Aflatoxin Exposure May Contribute to Chronic Hepatomegaly in Kenyan School Children
Aflatoxin Exposure May Contribute to Chronic Hepatomegaly in Kenyan School Children
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DOI：
10.1289/ehp.1104357
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发表时间：
2012-06-01
影响因子：
10.4
通讯作者：
Wild, Christopher P.
中科院分区：
文献类型：
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作者：
Gong, Yun Yun;Wilson, Shona;Wild, Christopher P.
背景：在撒哈拉以南非洲的学龄儿童中，多因素病因的慢性肝肿大的表现是常见的。目的：黄曲霉毒素是一种肝脏毒素和致癌物，污染玉米主粮。在这项研究中，我们研究了它在慢性肝肿大中的作用。方法：采用黄曲霉毒素-白蛋白加合物（AF-alb）生物标记物，分别于2002年和2004年采集邻近村庄两所学校的218名儿童的血浆样本进行黄曲霉毒素暴露检测。先前对肝肿大、疟疾和血吸虫病之间的关联进行了数据检查。结果：两校儿童AF-alb水平均较高，但2002年Matangini [206.5 (175.5, 243.0) pg/mg白蛋白]的几何平均值（95%可信区间）显著高于Yumbuni [73.2 (61.6, 87.0) pg/mg白蛋白]；P < 0.001]。肝实质肿大儿童AF-alb水平也高于正常儿童[176.6 (129.6,240.7)pg/mg] [79.9 (49.6, 128.7) pg/mg]；P = 0.029]。在对曼氏血吸虫和疟原虫感染进行调整后，我们估计AF-alb每增加一个自然对数单位，肝/肝脾肿大的患病率就会显著增加43%。2004年AF-alb水平明显高于2002年[539.7（463.3,628.7）比114.5 (99.7,131.4)pg/mg；P < 0.001]但在村庄之间或肝肿大组与正常组之间无显著差异[539.7（436.7,666.9）对512.6 (297.3,883.8)pg/mg]，可能是因为2004年黄曲霉中毒爆发期间的急性暴露可能掩盖了任何潜在的潜在关系。结论：2002年黄曲霉毒素暴露与儿童慢性肝肿大有关。这些初步数据表明，儿童接触黄曲霉毒素可能会带来额外的健康风险，这一假设值得进一步检验。
BACKGROUND: Presentation with a firm type of chronic hepatomegaly of multifactorial etiology is common among school-age children in sub-Saharan Africa.OBJECTIVE: Aflatoxin is a liver toxin and carcinogen contaminating staple maize food. In this study we examined its role in chronic hepatomegaly.METHODS: Plasma samples collected in 2002 and again in 2004 from 218 children attending two schools in neighboring villages were assayed for aflatoxin exposure using the aflatoxin-albumin adduct (AF-alb) biomarker. Data were previously examined for associations among hepatomegaly, malaria, and schistosomiasis.RESULTS: AF-alb levels were high in children from both schools, but the geometric mean (95% confidence interval) in year 2002 was significantly higher in Matangini [206.5 (175.5, 243.0) pg/mg albumin] than in Yumbuni [73.2 (61.6, 87.0) pg/mg; p < 0.001]. AF-alb levels also were higher in children with firm hepatomegaly [176.6 (129.6, 240.7) pg/mg] than in normal children [79.9 (49.6, 128.7) pg/mg; p = 0.029]. After adjusting for Schistosoma mansoni and Plasmodium infection, we estimated a significant 43% increase in the prevalence of hepatomegaly/hepatosplenomegaly for every natural-log-unit increase in AF-alb. In 2004, AF-alb levels were markedly higher than in 2002 [539.7 (463.3, 628.7) vs. 114.5 (99.7, 131.4) pg/mg; p < 0.001] but with no significant difference between the villages or between hepatomegaly and normal groups [539.7 (436.7, 666.9) vs. 512.6 (297.3, 883.8) pg/mg], possibly because acute exposures during an aflatoxicosis outbreak in 2004 may have masked any potential underlying relationship.CONCLUSIONS: Exposure to aflatoxin was associated with childhood chronic hepatomegaly in 2002. These preliminary data suggest an additional health risk that may be related to aflatoxin exposure in children, a hypothesis that merits further testing.