CAJ | 학술논문

目的评价早期暴露于(2008年9月以前)三聚氰胺污染奶粉对婴幼儿健康的较远期影响.方法在石家庄市某县开展前瞻性队列研究,队列有3个组:暴露1组纳入47例有污染奶粉喂养史且2008年筛查时泌尿系统B超异常的儿童；按照与暴露1组同乡、同性别、出生日期相差≤3个月的标准,选择有污染奶粉喂养史且筛查时B超正常的儿童(暴露2组)和无污染奶粉喂养史儿童(非暴露组)各47例.2011年11月至2012年6月,对3组儿童进行肝肾功能检查、体格发育评价及泌尿系统B超检查.采用协方差分析比较3组儿童肝肾功能及体格发育指标的差异.结果暴露1组儿童的异常B超影像全部消失,暴露2组和非暴露组儿童的B超影像亦未见异常.暴露1组、2组和非暴露组血尿酸和血清白蛋白差异均有统计学意义[(344±75)、(338±98)、(282±69) μmol/L,(47士5)、(47±6)、(43 ±5) g/L,均P＜0.05],其余肝肾功能及体格发育指标在3组间差异均无统计学意义(均P ＞0.05).进一步两组间比较显示,暴露1组血尿酸和血清白蛋白显著高于非暴露组(P=0.001和0.010),暴露2组也显著高于非暴露组(P=0.003和0.005).结论三聚氰胺污染奶粉所致的异常泌尿系统B超影像在4年后均已消失.未见婴幼期暴露于三聚氰胺影响儿童肝功能及体格发育,但对肾功能的影响尚待研究与评判.
목적 평개조기폭로우(2008년9월이전)삼취청알오염내분대영유인건강적교원기영향.방법 재석가장시모현개전전첨성대렬연구,대렬유3개조:폭로1조납입47례유오염내분위양사차2008년사사시비뇨계통B초이상적인동；안조여폭로1조동향、동성별、출생일기상차≤3개월적표준,선택유오염내분위양사차사사시B초정상적인동(폭로2조)화무오염내분위양사인동(비폭로조)각47례.2011년11월지2012년6월,대3조인동진행간신공능검사、체격발육평개급비뇨계통B초검사.채용협방차분석비교3조인동간신공능급체격발육지표적차이.결과 폭로1조인동적이상B초영상전부소실,폭로2조화비폭로조인동적B초영상역미견이상.폭로1조、2조화비폭로조혈뇨산화혈청백단백차이균유통계학의의[(344±75)、(338±98)、(282±69) μmol/L,(47사5)、(47±6)、(43 ±5) g/L,균P＜0.05],기여간신공능급체격발육지표재3조간차이균무통계학의의(균P ＞0.05).진일보량조간비교현시,폭로1조혈뇨산화혈청백단백현저고우비폭로조(P=0.001화0.010),폭로2조야현저고우비폭로조(P=0.003화0.005).결론 삼취청알오염내분소치적이상비뇨계통B초영상재4년후균이소실.미견영유기폭로우삼취청알영향인동간공능급체격발육,단대신공능적영향상대연구여평판.
Objective To prospectively evaluate the health status of infants with exposure to melamine-contaminated milk formula prior to September 2008.Methods The cohort study was conducted in an area close to the manufacturer of Sanlu dairy products.There were three groups (n =47 each).In September 2008,the exposure group Ⅰ included infants with exposure to melamine and a diagnosis of renal abnormalities,the exposure group Ⅱ had exposure to melamine but there was no diagnosis of renal abnormalities and the non-exposure group had no exposure to melamine.The exposure Ⅱ and non-exposure groups were matched with those of exposure group Ⅰ by birthplaces,gender and date of birth (± 3 months).Kidney function tests (urea nitrogen,serum creatinine,uric acid,serum albumin,β2-microglobulin and cystatin C),liver function tests (alanine aminotransferase and aspartate aminotransferase),growth and development assessment and urinary system ultrasonography were implemented between November 2011 and June 2012.The analysis of covariance (least significant difference method) was performed to compare the differences of relevant variables among three groups.Results The urinary system ultrasonography showed that all abnormalities disappeared in exposure group Ⅰ and all infants of another two groups had normal ultrasonography.There were statistically significant differences in serum uric acid and albumin of kidney function in exposure group Ⅰ,exposure group Ⅱ and non-exposure group ((344 ± 75) and (338 ± 98) and (282 ± 69) μmol/L,(47 ± 5) and (47±6) and (43 ± 5) g/L,all P ＜ 0.05) among three groups.However the differences in the remaining markers of kidney function,markers of liver function and Z scores of weight-for-age and height-for age were all statistically insignificant (all P ＞ 0.05).Further pair-wise comparisons showed that the levels of serum uric acid and albumin in exposure group Ⅰ were higher than those in non-exposure group (P =0.001 and 0.010).And the levels of serum uric acid and albumin in exposure group Ⅱ were also higher than those in non-exposure group (P =0.003 and 0.005).Conclusions All affected infants have recovered from kidney abnormalities.Early infant exposure to melamine-contaminated milk formula appears to have no obvious impact on liver function and growth.But its potential impact on kidney function should be further assessed.