【作者】 李俊；

【导师】 徐德祥；

【作者基本信息】 安徽医科大学 ， 卫生毒理学， 2018， 硕士

【摘要】 背景铅(Pb)是一种众所周知的发育毒物。血清铅浓度与早产和小于胎龄儿(small for gestational age,SGA)发生风险之间的关系仍需确定。目的本研究的目的是在基于人群的出生队列研究中分析母体血清铅水平与早产和SGA发生风险之间的关联。方法本研究分析了中国-安徽出生队列的一项子研究,该研究招募了3125对符合条件的母亲-单胎子女对。采用石墨炉原子吸收光谱法测定孕期母体血清铅含量。所有受试者根据血清铅水平按三分位数法划分为三组:低血清铅水平(L-Pb,<1.18μg/dl)、中血清铅水平(M-Pb,1.18-1.70μg/dl)和高血清铅水平(H-Pb,≥1.71μg/dl)。采用χ~2检验分析不同组别孕妇和新生儿特征、早产及SGA比例。对于多重比较,我们使用了单因素方差分析。母体血清铅水平与早产、SGA风险之间关联的优势比(OR)和95%置信区间(CI)使用二元logistic回归模型进行估计。结果不同组别的出生身长、头围和胸围无差异。受试者中L-Pb组、M-Pb组和H-Pb组的早产率分别为2.8%、6.1%和8.1%。控制混杂因素后,M-Pb组受试者早产的调整OR值为2.33(95%CI:1.49,3.65),H-Pb组受试者早产的调整OR值为3.09(95%CI:2.01,4.76)。孕期铅暴露增加早产的发生风险。而且,M-Pb组受试者晚期早产的调整OR值为3.51(95%CI:1.92,6.44),H-Pb组受试者晚期早产的调整OR值为4.62(95%CI:2.56,8.34)。母体血清铅水平仅与晚期早产风险增加有关。受试者中L-Pb组、M-Pb组和H-Pb组的SGA率分别为6.2%、8.7%和10.1%。M-Pb组受试者SGA的调整OR值为1.45(95%CI:1.04,2.02),H-Pb组受试者SGA的调整OR值为1.69(95%CI:1.22,2.34)。SGA婴儿的发生率只在孕早期H-Pb受试者中升高(校正OR 2.13;95%CI:1.24,3.38)。孕期母体高铅负荷升高SGA女孩的发生风险(校正OR 1.68;95%CI:1.12,2.54)。结论孕期铅暴露增加中国人群早产的发生风险。而且,母体血清铅水平仅与晚期早产风险增加有关。SGA婴儿的发生率只在孕早期H-Pb受试者中升高,孕期母体铅高负荷增加SGA女孩的发生风险。更多还原

【Abstract】 Background Lead(Pb)is a well-known developmental toxicant.The relationship between serum lead levels with risk of preterm birth and small for gestational age(SGA)remains to be determined.Objective The aim of the present study was to analyze the association between maternal serum Pb level with risk of preterm birth and SGA in a population-based birth cohort study.Methods The present study analyzed a sub-study of the China-Anhui Birth Cohort that recruited 3125 eligible mother-and-singleton-offspring pairs.Maternal serum Pb level during pregnancy was measured by graphite furnace atomic absorption spectrometry.All subjects were classified into three groups by tertile division according to serum Pb level: Low-Pb(L-Pb,<1.18 μg/dl),Medium-Pb(M-Pb,1.18-1.70 μg /dl),and High-Pb(H-Pb,≥1.71 μg /dl).The proportions of maternal and neonatal characteristics and the rate for preterm birth among different groups were analyzed using the chi-square test.For multiple comparisons,we used one-way ANOVA.The odds ratios(OR)and 95% confidence intervals(CI)for the association between maternal serum lead level and risk of preterm birth were estimated using multiple logistic regression models.Results There was no difference on birth length,head circumference and chest circumference among different groups.The rate of preterm birth was 2.8% among subjects with L-Pb,6.1% among subjects with M-Pb,and 8.1% among subjects with H-Pb,respectively.After controlling confounding factors,the adjusted OR for preterm birth was 2.33(95%CI: 1.49,3.65)among subjects with M-Pb and 3.09(95%CI: 2.01,4.76)among subjects with H-Pb.Lead exposure during pregnancy increases the risk of preterm birth.Moreover,the adjusted OR of late preterm birth was 3.51(95%CI: 1.92,6.44)in subjects with M-Pb and 4.62(95%CI: 2.56,8.34)in subjects with H-Pb.Maternal serum Pb level was only associated with increased risk of late preterm birth.The rate of SGA was 6.2% in subjects with L-Pb,8.7% in subjects with M-Pb,and 10.1% in subjects with H-Pb,respectively.The adjusted OR of SGA was 1.45(95%CI: 1.04,2.02)in subjects with M-Pb and 1.69(95%CI: 1.22,2.34)in subjects with H-Pb.Interestingly,the rate of SGA infants was elevated only in subjects with H-Pb in the first trimester(adjusted OR: 2.13;95%CI: 1.24,3.38).Maternal lead exposure during pregnancy increase the risk of SGA in girls(adjusted OR: 1.68;95%CI: 1.12,2.54).Conclusion Collectively,exposure to lead during pregnancy increase the risk of premature birth in the Chinese population and maternal serum Pb level was only associated with increased risk of late preterm birth.H-Pb in the first trimester elevate the rate of SGA infants.Maternal lead exposure during pregnancy increase the risk of SGA in girls.更多还原