【摘要】 目的 分析体内维生素/微量元素水平与室内空气污染物暴露与儿童注意力缺陷多动障碍（attention deficit hyperactivity disorder,ADHD）发生风险的关联。方法 采用1∶1配对病例对照设计，于2024年1—9月，选取大连市妇女儿童医疗中心确诊的ADHD患儿50例作为病例组，并按性别、年龄（±6个月）匹配同医院非ADHD儿童50例作为对照组。采集研究对象空腹外周静脉血样4 m L及居室内空气样本，分别采用高效液相色谱-串联质谱法测定研究对象血清中的维生素A（vitamin A,Vit A）、维生素D（vitamin D,Vit D）水平，电感耦合等离子体质谱法检测全血铅、血清铜及血清锌水平;依据《室内空气质量标准》（GB/T 18883-2022）检测居室可吸入颗粒物(inhalable particulate matter,PM₁₀)、甲醛、苯、甲苯、二甲苯、总挥发性有机物（total volatile organic compounds,TVOC）浓度。通过多因素条件Logistic回归分析ADHD的关联因素。结果 病例组血清Vit A[x±s:（0.35±0.02） mg/L]、Vit D[（22.38±6.60） ng/m L]平均浓度与对照组[分别为（0.38±0.08） mg/L、（26.24±7.60） ng/m L]相比，差异均有统计学意义（t分别为2.57和2.71,P<0.05）。病例组和对照组全血铅浓度M(P₂₅,P₇₅)分别为39.03（29.59,66.85）和30.76（26.42,41.38）μg/L，差异有统计学意义（Z=-2.52,P=0.01）。室内污染物中，病例组PM_{1 0}、甲醛、苯和TVOC浓度中位数与对照组相比，差异均有统计学意义（均P<0.001）;病例组甲醛超标率（40.0%）、PM₁₀超标率（100.0%）与对照组（分别为12.0%和84.0%）相比，差异均有统计学意义（χ²分别为10.19和8.70,P<0.05）。多因素条件Logistic回归分析表明，与低浓度暴露相比，甲醛（>59μg/m³）、TVOC（>41μg/m³）和血铅（>34.40μg/L）高浓度暴露均显著增加ADHD风险，OR值分别为2.219（95%CI:1.769～2.783）、4.043（95%CI:3.884～4.216）和1.036（95%CI:1.006～1.067）; Vit A（OR=0.420,95%CI:0.224～0.789）和Vit D（OR=0.841,95%CI:0.783～0.902）是ADHD的保护因素。结论 儿童血清Vit A和Vit D水平与ADHD风险呈负相关，而甲醛、TVOC和血铅为ADHD的危险因素。更多还原

【Abstract】 Objective To analyze the association of levels of vitamins/trace elements and exposure to indoor air pollutants with the risk of attention deficit hyperactivity disorder（ ADHD） in children.Methods A 1 ∶ 1 matched case-control design was adopted in the study. Fifty children diagnosed with ADHD at Dalian Women and Children’s Medical Center from January to September 2024 were selected as case group. Fifty sex-and age-matched（ ±6 months） non-ADHD children were selected from the same hospital as control group. Fasting peripheral venous blood samples（ 4 m L） and indoor air samples were collected from the study subjects. Serum levels of vitamin A（ Vit A） and vitamin D（ Vit D） were measured using high-performance liquid chromatography-tandem mass spectrometry. The levels of lead in whole blood and copper and zinc in serum were determined using inductively coupled plasma mass spectrometry. Concentrations of inhalable particulate matter( PM₁₀),formaldehyde,benzene,toluene,xylene,and total volatile organic compounds（ TVOC） in living rooms were measured according to the Standards for Indoor Air Quality（ GB/T 18883-2022）. A multivariable conditional Logistic regression model was used to identify factors associated with ADHD. Results Serum concentrations of Vit A [x ± s:（ 0. 35±0. 02） mg/L]and Vit D [（ 22. 38±6. 60） ng/m L]in the case group were significantly different from those in the control group[（ 0. 38±0. 08） mg/L and（ 26. 24±7. 60） ng/m L,respectively]（ t= 2. 57 and 2. 71,respectively,both P<0. 05）. There were significant differences in whole blood lead concentrations [M( P₂₅,P₇₅) ] between the case group and control group（ Z =-2. 52,P =0. 01）,with values of 39. 03（ 29. 59,66. 85） and 30. 76（ 26. 42,41. 38） μg/L,respectively. The median concentrations of PM_{1 0},formaldehyde,benzene,and TVOC in the case group were significantly different from those in the control group（ P<0. 001）. The exceedance rates of formaldehyde（ 40. 0%） and PM₁₀（ 100. 0%） in the case group were significantly different from those in the control group（ 12. 0% and 84. 0%,respectively）（ χ²= 10. 19 and 8. 70,respectively,both P<0. 05）. Multivariable conditional Logistic regression analysis showed that,compared with low-level exposure,high-level exposure to formaldehyde（ > 59 μg/m³）,TVOC（ >41μg/m³）,and blood lead（ >34. 40 μg/L） significantly increased the risk of ADHD,with odds ratios（ ORs） of 2. 219（ 95% confidence interval [CI]: 1. 769-2. 783）,4. 043（ 95% CI: 3. 884-4. 216）,and 1. 036（ 95% CI: 1. 006-1. 067）,respectively. Vit A（ OR= 0. 420,95% CI: 0. 224-0. 789） and Vit D（ OR = 0. 841,95% CI: 0. 783-0. 902） were protective factors against ADHD.Conclusion Serum levels of Vit A and Vit D are inversely associated with the risk of ADHD in children,while formaldehyde,TVOC,and blood lead are risk factors for ADHD.更多还原