上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (12): 1570-1578.doi: 10.3969/j.issn.1674-8115.2024.12.010
• 论著 · 公共卫生 • 上一篇
徐祖婧1,2(
), 江怡宁1,2, 徐健1,2,3()
收稿日期:2024-05-03
接受日期:2024-09-30
出版日期:2024-12-28
发布日期:2024-12-28
通讯作者:
徐健
E-mail:tzxuzujing@163.com;sonia0616@sjtu.edu.cn
作者简介:徐祖婧（1999—），女，硕士生；电子信箱：tzxuzujing@163.com。
基金资助:
XU Zujing1,2(), JIANG Yining1,2, XU Jian1,2,3()
Received:2024-05-03
Accepted:2024-09-30
Online:2024-12-28
Published:2024-12-28
Contact:
XU Jian
E-mail:tzxuzujing@163.com;sonia0616@sjtu.edu.cn
Supported by:摘要：
目的·分析出生前母体重（类）金属复合暴露与子代认知和气质发育的相关性。方法·利用2010—2012年在上海开展的前瞻性出生队列，在妊娠28~36周采集孕妇静脉血，检测静脉血重（类）金属浓度。在幼儿24~36月龄时，使用格塞尔发育量表和幼儿气质量表分别评估幼儿的认知和气质发育。通过问卷及医院病历系统收集孕妇及幼儿的基本信息。使用贝叶斯核机器回归（Bayesian kernel machine regression，BKMR）模型评估出生前母体重（类）金属复合暴露对幼儿认知和气质发育的影响。结果·最终共纳入139对信息完整的母婴。入组时孕妇年龄为（29.39±3.41）岁，婴儿出生体质量为（3.47±0.42）kg，女性占59.71%，随访时幼儿月龄为（32.91±2.69）个月。根据以往研究证据和多元线性回归模型筛选出和幼儿认知和气质发展可能有关联的4种重（类）金属元素，分别为铬（Cr）、锰（Mn）、砷（As）和铅（Pb）。出生前母体静脉血Mn、Pb、As、Cr的浓度中位数分别为3.32、3.60、2.03、1.78 μg/dL。BKMR模型分析发现，矫正相关混杂因素后，当4种重（类）金属的整体浓度高于第50个百分位时，随着重（类）金属整体浓度的增加，幼儿的精细动作发育商呈下降趋势，且幼儿气质量表的适应性、坚持性和反应阈维度得分均呈下降趋势。其中出生前母体Mn暴露对幼儿精细动作发育影响的贡献最大［后验包含概率（posterior inclusion probabilities，PIP）=0.617］，As暴露对幼儿坚持性维度影响的贡献最大（PIP=0.656），Cr暴露对幼儿反应阈维度影响的贡献最大（PIP=0.447），4种重（类）金属暴露对幼儿适应性维度影响的贡献相近。结论·出生前母体重（类）金属（Mn、As、Pb、Cr）复合暴露与幼儿的精细动作发育和气质的适应性、坚持性和反应阈维度发育之间可能存在相关性；尤其要重视Mn暴露与幼儿精细动作发育之间，以及As和Cr暴露与幼儿气质发育之间的关系。
中图分类号:
徐祖婧, 江怡宁, 徐健. 出生前母体重（类）金属复合暴露与子代认知和气质发育的相关性研究[J]. 上海交通大学学报（医学版）, 2024, 44(12): 1570-1578.
XU Zujing, JIANG Yining, XU Jian. Relationship between prenatal mixed heavy metal/metalloid exposure and offspring cognitive and temperament development[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(12): 1570-1578.
| Characteristic | Value |
|---|---|
| Maternal age/year | 29.39±3.41 |
| Maternal education level/n(%) | |
| Senior high school or below | 16 (11.50) |
| University or college | 105 (75.54) |
| Postgraduate | 18 (12.95) |
| Marital status/n(%) | |
| Married | 134 (96.40) |
| Single | 5 (3.60) |
| Occupation/n(%) | |
| Professional and technical personnel | 45 (32.37) |
| Administrative or management personnel | 30 (21.58) |
| Commercial personnel | 25 (17.99) |
| Others | 39 (28.06) |
| Family monthly income/n(%) | |
| <2 000 yuan | 6 (4.32) |
| 2 000‒5 000 yuan | 37 (26.62) |
| 5 000‒10 000 yuan | 54 (38.85) |
| >10 000 yuan | 42 (30.21) |
| Birth weight/kg | 3.47±0.42 |
| Gestational age/week | 39.27±1.36 |
| Child gender/n(%) | |
| Male | 56 (40.29) |
| Female | 83 (59.71) |
| Child age/month | 32.91±2.69 |
| DQ of GDS/score | |
| Gross motor | 108.36±11.05 |
| Fine motor | 100.47±13.32 |
| Language | 111.48±12.40 |
| Adaptive | 114.23±8.81 |
| Personal-social | 105.38±11.01 |
| Score of TTS/score | |
| Activity | 3.23±0.57 |
| Rhythm | 2.63±0.57 |
| Withdrawal | 2.94±0.77 |
| Adaptability | 2.90±0.58 |
| Reaction | 3.85±0.60 |
| Mood | 2.66±0.63 |
| Persistence | 2.86±0.66 |
| Attention | 3.72±0.53 |
| Threshold | 3.89±0.75 |
| Heavy metal/metalloid level/(μg·dL-1) | |
| Mn | 3.32 (2.24, 4.63) |
| Pb | 3.60 (2.55, 4.35) |
| As | 2.03 (1.01, 3.35) |
| Cr | 1.78 (0.77, 2.52) |
表1 研究对象的人口学特征及临床特征
Tab 1 Demographic and clinical characteristics of participants
| Characteristic | Value |
|---|---|
| Maternal age/year | 29.39±3.41 |
| Maternal education level/n(%) | |
| Senior high school or below | 16 (11.50) |
| University or college | 105 (75.54) |
| Postgraduate | 18 (12.95) |
| Marital status/n(%) | |
| Married | 134 (96.40) |
| Single | 5 (3.60) |
| Occupation/n(%) | |
| Professional and technical personnel | 45 (32.37) |
| Administrative or management personnel | 30 (21.58) |
| Commercial personnel | 25 (17.99) |
| Others | 39 (28.06) |
| Family monthly income/n(%) | |
| <2 000 yuan | 6 (4.32) |
| 2 000‒5 000 yuan | 37 (26.62) |
| 5 000‒10 000 yuan | 54 (38.85) |
| >10 000 yuan | 42 (30.21) |
| Birth weight/kg | 3.47±0.42 |
| Gestational age/week | 39.27±1.36 |
| Child gender/n(%) | |
| Male | 56 (40.29) |
| Female | 83 (59.71) |
| Child age/month | 32.91±2.69 |
| DQ of GDS/score | |
| Gross motor | 108.36±11.05 |
| Fine motor | 100.47±13.32 |
| Language | 111.48±12.40 |
| Adaptive | 114.23±8.81 |
| Personal-social | 105.38±11.01 |
| Score of TTS/score | |
| Activity | 3.23±0.57 |
| Rhythm | 2.63±0.57 |
| Withdrawal | 2.94±0.77 |
| Adaptability | 2.90±0.58 |
| Reaction | 3.85±0.60 |
| Mood | 2.66±0.63 |
| Persistence | 2.86±0.66 |
| Attention | 3.72±0.53 |
| Threshold | 3.89±0.75 |
| Heavy metal/metalloid level/(μg·dL-1) | |
| Mn | 3.32 (2.24, 4.63) |
| Pb | 3.60 (2.55, 4.35) |
| As | 2.03 (1.01, 3.35) |
| Cr | 1.78 (0.77, 2.52) |
图1 通过BKMR模型分析出生前母体4种重（类）金属复合暴露对幼儿精细动作发育的总效应Note： The overall concentration of the four heavy metals/metalloid (Mn, Cr, As, and Pb) at the P50 level was used as the reference (dashed lines). A. Without adjustment for confounders. B. After adjusting for maternal age, maternal education, gestational age, child age, and child gender.
Fig 1 Total effect of prenatal maternal exposure to a combination of four heavy metals/metalloid on the fine motor development of children by the BKMR model
图2 通过BKMR模型分析出生前母体4种重（类）金属复合暴露对幼儿适应性维度的总效应Note： The overall concentration of the four heavy metals/metalloid (Mn, Cr, As, and Pb) at the P50 level was used as the reference (dashed lines). A. Without adjustment for confounders. B. After adjusting for maternal age, maternal education, gestational age, child age, and child gender.
Fig 2 Total effect of prenatal maternal exposure to a combination of four heavy metals/metalloid on the adaptive dimension of the children by the BKMR model
图3 通过BKMR模型分析出生前母体4种重（类）金属复合暴露对幼儿坚持性维度的总效应Note： The overall concentration of the four heavy metals/metalloid (Mn, Cr, As, and Pb) at the P50 level was used as the reference (dashed lines). A. Without adjustment for confounders. B. After adjusting for maternal age, maternal education, gestational age, child age, and child gender.
Fig 3 Total effect of prenatal maternal exposure to a combination of four heavy metals/metalloid on the persistence dimension of the children by the BKMR model
图4 通过BKMR模型分析出生前母体4种重（类）金属复合暴露对幼儿反应阈维度的总效应Note： The overall concentration of the four heavy metals/metalloid (Mn, Cr, As, and Pb) at the P50 level was used as the reference (dashed lines). A. Without adjustment for confounders. B. After adjusting for maternal age, maternal education, gestational age, child age, and child gender.
Fig 4 Total effect of prenatal maternal exposure to a combination of four heavy metals/metalloid on the threshold of response dimension of the children by the BKMR model
图5 基于BKMR模型分析出生前母体4种重（类）金属暴露对幼儿认知和气质发育影响的主导性Note： The models were adjusted for maternal age, maternal education, gestational age, child age, and child sex. The impact of prenatal maternal exposure to various heavy metals/metalloid on the changes in fine motor DQ (A), and adaptability (B)/persistence (C)/threshold of response (D) dimension scores across different exposure levels was assessed. The figures illustrated the associations between the concentration of a specific heavy metal/metalloid and changes in the DQ value or dimension scores, while the concentration levels of the other three were fixed at the 50th percentile.
Fig 5 Analyses of the dominant effects of prenatal maternal exposure to the four heavy metals/metalloid on cognitive and temperament development in young children based on the BKMR model
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