JAMA子刊:降低室内铅暴露,不足以提高儿童神经发育水平

创作:洪翔 审核:Epi汪 01月11日
纳入355名孕妇,随机分为干预组和对照组,干预组采取综合措施降低室内铅暴露水平,在儿童出生后8年内监测血铅浓度及行为、认知等神经发育情况;
综合干预措施能够降低地面、窗台、窗槽等部位粉尘中的铅含量;
随年龄的增长,儿童血铅浓度呈现先短暂增加后逐渐下降的趋势,但是两组间无统计学差异;
干预组儿童的焦虑评分较低,其他神经发育评分均没有差异;
室内铅暴露水平可以通过干预降低,但其可能不足以预防铅相关的神经行为缺陷。
延伸阅读
JAMA Pediatrics [IF:10.769]

Effect of Residential Lead-Hazard Interventions on Childhood Blood Lead Concentrations and Neurobehavioral Outcomes: A Randomized Clinical Trial

室内铅暴露干预措施对儿童血铅浓度及神经发育的影响:一项随机临床试验

2018-10-01, Article, 10.1001/jamapediatrics.2018.2382more

Abstract:
IMPORTANCE: Childhood lead exposure is associated with neurobehavioral deficits. The effect of a residential lead hazard intervention on blood lead concentrations and neurobehavioral development remains unknown.
Objective : To determine whether a comprehensive residential lead-exposure reduction intervention completed during pregnancy could decrease residential dust lead loadings, prevent elevated blood lead concentrations, and improve childhood neurobehavioral outcomes.
Design, Setting, and Participants: This longitudinal, community-based randomized clinical trial of pregnant women and their children, the Health Outcomes and Measures of the Environment (HOME) Study, was conducted between March 1, 2003, and January 31, 2006. Pregnant women attending 1 of 9 prenatal care clinics affiliated with 3 hospitals in the Cincinnati, Ohio, metropolitan area were recruited. Of the 1263 eligible women, 468 (37.0%) agreed to participate and 355 women (75.8%) were randomized in this intention-to-treat analysis. Participants were randomly assigned to receive 1 of 2 interventions designed to reduce residential lead or injury hazards. Follow-up on children took place at 1, 2, 3, 4, 5, and 8 years of age. Data analysis was performed from September 2, 2017, to May 6, 2018.
Main Outcomes and Measures: Residential dust lead loadings were measured at baseline and when children were 1 and 2 years of age. At 1, 2, 3, 4, 5, and 8 years of age, the children’s blood lead concentrations as well as behavior, cognition, and executive functions were assessed.
Results : Of the 355 women randomized, 174 (49.0%) were assigned to the intervention group (mean [SD] age at delivery, 30.1 (5.5) years; 119 [68.3%] self-identified as non-Hispanic white) and 181 (50.9%) to the control group (mean [SD] age at delivery, 29.2 [5.7] years; 123 [67.9%] self-identified as non-Hispanic white). The intervention reduced the dust lead loadings for the floor (24%; 95% CI, –43% to 1%), windowsill (40%; 95% CI, –60% to –11%), and window trough (47%; 95% CI, –68% to –10%) surfaces. The intervention did not statistically significantly reduce childhood blood lead concentrations (–6%; 95% CI, –17% to 6%; P = .29). Neurobehavioral test scores were not statistically different between children in the intervention group than those in the control group except for a reduction in anxiety scores in the intervention group (β = –1.6; 95% CI, –3.2 to –0.1; P = .04).
Conclusions and Relevance: Residential lead exposures, as well as blood lead concentrations in non-Hispanic black children, were reduced through a comprehensive lead-hazard intervention without elevating the lead body burden. However, this decrease did not result in substantive neurobehavioral improvements in children.

First Authors:
Joseph M Braun

Correspondence Authors:
Joseph M Braun

All Authors:
Joseph M Braun,Richard Hornung,Aimin Chen,Kim N Dietrich,David E Jacobs,Robert Jones,Jane C Khoury,Stacey Liddy-Hicks,Samantha Morgan,Suzette Baez Vanderbeek,Yingying Xu,Kimberly Yolton,Bruce P Lanphear