血清β淀粉样蛋白<sub>1-42</sub>在儿童铅中毒中的表达及临床意义

doi:10.3877/cma.j.issn.1674-6880.2017.05.003

目的

研究血清β淀粉样蛋白（Aβ）_1-42在铅中毒患儿中的表达及其与血铅浓度的相关性。

方法

根据血铅浓度将84例铅中毒患儿分为轻度（40例）、中度（26例）和重度（18例）三组，同时选取同期健康体检的儿童为对照组（28例）。用原子吸收法测定受试者微量元素五项（包括血铅浓度），酶联免疫吸附测定法检测受试者血清Aβ_1-42水平，并采用智力量表评估患儿智力水平。二巯基丙磺酸钠针治疗后，检测患儿血铅浓度和血清Aβ_1-42水平。Pearson相关系数进行相关性分析。

结果

治疗前，四组受试儿童血铅浓度和血清Aβ_1-42水平的比较，差异均有统计学意义（F = 969.367、136.678，P均< 0.05）；随着铅中毒程度的增加，各组血铅浓度和血清Aβ_1-42水平也逐级增加（P均< 0.05）。Pearson相关性分析显示血铅浓度与血清Aβ_1-42水平存在正相关（r = 0.893，P < 0.001）。轻度[（219 ± 15）μg/L vs.（174 ± 15）μg/L]、中度[（289 ± 43）μg/L vs.（213 ± 43）μg/L]、重度组[（489 ± 40）μg/L vs.（378 ± 44）μg/L]治疗前后血铅浓度的比较，差异均有统计学意义（t = 15.295、10.130、9.237，P均< 0.05）；同时，轻度[（326 ± 43）ng/L vs.（301 ± 33）ng/L]、中度[（392 ± 60）ng/L vs.（342 ± 63）ng/L]、重度组[（515 ± 62）ng/L vs.（447 ± 54）ng/L]治疗前后血清Aβ_1-42水平下降，也均有显著性差异（t = 7.205、4.350、7.712，P均< 0.05）。不同年龄段铅中毒患儿随铅中毒程度增加，智力量表评分也逐级降低，存在显著性差异（P均< 0.05）。

结论

血清Aβ_1-42水平可评估铅中毒对神经系统的损害，对于年长儿童可结合智力评估进行综合评价。

关键词: 铅中毒, β淀粉样蛋白, 儿童

Objective

To investigate the expression of serum amyloid beta-protein (Aβ)₁-42 in children with lead poisoning and its relationship with the blood lead level.

Methods

Totally 84 cases of children with lead poisoning were enrolled and divided into three groups according to the blood lead levels: the mild group (n = 40), the moderate group (n = 26) and the severe group (n = 18). Meanwhile, 28 healthy children were selected as the control group. Five trace elements (including the blood lead level) were determined by the atomic absorption method; serum levels of Aβ_1-42 were tested by enzyme-linked immunosorbent assay. The intelligence scale was to assess children patients' intelligence. After sodium dimercaptosulphonate treatment, the blood lead level and serum Aβ_1-42 concentration in children patients were also detected. The correlation was analyzed by Pearson correlation coefficients.

Results

Before treatment, there were significant differences of the blood lead level and serum Aβ_1-42 concentration existing in four groups (F = 969.367, 136.678; all P < 0.05); as the level of lead poisoning increased, the blood lead concentration and serum Aβ_1-42 in each group increased as well. The blood lead level and serum Aβ_1-42 had positive correlation by Pearson correlation analysis (r = 0.893, P < 0.001). Before and after treatment, the blood lead levels in the mild [(219 ± 15) μg/L vs. (174 ± 15) μg/L], moderate [(289 ± 43) μg/L vs. (213 ± 43) μg/L], and severe [(489 ± 40) μg/L vs. (378 ± 44) μg/L] groups changed significantly (t = 15.295, 10.130, 9.237; all P < 0.05); the serum Aβ₁-42 concentrations in the mild [(326 ± 43) ng/L vs. (301 ± 33) ng/L], moderate [(392 ± 60) ng/L vs. (342 ± 63) ng/L], and severe [(515 ± 62) ng/L vs. (447 ± 54) ng/L] groups decreased significantly (t = 7.205, 4.350, 7.712; all P < 0.05). With the increased degree of lead poisoning in children patients at different ages, the score of the intelligence scale decreased significantly (all P < 0.05).

Conclusions

The serum Aβ_1-42 level can evaluate neurotoxicity caused by lead poisoning. It is an effective way combined with intelligence evaluation in older children.

Key words: Lead poisoning, Amyloid beta-protein, Children

表1 受试儿童血铅浓度和血清Aβ_1-42水平的比较（ ± s）

组别	例数	血铅浓度（μg/L）		血清Aβ_1-42水平（ng/L）
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	28	35 ± 14	-	238 ± 22	-
轻度组	40	219 ± 15^a	174 ± 15^b	326 ± 43^a	301 ± 33^b
中度组	26	289 ± 43^ac	213 ± 43^b	392 ± 60^ac	342 ± 63^b
重度组	18	489 ± 40^acd	378 ± 44^b	515 ± 62^acd	447 ± 54^b
F值	?	969.367		136.678
P值	?	< 0.001		< 0.001

表1 受试儿童血铅浓度和血清Aβ_1-42水平的比较（ ± s）

组别	例数	血铅浓度（μg/L）		血清Aβ_1-42水平（ng/L）
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	28	35 ± 14	-	238 ± 22	-
轻度组	40	219 ± 15^a	174 ± 15^b	326 ± 43^a	301 ± 33^b
中度组	26	289 ± 43^ac	213 ± 43^b	392 ± 60^ac	342 ± 63^b
重度组	18	489 ± 40^acd	378 ± 44^b	515 ± 62^acd	447 ± 54^b
F值	?	969.367		136.678
P值	?	< 0.001		< 0.001

图1 各组铅中毒患儿智力评估的比较图（n = 56）。注：与轻度组比较，^*P < 0.05；与中度组比较，^#P < 0.05

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Expression and clinical significance of serum amyloid beta-protein_1-42 in children with lead poisoning

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Expression and clinical significance of serum amyloid beta-protein1-42 in children with lead poisoning

Expression and clinical significance of serum amyloid beta-protein_1-42 in children with lead poisoning