尿中金属元素水平与儿童急性白血病之间的关系  

Correlation between level of metallic elements in urine and childhood acute leukemia

作　　者：朱莎[1] 张妍[2] 高宇[2] 王筱金[3] 陈涛[1] 杨友[1] 施蓉[2] 金萍[2] 田英[2] 沈晓明[1] 

机构地区：[1]上海交通大学医学院附属新华医院上海市环境与儿童健康重点实验室,200092 [2]上海交通大学公共卫生学院环境卫生教研室 [3]上海交通大学基础医学院生物统计教研室

出　　处：《中华预防医学杂志》2011年第2期146-149,共4页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金（30571542,30901171）;上海市自然科学基金（09ZR1416500）;上海交通大学医学院科技基金项目（09XJ21054）;上海市卫生局青年科研项目（2008Y119）

摘　　要：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（Х^2=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 Х^2=9.03,P＜0.05）,锰为4.46、2.44 ng/mg肌酐（Wald Х^2=10.57,P＜0.05）,铁为58.69、14.09 ng/mg肌酐（Wald Х^2=13.41,P＜0.05）,钴为0.98、0.77 ng/mg肌酐（Wald Х^2=4.46,P＜0.05）,铜为61.17、10.90 ng/mg肌酐（Wald Х^2=8.15,P＜0.05）,砷为55.93、36.11 ng/mg肌酐（Wald Х^2=4.57,P＜0.05）,钡为8.55、2.87 ng/mg肌酐（Wald Х^2=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.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 Х^2 = 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 Х^2 = 9.03,P 〈 0.05）;the median values for manganese were respectively 4.46 and 2.44 ng/mg creatinine （Wald Х^2 = 10.57,P 〈0.05）;the median values for iron were separately 58.69 and 14.09 ng/mg creatinine （Wald Х^2 = 13.41,P 〈 0.05）;the median values for cobalt were respectively 0.98 and 0.77 ng/mg creatinine （Wald Х^2 = 4.46,P 〈 0.05）;the median values for copper were 61.17 and 10.90 ng/mg creatinine （Wald Х^2 = 8.15,P 〈 0.05）;the median values for arsenic were respectively 55.93 and 36.11 ng/mg creatinine （Wald Х^2 = 4.57,P 〈 0.05）;and the median values for barium were 8.55 and 2.87 ng/mg creatinine （Wald Х^2 = 4.82,P 〈 0.05�

关 键 词：儿童 白血病 混合细胞 尿 铁 病例对照研究 

分 类 号：R733.71[医药卫生—肿瘤]