4385例儿童血铅水平调查研究与临床分析

A clinical study on blood lead levels in 4385 children

目的调查保健门诊儿童血铅水平以及铅中毒状况。方法采用阳极溶出伏安(ASV)法,检测4385例1个月～18岁儿童的血铅水平,并比较不同年龄组男、女童的血铅水平及其季节特点和临床特征。结果本组儿童血铅水平为(55.9±7.5)μg/L,男、女童血铅水平分别为(59.1±7.4)μg/L、(50.5±7.4)μg/L。血铅水平≥100μg/L者695例,占15.8%,其中男童506例,检出率18.0%;女童189例,检出率11.9%,两者比较P<0.001。不同年龄组儿童铅水平升高和铅中毒检出率随着年龄增长而增加,其铅中毒程度有明显差别,轻度铅中毒与年龄呈正相关(线性回归系数B=9.348389E-03),中度和重度铅中毒与年龄呈负相关(线性回归系数B=-9.348432E-03)。1岁以内中和重度铅中毒者占45.5%;儿童血铅水平、铅中毒率有明显的季节特点[CHI(M-EXT)=8.982P总<0.001],夏秋季节铅水平和铅中毒检出率显著增高。结论男童铅中毒检出率高于女童。儿童铅水平和铅中毒检出率随年龄增长而增加,但铅中毒程度与年龄呈负相关。夏秋季血铅水平高于冬春季。

Objective To know the blood lead levels of children in health care clinic and early diagnose lead poisoning in them. Methods The blood lead contents of 4385 children aged 0-18 were determined, by the Anodic Stripping Voltametry(ASV), who were received physical checkup from March 2002 to February 2003 in Beijing. Results The mean of all blood lead levels was 55.9 ± 7.5μg/L. 695 children(15.8%) were with a blood lead ≥100μg/L, mostly showing mild lead poisoning were slight . Both blood lead levels (59.1 ± 7.4μg/L) and the prevalence of lead poisoning (18.0%) in boys were higher than those (50.5 ± 7.4μg/L, 11.9%) in girls. The blood lead levels and the occurrence of lead poisoning for children were rising with age, Analysis on standarized rate ratio estimation for each level of exposure, Total linear trend test of exposure effects in boys:CHI(M-EXT)=6.485,P总 < 0.001,Linear Trend Test: X12=42.074 ,P1(One-Tailed)=4.414634E-11,test for departure from linearity of trend: X22=3.958, P2 > 0.3 ,Total linear trend test of exposure effects in girls:CHI(M-EXT)= 1.558,0.05 < P总 < 0.1, Linear Trend Test: X12=2.43,P1(One-Tailed)=5.952384E-02 ,test for departure from linearity of trend: X22=1.689 P2>0.7], and both were higher in summer and autumn than in other seasons CHI(M-EXT)=8.982 P总 < 0.001]. However, There was a significantly positive correlation between the mild lead poisoning and the age(Linear rgression coeffcient:B=9.348389E-03). There was a negatively correlation between the moderate-severe lead poisoning and the age(Linear rgression coeffcient:B=-9.348432E-03). the younger, the more serious lead poisoning. The moderate-severe lead poisoning was 45.4% under 1 year. Conclusions Blood lead levels of children and prevalence of lead poisoning in Beijing were relatively declined after introducing lead-free gasoline. Both outdoor and indoor environmental pollution are still beyond the control. So routine check of lead poisoning should be one of the urgent tasks in heaith care clinic, especially for infant.