域,随机选择年龄在3～7岁儿童2001名,使用原子吸收光谱法检测血铅水平。结果：2001名3～7岁儿童血铅水平均值为（0.381±0.227）μmol/L,铅中毒率为23.56%。男童铅中毒率高于女童,差异有统计学意义（P〈0.001）。结论：宜兴市城区3～7岁儿童血铅水平及铅中毒率较高,应引起高度重视。     

大庆市新村地区1～6岁儿童血铅水平的分析

目的了解大庆市新村地区儿童血铅水平及其相关影响因素,为防治儿童铅中毒提供依据。方法抽取大庆市新村地区1～6岁儿童1560名,对其血铅水平进行测定,并进行铅暴露危险因素的问卷调查。结果1560例儿童血铅分析中,儿童血铅值平均为62.14μg/L,血铅值≥100μg/L的比例为24.23% 铅中毒检出率为14.12%,影响儿童血铅水平的危险因素主要是父母从事铅接触作业、父母的文化程度低、家庭装修、家庭居住环境、咬指甲,玩油漆玩具和废旧电池等不良卫生习惯等。结论大庆市新村地区1～6岁儿童铅水平受到多种因素影响,通过对儿童血铅水平的筛选,能及早发现儿童高血铅及血铅中毒,达到及时预防环境铅污染对儿童健康的危害,采取相关措施,治疗铅中毒和保护儿童健康为目的。     

关于山西省1000例儿童血铅检测与分析

目的 调查山西省主要工业城市儿童血铅水平及影响因素,为制定防治环境铅污染,保护儿童健康提供科学依据。方法 采用随机抽样方法选择9个幼儿园为调查点,共1000名儿童为调查对象,测定血铅水平并进行问卷调查。结果 太原市儿童血铅水平最高,为(141±35.4)μg/L,其次是临汾市(132±27.6)μg/L,运城市最低为(129±25.2)μg/L。工业区学前儿童血铅水平均值为(153.7±42.5)μg/L,非工业区血铅水平均值为(118.6±38.9)μg/L,工业区明显高于非工业区(P<0.05)。从事接铅职业的家庭的儿童血铅水平较未从事接铅职业的家庭高(P<0.05)。结论 山西省主要工业发达地市儿童血铅水平明显高于附近省市,是铅污染较严重的地区之一,应引起高度重视。     

长春市儿童血铅水平三年监测结果分析

目的了解长春市0～6岁儿童血铅水平变化及高血铅检出率,为儿童高血铅防治提供依据。方法采用钨舟原子吸收光谱法对2010—2012年长春市各幼儿园、小学校、本院儿童保健科门诊及社区卫生服务中心随机抽取的0～6岁儿童进行血铅水平检测及统计分析。结果长春市0-6岁儿童血铅平均值（40．60±22．90）μg／L,高血铅检出率2．03％;2011年血铅平均值（43．45±22．73）μg／L,高血铅检出率为3．83％,明显高于其它两年;血铅水平随着年龄增长逐渐升高,0岁组儿童血铅平均值（29．20±18．39）μg／L,高血铅检出率0．33％,各其它年龄组比较差异有统计学意义;男童血铅平均水平（41．39±23．33）μg／L高于女童（39．67±22．34）μg／L,高血铅检出率男童（2．47％）亦高于女童（1．51％）,两组差异有统计学意义。结论长春市儿童血铅水平较低,但高铅血症仍然存在,应加强环境干预和健康教育,定期检测儿童血铅。     

盖天力驱铅疗效观察

我们对山西省壶关县、临汾市 3所幼儿园儿童进行了血铅筛查 ,对其中血铅 >10 0 μg L者进行了补钙治疗 ,取得了一定疗效 ,现将结果报告如下。1　资料与方法参照美国CDC1991年的儿童铅中毒诊断标准 ,血铅≥ 10 0μg L为铅中毒。采集 3所幼儿园共计 746名 3～ 6岁儿童末梢血 0 .1ml。根据美国CDC推荐的方案 ,用石墨炉原子吸收法检测 (测定仪器为美国PEZ 5 10 0型 )。将血铅 >10 0 μg L的 14 8名儿童随机分为三组 :A组 5 0名给予营养指导 ,纠正铅中毒的高危行为如啃咬铅笔和指甲 ,饭前不洗手或不认真洗手 ,被动吸烟 ,喜食皮蛋、膨化食品…     

大连开发区1168儿童血铅水平的调查及分析

目的 了解大连开发区0～14岁儿童的血铅水平,为及时发现儿童铅中毒提供科学依据.方法 研究对象为2011年3月至2011年10月到我院体检的0～14岁儿童1168例,采集静脉血,用BH2100 型原子吸收光谱法测定血铅水平.结果 1168 名儿童血铅均值为31.83 μg/L,铅中毒发生率0.26%.各年龄组之间血铅水平比较差异无统计学意义(P>0.05).不同性别儿童间血铅水平及中毒比率均没有差异(P>0.05).结论 大连开发区儿童血铅水平处于低水平,血铅中毒率较低.     

肾移植受者环孢素A治疗窗浓度研究

目的 :寻找环孢素A(CsA )在肾移植受者三联免疫抑制用药方案中的理想治疗窗浓度。方法 :用特异性荧光偏振免疫法测定268例患者全血CsA谷值浓度 ,并按术后时间及临床诊断分组比较。结果 :CsA理想治疗窗浓度为 :术后1mo内300～400μg/L ,2mo～3mo内250～350μg/L ,4mo～6mo内150～250μg/L ,7mo～12mo内100～200μg/L ,12mo以后100～150μg/L。结论 :CsA在理想治疗窗浓度内 ,既能达到满意的免疫抑制效果 ,又能减少CsA毒性反应和排斥反应     

不同孕期妇女尿碘水平与甲状腺功能关系的调查研究

目的：探讨孕早期、孕中期及孕晚期孕妇尿碘水平与甲状腺功能的关系。方法采用单纯随机抽样法抽取本地区孕妇405例进行调查,孕早期136例,孕中期141例,孕晚期128例,按甲状腺功能是否正常分为甲状腺功能正常组383例,甲状腺功能异常组22例。结果孕早期、孕中期甲状腺功能正常率明显高于孕晚期,甲状腺功能异常率低于孕晚期,差异有统计学意义（P＜0.05）,甲状腺功能正常组孕早期尿碘分级＜100μg/L妇女比例明显低于甲状腺功能异常组孕早期妇女,尿碘分级为100～300μg/L妇女比例明显高于甲状腺异常组孕早期妇女,差异有统计学意义（P＜0.05）。结论尿碘监测对孕早期的孕妇具有重要的意义,建议对尿碘分级＜100μg/L或100～300μg/L的孕妇进行甲状腺功能筛查。     

A Bland–Altman Comparison of the Lead Care® System and Inductively Coupled Plasma Mass Spectrometry for Detecting Low-Level Lead in Child Whole Blood Samples

Chronic childhood lead exposure, yielding blood lead levels consistently below 10 μg/dL, remains a major public health concern. Low neurotoxic effect thresholds have not yet been established. Progress requires accurate, efficient, and cost-effective methods for testing large numbers of children. The LeadCare® System (LCS) may provide one ready option. The comparability of this system to the “gold standard” method of inductively coupled plasma mass spectrometry (ICP-MS) for the purpose of detecting blood lead levels below 10 μg/dL has not yet been examined. Paired blood samples from 177 children ages 5.2–12.8 years were tested with LCS and ICP-MS. Triplicate repeat tests confirmed that LCS and ICP-MS had comparable repeatability. As compared with ICP-MS, LCS had a negative bias of 0.457 μg/dL with an average variability of 1.0 μg/dL. The reproducibility and precision of the LCS is appropriate for the evaluation and monitoring of blood lead levels of individual children in a clinical setting. Recent research however has suggested that increments as small as 0.5 μg/dL may distinguish those at risk of low-level lead-induced neurotoxicity. Thus, we also conclude that the LCS is not useful for research applications attempting to identify neurotoxic effect thresholds for chronic lowest level lead exposure in children. For these types of research applications, a convenient and low-cost device is needed for the precise detection of child blood lead levels below 10 μg/dL.     

Inorganic cobalt supplementation: Prediction of cobalt levels in whole blood and urine using a biokinetic model

Soluble cobalt (Co) supplements with recommended daily doses up to 1000 μg Co/day are increasingly being marketed to consumers interested in healthy living practices. For example, some athletes may consider using Co supplements as blood doping agents, as Co is known to stimulate erythropoesis. However, the distribution and excretion kinetics of ingested Co are understood in a limited fashion. We used a Co-specific biokinetic model to estimate whole blood and urine Co levels resulting from oral exposure or ingestion of Co in amounts exceeding typical dietary intake rates. Following 10 days of Co supplementation at a rate of 400 to 1000 μg/day, predicted adult Co concentrations range from 1.7 to 10 μg/L in whole blood, and from 20 to 120 μg/L in urine. Chronic supplementation (?1 year) at a rate of 1000 μg Co/day is predicted to result in blood levels of 5.7 to 13 μg/L, and in urine levels from 65 to 150 μg/L. The model predictions are within those measured in humans following ingestion of known doses. The methodology presented in this paper can be used to predict urinary or blood Co levels following acute or chronic occupational incidental ingestion, medicinal therapy, supplemental intake, or other non-occupational exposures.     

The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone in the National Health and Nutrition Examination Survey 1999-2002

The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone were assessed in a nationally representative sample of women, 35-60 years old, from the National Health and Nutrition Examination Survey 1999-2002. The blood lead levels of the women ranged from 0.2 to 17.0 μg/dL. The estimated geometric mean was 1.4 μg/dL, and the estimated arithmetic mean was 1.6 μg/dL. As the blood lead level increased, the concentration of serum follicle stimulating hormone increased in post-menopausal women, women who had both ovaries removed, and pre-menopausal women. The concentration of luteinizing hormone increased as blood lead level increased in post-menopausal women and women who had both ovaries removed. The lowest concentrations of blood lead at which a relationship was detected were 0.9 μg/dL for follicle stimulating hormone and 3.2 μg/dL for luteinizing hormone. Lead may act directly or indirectly at ovarian and non-ovarian sites to increase the concentrations of follicle stimulating hormone and luteinizing hormone.     

Metalloproteinase Inhibition Protects against Reductions in Circulating Adrenomedullin during Lead‐induced Acute Hypertension

Intoxication with lead (Pb) results in increased blood pressure by mechanisms involving matrix metalloproteinases (MMPs). Recent findings have revealed that MMP type two (MMP‐2) seems to cleave vasoactive peptides. This study examined whether MMP‐2 and MMP‐9 levels/activities increase after acute intoxication with low lead concentrations and whether these changes were associated with increases in blood pressure and circulating endothelin‐1 or with reductions in circulating adrenomedullin and calcitonin gene‐related peptide (CGRP). Here, we expand previous findings and examine whether doxycycline (a MMPs inhibitor) affects these alterations. Wistar rats received intraperitoneally (i.p.) 1st dose 8 μg/100 g of lead (or sodium) acetate, a subsequent dose of 0.1 μg/100 g to cover daily loss and treatment with doxycycline (30 mg/kg/day) or water by gavage for 7 days. Similar whole‐blood lead levels (9 μg/dL) were found in lead‐exposed rats treated with either doxycycline or water. Lead‐induced increases in systolic blood pressure (from 143 ± 2 to 167 ± 3 mmHg) and gelatin zymography of plasma samples showed that lead increased MMP‐9 (but not MMP‐2) levels. Both lead‐induced increased MMP‐9 activity and hypertension were blunted by doxycycline. Doxycycline also prevented lead‐induced reductions in circulating adrenomedullin. No significant changes in plasma levels of endothelin‐1 or CGRP were found. Lead‐induced decreases in nitric oxide markers and antioxidant status were not prevented by doxycycline. In conclusion, acute lead exposure increases blood pressure and MMP‐9 activity, which were blunted by doxycycline. These findings suggest that MMP‐9 may contribute with lead‐induced hypertension by cleaving the vasodilatory peptide adrenomedullin, thereby inhibiting adrenomedullin‐dependent lowering of blood pressure.     

Changes in low levels of lead over the course of pregnancy and the association with birth outcomes

Data are lacking on the effect of low level prenatal lead exposure. We examined the change in blood lead from the second trimester until delivery and the association between maternal and cord blood lead and birth outcomes in 98 participants of the CANDLE birth cohort study. Mixed effects models were constructed to assess blood lead change over pregnancy and regression models were used to explore the relationship with cord blood lead, characteristics effecting maternal lead, birth weight and gestational age. Overall, the geometric mean maternal blood level was 0.43 μg/dL. Maternal blood lead at each time point was predictive of cord blood lead level. A 0.1 μg/dL increase in second trimester lead was associated with lower birth weight and pre-term birth. Maternal blood lead below 1 μg/dL behaves in a manner similar to lead at higher levels and is associated with a small decrease in birth weight and gestational age.     

两种手术方法治疗垂体腺瘤的疗效比较

目的：比较两种经单鼻孔蝶窦入路微创垂体瘤手术的临床资料并分析其优缺点,为临床诊疗工作提供参考。方法采取前瞻性研究方案,垂体腺瘤患者54例自愿选择治疗方式,分为显微镜组31例和神经内镜组23例,分别使用经单鼻孔蝶窦入路的显微镜手术和神经内镜手术治疗。观察比较两组患者的手术时间、术中出血量、住院时间、有效切除率、术后的并发症（主要观察术后一过性尿崩症和短暂电解质紊乱）、术后各种激素水平以及患者1年内的随访结果。结果显微镜组手术时间（121．3±19．4）min较神经内镜组长,但术中出血量（50．3±3．2）mL较神经内镜组的（78．5±7．8）mL少,差异均有统计学意义（t＝0．993、1．032,均P＜0．05）。两组术后住院时间[（8．7±1．1）d与（9．1±2．3）d,t＝2．897,P＞0．05]、有效切除率（93．5％与91．3％,χ2＝3．191,P＞0．05）差异均无统计学意义,术后并发症（包括一过性尿崩症和短暂性电解质紊乱）差异无统计学意义。内分泌激素水平,显微镜组和神经内镜组术前、术后催乳素（PRL）[（387．3±100．8）μg/L与（145．3±27．4）μg/L、（390．2±133．7）μg/L与（148．4±57．2）μg/L]、生长激素（GH）[（63．4±5.7）μg/L与（10．6±2．4）μg/L、（65．6±6．2）μg/L 与（12．4±1．6）μg/L]、促肾上腺皮质激素（ ACTH）[（202.9±73．7）ng/L与（38．5±4．6）ng/L、（206．8±78．6）ng/L与（35．6±2．5）ng/L],差异均有统计学意义（t＝1．456、1．301、0．973、1．034、0．774、0,732,均P＜0．05）。结论两种手术方法治疗垂体腺瘤的疗效无明显差别,均具有微创、安全、有效等优点,其中显微镜下手术出血较少,而神经内镜手术则可缩短手术时间。     

甲状腺疾病患者血清可溶性细胞间黏附分子-1测定的临床意义

目的 探讨单纯甲状腺肿、格雷夫斯病（GD）和桥本甲状腺炎（HT）患者血清可溶性细胞间黏附分子-1（sICAM-1）的含量及其临床意义.方法 用放射免疫分析法检测单纯性甲状腺肿大100例、GD 250例、HT 50例及健康人对照组100例血清sICAM-1含量,进行比较分析.结果 健康人sICAM-1含量（170.43±34.23）μg/L和单纯性甲肿（182.48±40.05）μg/L差异无统计学意义（t=1.104,P＞0.05）;GD和HT的sICAM-1含量分别为（279.93±86.69）μg/L,（250.36±81.56）μg/L,均高于对照组（t=2.310,2.210,均P＜0.05）;三种方法治疗后sICAM-1含量[（178.95±59.78）μg/L,（185.65±53.25）μg/L,（259.41±71.46）μg/L）]均明显低于治疗前[（316.53±66.13）μg/L,（277.79±64.30）μg/L,（285.71±72.14）μg/L]（t=2.312,2.278,2.328,均P＜0.05）;GD停药复发患者血清sICAM-1为（329.34±90.47）μg/L,明显高于抗甲状腺药物治疗后甲状腺功能恢复正常的GD患者（251.92±77.75）μg/L（t=2.412,P＜0.05）.结论 血清sICAM-1含量可作为自身免疫性甲状腺疾病诊断的一个参考指标,并在临床评价Graves病的疗效、停药和复发等方面具有重要意义.