女童血铅浓度与青春期发育延迟

Blood lead concentration and delayed puberty in girls.

作者信息

Selevan Sherry G, Rice Deborah C, Hogan Karen A, Euling Susan Y, Pfahles-Hutchens Andrea, Bethel James

机构信息

National Center for Environmental Assessment, Office of Research and Development, Environmental Protection Agency, Washington, DC 20460, USA.

出版信息

N Engl J Med. 2003 Apr 17;348(16):1527-36. doi: 10.1056/NEJMoa020880.

DOI:10.1056/NEJMoa020880

PMID:12700372

Abstract

BACKGROUND

Environmental lead exposure has been linked to alterations in growth and endocrine function. It is not known whether such exposure affects pubertal development.

METHODS

We analyzed the relations between blood lead concentration and pubertal development among girls (defined as females 8 to 18 years of age) who were enrolled in a cross-sectional study (the third National Health and Nutrition Examination Survey) in which race was self-reported or proxy-reported: 600 were non-Hispanic white, 805 were non-Hispanic African-American, and 781 were Mexican-American girls. Puberty was measured on the basis of the age at menarche and Tanner stage for pubic-hair and breast development.

RESULTS

Geometric mean lead concentrations were less than 3 microg per deciliter (0.144 micromol per liter) in all three groups. As compared with concentrations of 1 microg per deciliter (0.048 micromol per liter), lead concentrations of 3 microg per deciliter were associated with decreased height (P<0.001), after adjustment for age, race, and other factors, but not with body-mass index or weight. Blood lead concentrations of 3 microg per deciliter were associated with significant delays in breast and pubic-hair development in African-American and Mexican-American girls. The delays were most marked among African-American girls; in this group, the delays in reaching Tanner stages 2, 3, 4, and 5 associated with a lead concentration of 3 microg per deciliter as compared with 1 microg per deciliter were 3.8, 5.3, 5.8, and 2.1 months, respectively, for breast development and 4.0, 5.5, 6.0, and 2.2 months, respectively, for pubic-hair development; the associated delay in age at menarche was 3.6 months. In white girls, there were nonsignificant delays in all pubertal measures in association with a lead concentration of 3 microg per deciliter.

CONCLUSIONS

These data suggest that environmental exposure to lead may delay growth and pubertal development in girls, although confirmation is warranted in prospective studies.

摘要

背景

环境铅暴露与生长及内分泌功能改变有关。尚不清楚这种暴露是否会影响青春期发育。

方法

我们分析了参加一项横断面研究（第三次全国健康和营养检查调查）的女孩（定义为8至18岁女性）血铅浓度与青春期发育之间的关系。在该研究中，种族由本人或他人报告：600名是非西班牙裔白人女孩，805名是非西班牙裔非裔美国女孩，781名是墨西哥裔美国女孩。青春期发育通过月经初潮年龄以及阴毛和乳房发育的坦纳分期来衡量。

结果

所有三组的几何平均铅浓度均低于每分升3微克（每升0.144微摩尔）。与每分升1微克（0.048微摩尔）的浓度相比，在调整年龄、种族和其他因素后，每分升3微克的铅浓度与身高降低相关（P<0.001），但与体重指数或体重无关。每分升3微克的血铅浓度与非裔美国女孩和墨西哥裔美国女孩的乳房及阴毛发育显著延迟有关。这种延迟在非裔美国女孩中最为明显；在该组中，与每分升1微克相比，每分升3微克的铅浓度使达到坦纳2期、3期、4期和5期的延迟分别为：乳房发育3.8个月、5.3个月、5.8个月和2.1个月，阴毛发育4.0个月、5.5个月、6.0个月和2.2个月；月经初潮年龄的相关延迟为3.6个月。在白人女孩中，与每分升3微克的铅浓度相关的所有青春期发育指标的延迟均不显著。