中国3-5岁儿童铅暴露与生长迟缓和低体重的关联研究

Association of lead exposure with stunting and underweight among children aged 3-5 years in China

目的分析我国3-5岁儿童铅暴露与生长迟缓、低体重的关联。方法研究对象来自2017—2018年国家人体生物监测项目。于2017年1月至2018年12月,采用多阶段抽样方法,最终将3554名3-5岁儿童纳入研究。通过问卷调查和体格检查收集调查对象的一般人口学特征、生活习惯和膳食频率等情况;采用标准化方法测量调查对象身高、体重,通过计算年龄别身高/体重z评分判定其生长迟缓、低体重状况;同时采集调查对象的空腹静脉全血和随机中段尿检测血铅、尿铅和尿肌酐等水平。根据血铅水平和尿肌酐校正后尿铅水平的四分位数分别将调查对象分为4组(Q_(1)-Q_(4)组),采用复杂抽样logistic回归模型分别分析血铅水平、尿铅水平和生长迟缓、低体重的关联。结果3554名研究对象年龄为(4.09±1.06)岁,其中女性1779名(80.64%);城市儿童1948名(55.84%);生长迟缓者244名(7.34%),低体重者97名(2.96%)。研究对象血铅、尿铅的M(Q_(1),Q_(3))分别为17.49(12.80,24.71)μg/L、1.20(0.61,2.14)μg/g Cr。复杂抽样logistic回归结果显示,在调整相关混杂因素后,与儿童血铅浓度Q_(1)组相比,Q_(3)、Q_(4)组的生长迟缓风险逐渐升高(P_(趋势)=0.010),OR(95%CI)值分别为1.40(0.80-2.46)和1.80(1.07-3.04);与儿童尿铅浓度Q_(1)组相比,Q_(3)、Q_(4)组的生长迟缓风险逐渐升高(P_(趋势)=0.012),OR(95%CI)值分别为1.69(1.01-2.84)和1.79(1.05-3.06)。不同铅暴露水平与低体重之间未发现统计学关联(P>0.05)。结论我国3-5岁儿童铅暴露与生长迟缓发生风险之间存在正向关联。

Objective To evaluate the association of lead exposure with stunting and underweight among children aged 3-5 years in China.Methods Data was collected from China National Human Biomonitoring(CNHBM)between January 2017 and December 2018.A total of 3554 children aged 3-5 years were included.Demographic characteristic,lifestyle and nutritional status were collected through questionnaires.Height and weight were measured by standardized method.Stunting and underweight status were determined by calculating height for age Z-score and weight for age Z-score.Blood and urine samples were collected to detect the concentrations of blood lead,urinary lead and urinary creatinine.Children were stratified into 4 groups(Q_(1) to Q_(4))by quartiles of blood lead level and corrected urinary lead level,respectively.Complex sampling logistic regression models were applied to evaluate the association of the blood lead level,urinary lead level with stunting and underweight.Results Among 3554 children,the age was(4.09±1.06)years,of which 1779(80.64%)were female and 1948(55.84%)were urban residents.The prevalence of stunting and wasting was 7.34%and 2.96%,respectively.The M(Q_(1),Q_(3))for blood lead levels and urinary lead levels in children was 17.49(12.80,24.71)μg/L,1.20(0.61,2.14)μg/g Cr,respectively.After adjusting for confounding factors,compared with the lowest blood lead concentration group Q_(1),the risk of stunting gradually increased in the Q_(3) and Q_(4) group(P_(trend)=0.010),with OR(95%CI)values of 1.40(0.80-2.46)and 1.80(1.07-3.04),respectively.Compared with the lowest urinary lead concentration group Q_(1),the risk of stunting still increased in the Q_(3) and Q_(4) group(P_(trend)=0.012),with OR(95%CI)values of 1.69(1.01-2.84)and 1.79(1.05-3.06),respectively.The correlation between the lead exposure and underweight was not statistically significant(P>0.05).Conclusion Lead exposure is positively associated with the risk of stunting among children aged 3-5 years in China.