铅暴露对注意缺陷多动障碍影响的系统综述

Systematic review of the effects of lead exposure onattention deficit hyperactivity disorder

目的 对铅暴露与注意缺陷多动障碍(ADHD)的相关性,以及铅暴露水平与ADHD症状的关系进行系统综述,探讨铅暴露对ADHD的影响。方法 通过相关文献库检索和收集2016—2022年关于铅暴露与ADHD相关文献,进行质量评定并提取文献特征,进行统计分析。结果 共检索到文献1 884篇,最终纳入19篇,13项病例对照研究结果显示,ADHD儿童的血铅水平明显高于正常对照组儿童的血铅水平,合并标准化均数差和95%可信区间分别为0.85(0.45~1.25),合并效应量检验Z=4.14,P<0.001。4项研究表明铅暴露会增加ADHD的发生的风险,5项研究表明铅暴露与至少一种ADHD症状之间存在关联,1项研究表明铅暴露与ADHD症状之间无关联。结论 铅水平与儿童ADHD有关,铅暴露是儿童ADHD的独立危险因素,铅暴露水平与ADHD的症状的严重程度存在一定的联系。应积极采取相应干预措施降低儿童铅暴露,预防ADHD发生。

Objective To investigate the impact of lead exposure on attention deficit hyperactivity disorder(ADHD),this study will conduct a systematic review of the correlation between lead exposure and ADHD,as well as the relationship between the level of lead exposure and the symptoms of ADHD.Methods The literature pertaining to the connection between lead exposure and ADHD during the period of 2016 to 2022 was gathered and compiled from the appropriate literature database.The quality of the literature was evaluated and the literature's features were extracted for the purpose of statistical analysis.Results A total of 1884 pieces of literature were identified with 19 being included in the final analysis.The findings from 13 case-control studies revealed a significantly higher blood lead level among children with ADHD as compared to their healthy counterparts.The combined standardized mean difference and 95%confidence interval were 0.85(0.45-1.25),and the combined effect size test z-score was 4.14(P<0.001).Four studies demonstrated a heightened risk of ADHD due to lead exposure,whilst five studies indicated an association between lead exposure and at least one ADHD symptom.In contrast,one study found no correlation between lead exposure and ADHD symptoms.Conclusions Lead levels are associated with ADHD in children,and lead exposure is an independent risk factor for the development of ADHD in children.There is a significant correlation between lead exposure and the severity of ADHD symptoms.Therefore,it is essential to take appropriate intervention measures to reduce children's exposure to lead actively and prevent the occurrence of ADHD.