摘要目的 探索重庆市乡镇学龄儿童血铅水平及其与神经行为的关联.方法 采用随机整群抽样方法,抽取重庆市某地区14个乡镇2014年秋季学期3到6年级的697名学生纳入研究.采用问卷调查、身体测量、实验室检测及神经行为测试的方法,收集血铅水平、认知能力和学习记忆能力等相关信息.根据血铅水平四分位数将研究对象分为Q1~Q4组,采用多因素logistic回归模型和限制性样条回归分析血铅水平与神经行为的关联.结果 研究对象年龄为(10.07±1.36)岁,血铅水平M (IQR)为44.31(35.42)μg/L.多因素logistic回归模型结果显示,调整年龄、性别、体重指数和母亲文化水平后,与Q 1组相比,Q 3组数字符号替换测试(DSST)获得高分的OR(95%CI)值为1.65(1.01~2.70),整体记忆商(MQ)获得高分的OR(95%CI)值为2.10(1.21~3.62);Q 4组长期记忆(LTM)获得高分的OR (95%CI)值为0.53(0.31~0.92).限制性立方样条回归模型结果显示,血铅和MQ、LTM测试成绩间的剂量反应曲线呈抛物线形状(P值均<0.05).结论 重庆市乡镇学龄儿童的血铅水平与全国其他地区基本一致,但稍高于重庆市其他地区;血铅水平较高的儿童长期记忆能力较差.

abstractsObjective To explore the blood lead level and its relationship with behavior in school?age children from rural areas of Chongqing. Methods A total of 697 students from grades 3 to 6 in the fall semester of 2014 from 14 rural townships in one district of Chongqing was selected by using the random cluster sampling method. Blood were sampled to analyze the lead level. Neurobehavioral tests were performed to determine their personal cognitive and memory ability. Questionnaires and physical examinations were administered to obtain the information of confounding factors. All students were divided into Q1-Q4 groups according to the quartile of their blood lead level. The relationship between the blood lead level and behavior was analyzed by multivariate logistic regression model and restricted spline regression model. Results The mean age of 697 students was (10.07±1.36) years old, and the median (interquartile range) of their blood lead level was 44.31 (35.42) μg/L. Multivariate logistic regression model showed that after adjusting for age, gender, body mass index and maternal culture level, compared with Q1 group, the OR (95%CI ) values of high digit symbol substitution test (DSST) scores and high overall memory quotient (MQ) scores in Q 3 group were 1.65 (1.01-2.70) and 2.10 (1.21-3.62), and the OR (95%CI ) value of high long term memory (LTM) scores in Q4 group was 0.53 (0.31-0.92). The results of the restricted spline regression model showed that the dose?response curves between the blood lead level and MQ/LTM test scores were both parabolic (P<0.05). Conclusion The blood lead level of school?age children from rural areas of Chongqing is the same as that from other areas of China, but slightly higher than that from other areas of Chongqing. Children with higher blood lead level have poor long?term memory ability.