DECLINING BLOOD LEAD LEVELS AND COGNITIVE CHANGES IN MODERATELY LEAD-POISONED CHILDREN
DECLINING BLOOD LEAD LEVELS AND COGNITIVE CHANGES IN MODERATELY LEAD-POISONED CHILDREN
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DOI：
10.1001/jama.269.13.1641
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发表时间：
1993-04-07
影响因子：
120.7
通讯作者：
ROSEN, JF
中科院分区：
文献类型：
--
作者：
RUFF, HA;BIJUR, PE;ROSEN, JF
客观。-确定在铅中毒的儿童中，在铅降低干预过程中螯合治疗或生化变化是否与认知功能的变化相关。据推测，随着时间的推移，血铅水平下降，认知能力会提高。短期干预研究与干预前后获得的措施。设置。医院专科诊所和大学研究中心。患者。-共有154名先前未经治疗的儿童在入组时血铅水平在1.21和2.66 mumol/L（25和55 mug/dL）之间。年龄从13到87个月不等。入组儿童接受依地酸钙二钠（EDTA）治疗（如果合格）和/或口服铁剂（如果缺铁）。对于所有儿童，住房检查和减排程序进行了必要的。采用Bayley精神发育量表或Stanford-Binet智力量表（第4版）评分。依地酸钙二钠治疗本身无影响。在短期内（7周），血铅水平的变化与认知评分的变化无关。然而，从长期来看（6个月），即使在控制了混杂变量后，表现的变化与血铅水平的变化也显著相关。血铅水平每降低0.14 mumol/L（3 mug/dL），标准化评分增加1分。研究结果表明，中度铅中毒儿童血铅水平降低与认知能力改善之间存在关联。
Objective.-To determine whether chelation therapy or biochemical changes during a lead-lowering intervention was associated with changes in cognitive functioning of moderately lead-poisoned children. It was hypothesized that cognitive performance would improve as blood lead level declined over time.Design.-Short-term intervention study with measures obtained before and after intervention.Setting.-Hospital specialty clinic and university research center.Patients.-A total of 154 previously untreated children referred to clinic with blood lead levels between 1.21 and 2.66 mumol/L (25 and 55 mug/dL) at time of enrollment. Ages ranged from 13 to 87 months.Intervention.-Enrolled children were treated with edetate calcium disodium (EDTA) if eligible and/or with orally administered iron supplement if iron deficient. For all children, housing inspections and abatement procedures were performed as necessary.Main Outcome Measures.-Score on Bayley Mental Development Scale or Stanford-Binet Intelligence Scale (4th edition).Results.-There was no effect of edetate calcium disodium treatment per se. In the short term (7 weeks), changes in blood lead levels were not related to changes in cognitive scores. In the long term (6 months), however, changes in performance were significantly related to changes in blood lead level, even after controlling for confounding variables. The standardized score increased 1 point for every decrease of 0.14 mumol/L (3 mug/dL) in blood lead level.Conclusion.-The results suggest an association between decreases in blood lead level and cognitive improvements in moderately lead-poisoned children.