中国北方3县妊娠妇女血液锰浓度及其影响因素

Blood manganese levels among pregnant women and the associated factors in three counties of northern China

目的:了解中国北方3县妊娠早、中期妇女血锰浓度,分析血锰水平的影响因素。方法:2010年4月至9月在山西省榆社县和代县、河北省香河县调查273例妊娠早、中期妇女,面对面问卷调查收集妇女一般人口学特征、室内燃煤污染暴露以及膳食摄入等信息,并采集其空腹静脉血,用电感耦合等离子质谱法(inductively coupled plasma mass spectrometry,ICP-MS)检测血锰浓度。用非参数检验、单因素及多因素二分类Logistic回归法进行数据分析。结果:3县妇女血锰浓度几何均数为16.78(95%CI:16.14~17.45)μg/L,中位数(四分位数间距)为16.59(13.68~20.44)μg/L。按照一般健康成年女性血锰浓度参考值范围(3.39~20.67μg/L),23.4%的妇女血锰浓度高于正常范围,未发现血锰浓度低于正常值范围的妇女。榆社县、代县、香河县妊娠妇女血锰浓度中位数分别为17.51(13.96~22.04)、16.92(13.78~21.45)和15.43(12.25~17.56)μg/L(P<0.05),多因素分析发现山西省榆社县的妇女血锰浓度异常偏高的发生风险是河北香河县的6.15(95%CI:1.21~31.35)倍;农民、低收入、食用肉类较少、食用醋较多、食用辣椒较少的妇女血锰水平较相应的对比组高(P值均小于0.05),但调整混杂因素后未见上述因素与妊娠妇女血锰浓度的关联有统计学意义。单因素分析和多因素分析中血锰水平与室内燃煤污染的关联性均无统计学意义(P>0.05)。结论:3县妇女血锰水平与国外妊娠妇女研究结果接近,与国内妊娠妇女研究结果差别较大,榆社县妊娠妇女血锰异常风险高于香河县,未发现妊娠妇女血锰浓度偏高与室内燃煤污染暴露和膳食暴露因素有关联。

Objective： To explore the levels of blood manganese concentration in pregnant women in 1 st and 2 ndtrimester and the associated factors in three counties of northern China. Methods： We carried out a cross-sectional investigation in three counties of northern China in 2010. Two hundred and seventy three pregnant women whose gestational age was less than 28 weeks were recruited,their demographic characteristics and information on exposure to indoor air pollution from coal combustion and dietary during one month before pregnancy till the date of investigation were collected with questionnaires by face-to-face interview,their fasting venous whole blood samples were collected with vacuum blood collection tube containing heparin lithium at the Maternal and Child Health Hospital in the three counties. Their blood manganese concentrations were measured with inductively coupled plasma mass spectrometry（ ICP-MS）.Nonparametric tests were used to compare the concentrations among the groups and multivariate unconditional Logistic regression model was used to adjust the confounding factors. Results： The geometric mean of blood manganese of the women was 16. 78（ 95% CI： 16. 14-17. 45） μg/L,and the median（ interquartile range） was 16. 59（ 13. 68-20. 44） μg/L. According to the reference range of general healthy adult female＇s manganese concentration in the whole blood 3. 39-20. 67 μg/L,the proportion of manganese concentration lower than normal,normal,higher than normal were 0%,76. 6% and 23. 4%,respectively. Medians of blood manganese concentrations among the women in Yushe,Dai and Xianghe were 17. 51（ 13. 96-22. 04）,16. 92（ 13. 78-21. 45） and 15. 43（ 12. 25-17. 56） μg/L,respectively（ P〈0. 05）,and multivariate analysis found that the risk of higher than normal in Yushe County was6. 15（ 95% CI： 1. 21-31. 35） times the risk in Xianghe county. Blood manganese concentrations were higher in women who were farmers,had lower income per month,and consumed more vinegar and less peppers,pork,beef and mutton during the month before investigation（ all P〈0. 05）,the adjusted odds ratio（ AOR） between these factors and high blood manganese concentration were not statistically significant No statistical associations were found between blood manganese levels and indoor air pollution from coal combustion for both of crude odds ratrio（ COR） and AOR（ P〈0. 05）. Conclusion： The blood manganese concentration among pregnant women in the three counties is similar to the women in some other studies abroad and quite different from the findings of several domestic researches. The risk of blood manganese concentration higher than normal in Yushe county was higher than Xianghe county. The relationships between high manganese concentration and exposure to indoor air pollution from coal combustion or dietary need further research in the future.