Suppr超能文献

[美国及其他国家近期流行病学研究中的低水平铅暴露与儿童智力,以及美国在减少铅暴露和筛查方面的进展]

[Low-level lead exposure and children's intelligence from recent epidemiological studies in the U.S.A. and other countries to progress in reducing lead exposure and screening in the U.S.A].

作者信息

Koike S

机构信息

Department of Hygiene, Showa University School of Medicine, Tokyo, Japan.

出版信息

Nihon Eiseigaku Zasshi. 1997 Oct;52(3):552-61. doi: 10.1265/jjh.52.552.

Abstract

From the 1980s many well-designed epidemiological studies have confirmed that low-level, subclinical lead exposure in early life is associated with decrements in children's intelligence. Neurodevelopmental deficits from exposure to a low level of lead have been held to be not only an American problem, but also a worldwide issue in the past decade. Good epidemiological studies were reported from England, Scotland, Germany, Greece, Australia and New Zealand. Well-designed cross-sectional and prospective studies were carried out to quantify the magnitude of the relation between full scale IQ in children aged five years or more and the burden of lead (PbB or PbT) in early life of children. Of five cross-sectional studies of blood lead, two demonstrated a significant inverse association between lead and IQ even after adjustment for confounders. Two other studies, however, showed no firm evidence of inverse association after adjustment for confounders, and the remaining study demonstrated no significant inverse association of five cross-sectional studies of tooth lead, two indicated an inverse association between tooth lead and IQ, two others showed no significant inverse association after adjustment for confounders, and the remaining one manifested no association. Of four prospective studies, two revealed strong evidence of an inverse association between blood lead at the age of around two years and IQ. Another one, however, revealed an inverse association between mean postnatal blood level and IQ, while the remaining one demonstrated no significant inverse association between IQ and postnatal blood lead level after adjustment for confounders. In a comprehensive review of 26 epidemiological studies since 1979, including a meta-analysis, Pococok et al. indicated that doubling of the body lead burden (from 10 to 20 micrograms/dl) blood lead or (from 5 to 10 micrograms/g) tooth lead is typically associated with a mean deficit in full-scale IQ of around 1-2 IQ points. Lead in interior household dust, exterior surface soil, and old residential lead paint, which is deteriorated or removed, constitute the major sources of lead poisoning in children in the United States. Infants and children, who typically engage in hand to mouth activities, frequently come into contact with lead dust in soil and on the floor. Marked declines both in air lead and blood lead concentrations are evident parallel to the phase-down of lead in gasoline and soldered cans by U.S. food processors. The major source of lead in drinking water is from lead pipes used in household plumbing. The CDC revised its guidelines concerning childhood lead poisoning, stating that community prevention activities should be triggered when a large percentage of children in a community have blood lead levels of 10 micrograms/dl, the lowest level at which neurodevelopmental effects were believed to occur. For children with blood lead level concentrations between 10 and 14 micrograms/dl, more frequent rescreening may be needed. For concentrations between 15 and 19 micrograms/dl, in addition to more frequent screening, nutritional and educational advice should be given. In cases where these levels persist, there should be environmental investigation and intervention. All children with blood levels of 20 micrograms/dl or greater should receive environmental evaluation and medical examination. Such children may need pharmacological treatment.

摘要

自20世纪80年代以来,许多设计精良的流行病学研究证实,儿童早期低水平、亚临床铅暴露与儿童智力下降有关。过去十年间,低水平铅暴露导致的神经发育缺陷不仅被认为是美国的问题,也是一个全球性问题。英国、苏格兰、德国、希腊、澳大利亚和新西兰都报道了良好的流行病学研究。研究人员开展了设计精良的横断面研究和前瞻性研究,以量化5岁及以上儿童的全量表智商与儿童早期铅负荷(血铅或骨铅)之间关系的程度。在五项血铅横断面研究中,两项研究表明,即使在对混杂因素进行调整后,铅与智商之间仍存在显著的负相关。然而,另外两项研究表明,在对混杂因素进行调整后,没有确凿证据证明存在负相关,其余一项研究在五项血铅横断面研究中未显示出显著的负相关。在五项牙铅横断面研究中,两项表明牙铅与智商之间存在负相关,另外两项在对混杂因素进行调整后未显示出显著的负相关,其余一项则未显示出相关性。在四项前瞻性研究中,两项有力地证明了两岁左右血铅水平与智商之间存在负相关。然而,另一项研究表明出生后平均血铅水平与智商之间存在负相关,而其余一项研究在对混杂因素进行调整后未显示出智商与出生后血铅水平之间存在显著的负相关。在对1979年以来的26项流行病学研究(包括一项荟萃分析)的综合综述中,波科克等人指出,体内铅负荷翻倍(血铅从10微克/分升增至20微克/分升,或牙铅从5微克/克增至10微克/克)通常与全量表智商平均下降约1-2个智商点相关。家庭室内灰尘、室外地表土壤以及已恶化或已清除的旧住宅铅漆中的铅,是美国儿童铅中毒的主要来源。婴儿和儿童通常有手口活动,经常接触土壤和地板上的铅尘。随着美国食品加工商逐步减少汽油和焊接罐中的铅含量,空气中铅和血铅浓度显著下降。饮用水中铅的主要来源是家庭管道中使用的铅管。美国疾病控制与预防中心修订了关于儿童铅中毒的指南,指出当社区中很大比例的儿童血铅水平达到10微克/分升(据信会产生神经发育影响的最低水平)时,应启动社区预防活动。对于血铅水平在10至14微克/分升之间的儿童,可能需要更频繁地重新筛查。对于血铅水平在15至19微克/分升之间的儿童,除了更频繁地筛查外,还应提供营养和教育建议。如果这些水平持续存在,应进行环境调查和干预。所有血铅水平达到或高于20微克/分升的儿童都应接受环境评估和医学检查。这些儿童可能需要药物治疗。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验