CAJ | 학술논문

目的探讨尿液中金属元素水平与儿童急性白血病发病之间的关系. 方法选取2007年9月至2008年8月就诊于上海儿童医学中心的71例新发急性白血病患儿作为病例组,患儿均15岁以下且排除唐氏综合征及其他肿瘤性疾病.以同期就诊于该院的,年龄性别与病例组匹配,且无肿瘤和先天性疾病病史的113例患儿作为对照组.应用问卷调查研究对象一般情况,同时取其随机尿(病例组尿液取白化疗前),用电感耦合等离子体质谱仪检测尿液中金属元素含量,运用logistic模型对其进行单因素和多因素分析. 结果问卷调查显示,母亲孕期或孕前3个月服用铁剂者,在病例组和对照组中的构成比分别为28.2%(20/71)和14.2%(16/113),差异有统计学意义(x2=5.438,P=0.02).单因素分析显示,两组尿中含量差异有统计学意义的元素分别为钒、锰、铁、钴、铜、砷、钡,且均为病例组高于对照组;病例组和对照组中钒的含量(中位数)分别为5.39、3.04 ng/mg肌酐(Wald x2=9.03,P＜0.05),锰为4.46、2.44 ng/mg肌酐(Wald x2=10.57,P＜0.05),铁为58.69、14.09 ng/mg肌酐(Wald x2=13.41,P＜0.05),钴为0.98、0.77 ng/mg肌酐(Wald x2=4.46,P＜0.05),铜为61.17、10.90 ng/mg肌酐(Wald x2=8.15,P＜0.05),砷为55.93、36.11 ng/mg肌酐(Wald x2=4.57,P＜0.05),钡为8.55、2.87 ng/mg肌酐(Wald x2=4.82,P＜0.05).多因素分析显示,尿中铁元素含量升高可增加儿童急性白血病发病风险(OR=1.009;95%CI=1.002～1.016). 结论体内铁的水平与儿童急性白血病发病相关,其具体机制有待进一步深入研究.
목적 탐토뇨액중금속원소수평여인동급성백혈병발병지간적관계. 방법 선취2007년9월지2008년8월취진우상해인동의학중심적71례신발급성백혈병환인작위병례조,환인균15세이하차배제당씨종합정급기타종류성질병.이동기취진우해원적,년령성별여병례조필배,차무종류화선천성질병병사적113례환인작위대조조.응용문권조사연구대상일반정황,동시취기수궤뇨(병례조뇨액취백화료전),용전감우합등리자체질보의검측뇨액중금속원소함량,운용logistic모형대기진행단인소화다인소분석. 결과 문권조사현시,모친잉기혹잉전3개월복용철제자,재병례조화대조조중적구성비분별위28.2%(20/71)화14.2%(16/113),차이유통계학의의(x2=5.438,P=0.02).단인소분석현시,량조뇨중함량차이유통계학의의적원소분별위범、맹、철、고、동、신、패,차균위병례조고우대조조;병례조화대조조중범적함량(중위수)분별위5.39、3.04 ng/mg기항(Wald x2=9.03,P＜0.05),맹위4.46、2.44 ng/mg기항(Wald x2=10.57,P＜0.05),철위58.69、14.09 ng/mg기항(Wald x2=13.41,P＜0.05),고위0.98、0.77 ng/mg기항(Wald x2=4.46,P＜0.05),동위61.17、10.90 ng/mg기항(Wald x2=8.15,P＜0.05),신위55.93、36.11 ng/mg기항(Wald x2=4.57,P＜0.05),패위8.55、2.87 ng/mg기항(Wald x2=4.82,P＜0.05).다인소분석현시,뇨중철원소함량승고가증가인동급성백혈병발병풍험(OR=1.009;95%CI=1.002～1.016). 결론 체내철적수평여인동급성백혈병발병상관,기구체궤제유대진일보심입연구.
Objective To explore the relation between the level of metallic elements in urine and childhood acute leukemia. Methods A total of 71 patients under 15 years old who were newly diagnosed with acute leukemia between September 2007 and August 2008 without Downs' syndrome or other tumors,and 113 gender-and age-matched controls without tunors or congenital diseases were enrolled for the case-control study.The general data and potential risk factors were obtained by questionnaires.Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the metal concentrations in urine,which was collected randomly before chemotherapy.Logistic regression model was performed for univariate and multivariate analysis. Results The questionnaire showed that there was significant difference in the proportion of children whose mothers had taken iron supplements during or 3 months before pregnancy between case group and control group,which was 28.2% (20/71) and 14.2% (16/113) respectively (Wald x2 = 5.438,P =0.02).Univariate logistic regression analysis showed that levels of vanadium,manganese,iron,cobalt,copper,arsenic,and barium in urine from case group were all higher than those of control group with significant difference.The median values for vanadium in urine from case and control groups were 5.39 and 3.04 ng/mg creatinine (Wald x2 = 9.03,P ＜ 0.05);the median values for manganese were respectively 4.46 and 2.44 ng/mg creatinine (Wald x2 = 10.57,P ＜0.05);the median values for iron were separately 58.69 and 14.09 ng/mg creatinine (Wald x2 = 13.41,P ＜ 0.05);the median values for cobalt were respectively 0.98 and 0.77 ng/mg creatinine (Wald x2 = 4.46,P ＜ 0.05);the median values for copper were 61.17 and 10.90 ng/mg creatinine (Wald x2 = 8.15,P ＜ 0.05);the median values for arsenic were respectively 55.93 and 36.11 ng/mg creatinine (Wald x2 = 4.57,P ＜ 0.05);and the median values for barium were 8.55 and 2.87 ng/mg creatinine (Wald x2 = 4.82,P ＜ 0.05).Multivariate logistic regression analysis showed that the level of iron in urine had a significantly positive relation with the incidence of childhood acute leukemia (OR = 1.009,95% CI = 1.002-1.016). Conclusion The level of iron in urine might be related to the occurrence of childhood acute leukemia,but its specific role needs further investigation.