农村妇女孕全程拟除虫菊酯类农药暴露对2岁儿童神经发育影响的队列研究  

Prenatal pyrethroid pesticides exposure and neurodevelopment of 2-year-old children:a birth cohort study

作　　者：齐志业[1] 宋肖肖 肖霞 徐庆华 吴洁[4] 郭光萍[5] 陈舒旗 陈颖 徐灵灵 李燕 Qi Zhiye;Song Xiaoxiao;Xiao Xia;Xu Qinghua;Wu Jie;Guo Guangping;Chen Shuqi;Chen Ying;Xu Lingling;Li Yan(Department of Pediatrics,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;School of Public Health,Kunming Medical University,Kunming 650500,China;Yunnan Institute of Pediatric Research,Kunming Children′s Hospital,Kunming 650228,China;Department of Pediatrics,Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Yunnan Maternal and Child Health Care Hospital,Kunming 650021,China)

机构地区：[1]昆明医科大学第一附属医院儿科,昆明650032 [2]昆明医科大学公共卫生学院,昆明650500 [3]昆明市儿童医院云南省儿科研究所,昆明650228 [4]昆明医科大学第二附属医院儿科,昆明650101 [5]云南省妇幼保健院,昆明650021

出　　处：《中华预防医学杂志》2022年第3期270-279,共10页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金(81673186);云南公共卫生与疾病防控协同创新中心项目(2015YNPHXT01)。

摘　　要：目的探讨孕期全程拟除虫菊酯类农药(pyrethroid pesticides,PYRs)暴露对2岁儿童神经发育的影响及其关键窗口期。方法2016年1月至2018年12月在云南省宣威市2个乡镇招募孕早期妇女建立出生队列。采用超高效液相色谱-串联质谱法检测482名妇女孕8~12^(+6)周、20~23^(+6)周和32~35^(+6)周尿PYRs代谢产物水平,贝利婴幼儿发育量表-第3版评估2岁儿童神经发育水平。采用多元线性回归分析模型和二元Logistic回归分析模型分析孕期PYRs暴露与儿童神经发育之间的关联。结果共完成360个母子对孕期尿液PYRs代谢产物检测和儿童神经发育水平评估。孕早、中、晚期至少检出一种PYRs代谢产物的检出率分别为93.6%(337/360)、90.8%(327/360)和94.2%(339/360)。2岁儿童认知、语言、运动、社会情感和适应性行为得分分别为(102.3±18.9)、(100.2±16.3)、(102.0±20.3)、(107.8±23.3)和(85.8±18.6)分。调整其他混杂因素后,孕早期尿PYRs代谢产物4-氟-3-苯氧基苯甲酸暴露可降低2岁儿童运动(β=-5.02,95%CI:-9.08~-0.97)和适应性行为(β=-4.12,95%CI:-7.92~-0.32)得分,可增加2岁儿童适应性行为发育迟缓的风险(OR=2.07,95%CI:1.13~3.82)。结论农村妇女孕早期日常生活PYRs暴露可能会影响2岁儿童神经发育,孕早期可能是其关键窗口期。孕中、晚期同等水平PYRs暴露可能对2岁儿童神经发育影响不明显。Objective To investigate the influence and critical windows of prenatal exposure to pyrethroid pesticides(PYRs)on neurodevelopment of 2-year-old children.Methods The subjects of this study were derived from the Xuanwei Birth Cohort.A total of 482 pregnant women who participated in the rural district of Xuanwei birth cohort from January 2016 to December 2018 were included.Maternal urinary concentrations of PYRs metabolites during 8-12 gestational weeks,20-23 gestational weeks and 32-35 gestational weeks were measured with ultra high performance liquid chromatography system coupled with a tandem mass spectrometry detector.Child neurodevelopment was evaluated with the Bayley Scales of Infant and Toddler Development-Third Edition at 2 years of age.Multivariate linear regression models and binary logistic regression models were used to assess the association between PYRs exposure during pregnancy and children′s neurodevelopment.Results A total of 360 mother-child pairs had complete data on maternal urinary PYRs metabolites detection and children′s neurodevelopment assessment.The detection rate of any one PYRs metabolites during the first,second and third trimester were 93.6%(337/360),90.8%(327/360)and 94.2%(339/360),respectively.The neurodevelopmental scores of Cognitive,Language,Motor,Social-Emotional,and Adaptive Behavior of 2-year-old children were(102.3±18.9),(100.2±16.3),(102.0±20.3),(107.8±23.3)and(85.8±18.6)points,respectively.After controlling for confounding factors,4-fluoro-3-phenoxybenzoic acid(4F3PBA,one of PYRs metabolites)exposure in the first trimester reduced Motor(β=-5.02,95%CI:-9.08,-0.97)and Adaptive Behavior(β=-4.12,95%CI:-7.92,-0.32)scores of 2-year-old children,and increased risk of developmental delay of adaptive behavior(OR=2.07,95%CI:1.13-3.82).Conclusion PYRs exposure during the first trimester of pregnancy may affect neurodevelopment of 2-year-old children,and the first trimester may be the critical window.

关 键 词：孕期 拟除虫菊酯 儿童 神经发育 关键窗口期 

分 类 号：R994.3[医药卫生—毒理学]