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目的探讨在宫内低水平铅暴露状态下,新生儿脐血铅含量与神经行为发育的关系,研究目的是评价脐血铅对孕妇妊娠结局和4岁学龄前儿童的神经发育的影响。课题的研究现场选在南京市妇幼保健院医院产科、新生儿科、儿童保健科门诊。2005年10月至2006年10月共170名孕妇被随机选入我们的研究。所采血液和脐血铅测定使用电感耦合等离子体质谱(ICP-MS)法,106名4岁上面提及孕妇所生的子女被随防,随防率是97.25%。方法通过问卷调查和体格检查分别了解上述儿童的一般状况、生长发育情况。用韦克斯勒氏学龄前儿童智商测量量表测定儿童智商,多元线性回归分析脐血铅和学龄前儿童体格和智商的相关性。同时随机选取南京市妇幼保健院医院产科出生的足月新生儿170例。以脐血铅含量作为新生儿铅暴露的指标,新生儿神经行为(NBNA)发育评分作为效应指标,以脐血铅中位数49.7U/L被分为高低铅组。结果高暴露组在新生儿主动肌张力、原始反射,和神经行为发育总评分上低于低暴露组,差异有统计学意义,在新生儿行为能力、被动肌张力、一般估价上差异无统计学意义。根据智商测定揭示,低铅组的操作智商和言语智商明显高于高铅组(t=2.91,P<0.01;t=5.87,P<0.01)。结论脐血铅水平和与婴儿的早期发育有关,铅可通过脐血造成新生儿的铅接触,对新生儿婴儿早期神经行为发育产生不良影响。随着脐血铅水平的增加,学龄前期儿童总智商评分和操作智商评分下降,妊娠期脐铅暴露水平可能是学龄前期儿童总智商评分和操作智商评分降低的危险因素。
Objective To investigate the relationship between cord blood lead levels and neurobehavioral development in low-level lead exposure in utero. The purpose of this study was to evaluate the effect of cord blood lead on pregnancy outcome and neurological development in 4-year-old preschool children. The subject of the research site selected in Nanjing Maternal and Child Health Hospital obstetrics, neonatology, child health clinic. A total of 170 pregnant women were enrolled in our study from October 2005 to October 2006. Blood and Umbilical Cord Blood Lead Determination Induced-coupling plasma mass spectrometry (ICP-MS) was used to detect the presence of 106 children aged 4 years with the above-mentioned pregnant women, with a prevention rate of 97.25%. Methods By questionnaire and physical examination to understand the general situation of children, respectively, the growth and development. Childhood IQ was measured by Wechsler’s pre-school children’s IQ test, and multivariate linear regression was used to analyze the association between cord blood and preschoolers’ physique and IQ. At the same time randomly selected 170 cases of full-term newborns born in Obstetrics and Gynecology Hospital of Nanjing MCH Hospital. Using cord blood lead as an indicator of neonatal lead exposure, neonatal neurobehavioral (NBNA) developmental score was used as an index of effect, and the cord blood lead median 49.7U / L was divided into high and low lead groups. Results The high exposure group was lower than the low exposure group in neonatal active muscle tone, initial reflex, and total score of neurobehavioral development, the difference was statistically significant. There was no significant difference in neonatal behavioral ability, passive muscle tone, general evaluation significance. According to the IQ test, the IQ and verbal IQ of the low lead group were significantly higher than those of the high lead group (t = 2.91, P <0.01; t = 5.87, P <0.01). Conclusion Umbilical cord blood lead levels are related to the early development of infants. Lead can lead to neonatal lead exposure through umbilical cord blood and have an adverse effect on the early neurobehavioral development of newborn infants. With the increase of umbilical cord blood lead level, the total IQ score and the operation IQ score of preschool children decreased. The umbilical lead exposure level during pregnancy may be the risk factor of preschool children’s total IQ score and operation IQ score decreasing.