脐血BPDE-DNA与0岁和2岁儿童神经发育关系的出生队列研究

Association between cord blood BPDE-DNA and neurodevelopment of children aged 0 and 2 years:A birth cohort study

目的探究母亲孕期多环芳烃暴露与0岁和2岁儿童神经发育关系。方法于2009年11月-2010年4月, 在太原市的两家医院共招募221对孕晚期的孕妇及新生儿, 并在其子女2岁时进行随访。采用高效液相色谱法测定脐血白细胞中BPDE-DNA水平。应用《新生儿神经行为发育量表》(NBNA)评估新生儿神经发育情况, 包括行为能力, 主、被动肌张力, 原始反射和一般反应, 总分为40分。应用《格赛尔发育量表》评估2岁儿童智力发育水平, 主要包括行为能、应物能、言语能和应人能4个部分。正态分布的连续性变量用±s描述, 非正态分布的连续性变量用中位数[M(Q_(1), Q_(3))]描述;分类变量用频数和构成比描述。应用限制性立方样条模型分析母亲孕期多环芳烃暴露与其子女神经行为发育水平之间的剂量-反应关系, 应用广义线性模型分析母亲孕期多环芳烃暴露对其子女0岁和2岁时神经行为发育的影响。结果新生儿NBNA得分为38.0±0.8, 2岁儿童行为能、应物能、言语能和应人能的得分分别是111.6±15.0、110.5±14.6、108.8±17.2和111.7±14.5。调整混杂因素后, 孕妇脐血BPDE表达水平与新生儿NBNA评分无剂量-反应关系, 但与2岁儿童行为能、应物能、言语能和应人能得分之间均存在剂量-反应关系。控制相关的混杂因素后, 经自然对数转换后的BPDE-DNA每增加一个单位, 2岁儿童的行为能、应物能、言语能及应人能评分平均降低4.54、6.29、8.41和7.02分。结论母亲孕期多环芳烃暴露与其子女2岁时神经行为发育水平降低存在关联性。

Objective To explore the effects of mothers'exposure to polycyclic aromatic hydrocarbons during pregnancy on their children's neurobehavioral development.Methods In November 2009 to April 2010,a total of 221 pairs of mother-newborn pairs were recruited from two cooperative hospitals in Taiyuan,and their children were followed up at age two.High performance liquid chromatography was used to determine the level of BPDE-DNA in cord blood leukocytes.The Neonatal behavioral neurological assessment(NBNA)was used to assess the neurodevelopment of newborns,and the Gesell Development Scale was used to measure neurodevelopmental indexes of 2-year-old children.NBNA includes behavior,active and passive tone,primitive reflexes and general assessment,with a total score of 40 points.The Gesell Developmental Schedules consisted of four sub-scales:motor development,adaptive behavior development,language development and personal-social behavior development.We used mean and standard deviation to describe continuous variables with normal distribution,median(interquartile range)to describe continuous variables with skewed distribution,and frequency and proportion to describe categorical variables.Restricted cubic spline models were applied to assess the dose-response relationships between maternal prenatal polycyclic aromatic hydrocarbons exposure and children's neurobehavioral development at two years old.Generalized linear models were applied to evaluate the effect of exposure to maternal prenatal polycyclic aromatic hydrocarbons exposure on children's neurobehavioral development at 0 and two years old.Results The NBNA score was 38.0±0.8,and the scores of 2-year-old children's motor,adaptive,language and personal-social were 111.6±15.0,110.5±14.6,108.8±17.2 and 111.7±14.5,respectively.After adjusting for confounding factors,there is no dose-response association between the cord blood BPDE of pregnant women and neonatal NBNA scores,but there were dose-response associations between BPDE and scores of 2-year-old children's motor,adaptive,language and personal-social.A unit increase in cord blood ln(BPDE-DNA),the score of motor,adaptive,language and personal-social of 2-year-old children decreased on average by 4.54、6.29、8.41 and 7.02 points.Conclusion Maternal exposure to polycyclic aromatic hydrocarbons during pregnancy is associated with decreased children's neurobehavioral development at two years old.