PM2.5论文：PM2.5 元素 不良妊娠结局 胎盘屏障

PM2.5论文：PM2.5 元素 不良妊娠结局 胎盘屏障 【关键词】PM2.5 元素 不良妊娠结局 胎盘屏障 【英文关键词】PM2.5 elements adverse pregnancy outcome placental barriers PM2.5论文:镍污染区大气PM_(2.5)中几种元素对不良妊娠结局的影响及胎盘屏障作用研究 【中文摘要】1.通过分析比较镍污染区和对照区空气细颗粒物PM2.s中各元素含量及两地不良妊娠结局的发生情况,探讨PM2.5在引起不良妊娠结局中的可能致病成分。2.分析比较两地母血和脐带血中钻(Co)、镍(Ni)、铜(Cu)、砷(As)和硒(Se)5种元素的含量,探讨母血和脐带血中元素含量是否与空气细颗粒物PM2.5中元素暴露有关以及胎盘屏障对这5种元素的屏障作用。方法:1.选择镍污染区与对照区,于2009年3月—2010年4月同时在两地居民生活区进行空气细颗粒物PM2.5的采集,并采用X线荧光光谱仪测定PM2.5中各元素含量,分析比较两地空气PM2.5中的主要差异元素;同时收集两地2007年1月—-2011年11月市区几所大型医院孕妇住院分娩登记资料,了解两地不良妊娠结局的发生情况,从而探讨PM2.5中与不良妊娠结局相关的成分。2.在镍污染区和对照区通过问卷调查、体检和化验、年龄和体质指数配对等方式各选择30名健康的孕妇及其分娩的30名新生儿作为研究对象,于孕妇分娩前采集母亲静脉血,分娩时采集其胎儿脐带血,使用电感耦合等离子体质谱仪(ICP-MS)对全血中 Co、Ni、Cu、As和Se元素的含量进行测定,分析比较两地母血和脐带血中这5种元素的含量及其相关性,探讨母血和脐带血中元素含量是否与PM2.5中元素暴露有关以及胎盘屏障对Co、Ni、Cu、As和Se的屏障作用。结果:1.镍污染区大气PM2.5中几种元素对不良妊娠结局的影响(1)镍污染区和对照区PM2.5中元素Co、Ni、Cu、As和Se在镍污染区的含量均高于对照区,分别相差4倍、82倍、26倍、12倍和6倍,而其它元素水平在两地间相近;(2)镍污染区不良妊娠结局的总体发生率明显高于对照区(χ2=161.26,P,0.01);两地不良妊娠结局的发生率均以,20岁和?35岁为最高,且在各年龄段之间均存在统计学差异(P,0.01);在相同年龄段下,镍污染区不良妊娠结局的发生率均高于对照区(P,0.01,P,0.05);(3)随着孕次、产次和流产次数的增加,两地不良妊娠结局的发生率均有上升趋势(P,0.01);在同一孕次、产次和流产次数下,镍污染区不良妊娠结局的发生率均显著高于对照区(P<0.01,P<0.05);(4)两地经剖宫产分娩的孕妇不良妊娠结局的发生率均高于顺产孕妇(P<0.01);在同一分娩方式下,镍污染区不良妊娠结局的发生率均显著高于对照区(P<0.01);(5)两地高危孕妇不良妊娠结局的发生率均高于正常孕妇(P<0.01);在相同情况下,镍污染区不良妊娠结局的发生率均显著高于对照区(P<0.01);(6)两地各种不良妊娠结局的发生率相比,早产、低出生体重、死胎及死产和出生缺陷的发生率在镍污染区均显著高于对照区(P<0.01);而巨大儿和新生儿窒息的发生率在两地间差异均无统计学意义(P>0.05); (7)不同年龄段下,两地孕妇各种不良妊娠结局的发生率相比。年龄<20岁时,镍污染区低出生体重的发生率显著高于对照区(P<0.05);年龄20,岁时,镍污染区早产、低出生体重、死胎及死产的发生率均显著高于对照区(P<0.01);年龄25,岁时,镍污染区早产、低出生体重、死胎及死产和出生缺陷的发生率均显著高于对照区(P<0.01);年龄30,岁时,镍污染区早产、低出生体重的发生率均显著高于对照区(P<0.01);年龄在35岁及以上时,镍污染区死胎及死产的发生率显著高于对照区(P<0.01);其余类型在两地间差异均无统计学意义(P,0.05);(8)不同孕次下,两地孕妇各种不良妊娠结局的发生率相比。孕次为1时,镍污染区早产、低出生体重的发生率均显著高于对照区(P<0.01);孕次为2时,镍污染区低出生体重、死胎及死产、出生缺陷的发生率均显著高于对照区(P<0.01);孕次大于或等于3时,镍污染区早产的发生率显著高于对照区(P<0.01);其余类型在两地间差异均无统计学意义(P>0.05);(9)不同产次下,两地孕妇各种不良妊娠结局的发生率相比。产次为0时,镍污染区早产、低出生体重、死胎及死产和出生缺陷的发生率均显著高于对照区(P<0.01);产次为1时,镍污染区早产的发生率显著高于对照区(P<0.01);产次为2及以上时,镍污染区早产和出生缺陷的发生率均显著高于对照区(P<0.01);其余类型在两地间差异均无统计学意义(P>0.05);(10)不同流产次数下,两地孕妇各种不良妊娠结局的发生率相比。流产0次时,早产、低出生体重、死胎及死产、出生缺陷的发生率在镍污染区均显著高于对照 区(P<0.01);流产1次时,镍污染区早产和低出生体重的发生率均显著高于对照区(P<0.01);流产2次时,镍污染区早产的发生率均显著高于对照区(P<0.05);流产3次及以上时,镍污染区早产和出生缺陷的发生率均显著高于对照区(P<0.05,P<0.01);其余类型在两地间差异均无统计学意义(P>0.05);(11)不同分娩方式下,两地孕妇各种不良妊娠结局的发生率相比。镍污染区顺产孕妇早产、低出生体重、巨大儿、新生儿窒息及出生缺陷的发生率均明显高于对照区(P<0.01,P<0.05);镍污染区剖宫产孕妇早产、低出生体重、死胎及死产和出生缺陷的发生率均显著高于对照区(P<0.01,P<0.05);其余类型在两地间差异均无统计学意义(P>0.05);(12)两地有、无高危情况孕妇各种不良妊娠结局的发生率相比。镍污染区正常孕妇早产、低出生体重、死胎及死产和出生缺陷的发生率均显著高于对照区(P<0.01);镍污染区高危孕妇早产、低出生体重的发生率均显著高于对照区(P<0.01,P<0.05);其余类型在两地间差异均无统计学意义(P>0.05);(13)两地孕妇情况比较。镍污染区剖宫产率明显低于对照区(χ2=59.62,P<0.01);镍污染区流产率显著高于对照区(χ2=10.81,P<0.01);镍污染区孕妇妊娠合并胆汁淤积、贫血、胎膜早破的发生率均显著高于对照区(P<0.01);妊高症、胎盘异常的发生率均低于对照区(P<0.05,P<0.01);而两地产后出血的发生率差异无统计学意义(P>0.05);(14)两地胎儿情况比较。镍污染区胎儿宫内发育迟缓和胎儿窘迫的发生率均显著高于对照区(P<0.01);而两地脐带缠 绕的发生率差异无统计学意义(P,0.05)。2.胎盘对PM2.5中元素的屏障作用(1)在两地母血及脐带血中,镍污染区Co、Ni、Cu、As和Se元素的水平均高于对照区,Co、As、Se3种元素差异均有统计学意义(P<0.01),两地Ni含量差异无统计学意义(P>0.05);两地脐带血中Cu含量有显著性差异(P<0.05),两地母血中Cu含量差异无统计学意义(P>0.05);(2)母血与脐带血中元素水平比较,在镍污染区,脐带血中Ni、As、Se3种元素的水平均显著高于母血(P<0.01,P<0.05),脐带血中Cu元素水平明显低于母血(P<0.01),Co元素在母血和脐带血水平相近(P>0.05);在对照区,脐带血中Ni元素水平明显高于母血(P<0.05),脐带血中Cu元素水平明显低于母血(P<0.01),母血和脐带血Co、As和Se元素水平相近,差异均无统计学意义(P,0.05):(3)在同一地区,脐带血与母血中Co、Ni、As和Se元素浓度的比值均约等于或者大于1,而Cu元素浓度比值均小于1;两地间脐带血与母血中各元素水平的比值比较,差异均无统计学意义(P>0.05);(4)母血和脐带血Co、Cu、As和Se4种元素含量均呈显著性J正相关(P<0.01,P<0.05),相关系数分别为0.334,0.479,0.269,0.350;而母血与脐带血Ni含量无相关性(P>0.05)。结论:1、镍污染区与对照区PM2.5中的主要差异元素为Co、Nk、Cu、As和Se,且在镍污染区的含量均显著高于对照区;镍污染区发生不良妊娠结局的危险性显著高于对照区;Ni可能是PM2.5导致不良妊娠结局的主要成分。2、孕妇体内Co、Ni、Cu、As和Se水平的增加可能与环境污染物PM2.5中各元 素暴露有关;胎盘屏障不能有效地阻止PM2.5中Co、Ni、As和Se4 种元素进入胎儿体内,且Ni在胎儿体内有一定的蓄积性,而对Cu起到 了一定的屏障作用。 【英文摘要】s:1.To explore the possible elements in ambient PM2.5causing adverse pregnancy outcome through analyzing the concentration of elements in PM2.5and the occurrences of the adverse pregnancy outcomes between a nickel-contaminated area and control area.2. To discuss the relationship between elements concentration in cord blood and venous blood of pregnant women and the concentration of elements in PM2.5,and the barrier function of placental barriers to cobalt (Co), nickel (Ni), copper (Cu), arsenic (As) and selenium (Se) by analyzing and comparing the five elements concentration in blood between the nickel-contaminated area and control area.Methods:1.Two cities were selected as the nickel-contaminated area and control area, and ambient PM2.5in their communities were collected and the elements concentrations in ambient PM2.5were analyzed with X-ray fluorescence spectrometer from March2009to April of2010and found the main difference of the elements in PM2.5between two sites, and inpatient delivery data of pregnancy women from these two areas were collected Simultaneously and the occurrences of the adverse pregnancy outcome were analyzed.2. Thirty healthy pregnant women and their newborns were selected through the questionnaire with physical examination and test, age and body mass index matched between the two areas, maternal venous blood and fetal cord blood were respectively collected before and at delivery respectively. The concentration of Co, Ni, Cu, As and Se were determined with the inductively coupled plasma mass spectrometer (ICP-MS) and were assessed the differences between the two areas and correlation between maternal and cord blood.Results: 1. The results of the effection between certain elements in ambient PM2.5and the adverse pregnancy outcome in nickel-contaminated area(1) The concentrations of Co, Ni, Cu, As and Se in ambient air in the nickel-contaminated area, were found to be higher in PM2.5than that in the control area, and the former were4times,82times,26times,12times and6times as the latter respectively, but the levels of other elements were similar between the two regions.(2) The incidence of the adverse pregnancy outcomes in the nickel-contaminated area was significantly higher than that in the control area (x2=161.26, P<0.01); in both areas, the incidence of adverse pregnancy outcomes was the higher in under20and over35years old; there were statistically significant difference among age groups(P<0.01); at the same age group, the incidence of adverse pregnancy outcomes in the nickel-contaminated area were significantly higher than that in the control area (P<0.01,P<0.05).(3) With the increase of gravidity, parity and abortions rates, the incidence of adverse pregnancy outcomes in the two regions showed an upward trend (P<0.01); the incidence of adverse pregnancy outcomes in the nickel-contaminated area were significantly higher than that in the control area (P<0.01, P<0.05) at the same gravidity, parity and abortions rates.(4) The incidence of adverse pregnancy outcomes in the pregnant women giving birth by cesarean section was higher than that in the pregnant women by natural labor (P<0.01); the incidence of adverse pregnancy outcomes in the nickel-contaminated area were significantly higher than that in the control area (P<0.01) in the same delivery mode.(5) The incidence of adverse pregnancy outcomes in the pregnant women with high-risk situations in the two regions was significantly higher than that without it(P<0.Ol); the incidence of adverse pregnancy outcomes in the nickel-contaminated area were significantly higher than that in the control area (P<0.01) at the same situation.(6) The incidence of premature birth, low birth weight, still births, stillbirth and birth defects in nickel-contaminated area were significantly higher than that in the control area (P<0.01); however, there was no statistically difference in the incidence of giant infant and neonatal asphyxia between the two regions (P>0.05).(7) The incidence of low birth weight in the age of under20years old in the nickel-contaminated area was significantly higher than that in the control area (P<0.05); the incidence of premature birth, low birth weight, still births, stillbirth and birth defects in the pregnant women aged20to24in the nickel-contaminated area were significantly higher than that in the control area (P<0.01); the incidence of premature birth, low birth weight, still births, stillbirth and birth defects of pregnant women aged25to29in the nickel-contaminated area were significantly higher than that in the control area (P<0.01); the incidence of premature birth and low birth weight of pregnant women aged30to49in the nickel-contaminated area were significantly higher than that in the control area (P<0.01); the incidence stillbirths and deadbirth rate of pregnant women aged over35years old in the nickel-contaminated area were significantly higher than that in the control area (P<0.01); there was no statistical difference in the rest between the two regions (P>0.05).(8)The incidence of premature birth, low birth weight in the nickel-contaminated area were significantly higher than that in the control area at the first gestation group (P<0.01); the incidence of low birth weight, still births, stillbirth birth defects in the nickel-contaminated area were significantly higher than that control area at two gestation time group (P<0.01); the incidence of preterm birth in the nickel-contaminated area was significantly higher than that in the control area in three and above three gestation time groups (P<0.01); there was no statistical difference in the rest between the two regions (P>0.05).(9)The incidence of premature birth, low birth weight, stillbirth, deadbirth and birth defects in the nickel-contaminated area were significantly higher than that in the control area in zero birth time group (P<0.01); the incidence of preterm birth in the nickel-contaminated area was significantly higher than that in the control area in one birth time group (P<0.01); the incidence of premature birth and birth defects in the nickel-contaminated area were significantly higher than that in the control area in two and above two birth time groups (P<0.01); there was no statistical difference in the rest between the two regions (P>0.05).(10) The incidence of premature birth, low birth weight, stillbirth and birth defects in the nickel-contaminated area were significantly higher than that in the control area in zero abortion time group (P<0.01); the incidence of premature birth and low birth weight in the nickel-contaminated area were significantly higher than that in the control area in one abortion time groups (P<0.01); the incidence of preterm birth in the nickel-contaminated area was significantly higher than that in the control area in two abortion time groups (P<0.05); the incidence of premature birth and birth defects in the nickel-contaminated area were significantly higher than that in the control area in three and above three abortion time groups (P<0.05, P<0.01); there was no statistical difference in the rest between the two regions (P>0.05).(11) The incidence of adverse pregnancy outcomes among the natural labor of pregnant women in the nickel-contaminated area were significantly higher than that in the control area (P<0.01, P<0.05); the incidence of premature birth, low birth weight, still births, stillbirth and birth defects among the cesarean section of pregnant women in the nickel-contaminated area were significantly higher than that in the control area (P<0.01, P<0.05); however, there was no statistically difference in the incidence of giant infant and neonatal asphyxia between two regions (P>0.05).(12)The incidence of premature birth, low birth weight, stillbirths, deadbirth and birth defects of normal pregnant women in the nickel-contaminated area were significantly higher than that in the control area (P<0.01); the incidence of premature birth, low birth weight of high-risk pregnant women in nickel-contaminated area were significantly higher than that in the control area (P<0.01, P<0.05); there was no statistical difference in the rest between the two regions (P>0.05).(13) The rate of cesarean section in the nickel-contaminated area was significantly lower than that in the control area (x2=59.62, P<0.01); the abortion rate in the nickel-contaminated area was significantly higher than that in the control area (x2=10.81, P<0.01); the incidence of pregnancy with cholestasis, anemia, premature rupture of membranes in the nickel-contaminated area were significantly higher than that in the control area (P<0.01); the incidence of pregnancy-induced hypertension, abnormal placenta in the control area was significantly higher than that in nickel-contaminated areas (P<0.05, P<0.01).(14) The incidence of fetal with intrauterine growth retardation and fetal distress in the nickel-contaminated area were significantly higher than that in the control area (P<0.01), while there was no statistical difference in the incidence of others between the two regions (P>0.05).2. The effect of placental to the trace elements in pregnant women bodies(1)The levels of Co, Ni, Cu, As and Se both in the maternal blood and cord blood in the nickel-contaminated area were higher than that in the control area, there were significant differences in the levels of Co, As, Se between the two areas (P<0.01), there was no significant difference in Ni (P>0.05); there was significant difference in the concentration of Cu in cord blood (P<0.05), but no statistical significant in matermal blood between the two areas(P>0.05).(2) In the nickel-contaminated area, the levels of Ni, As, Se in umbilical cord blood were significantly higher than that in maternal blood (P<0.01, P<0.05), the levels of Cu elements in cord blood were significantly lower than that in maternal blood (P<0.01), the concentration of Co was similar in both blood (P>0.05); in the control area, the level of Ni in cord blood was significantly higher than that in maternal blood (P<0.05), the level of Cu in cord blood was significantly lower than that in maternal blood (P<0.01), the concentration of Co, As, Se were similar in both blood (P>0.05).(3) In the same area, the concentration ratio of Co, Ni, As, Se in cord blood to maternal blood were equal or greater than1, and the concentration ratio of Cu was less than1; there were no significantly difference in the ratios of each element in the cord blood to maternal blood between the nickel-contaminated area and control area (P>0.05).(4) There were significantly positive correlation in the levels of Co, Cu, As and Se (P<0.01, P<0.05) between maternal blood and cord blood, and the correlation coefficient were0.334,0.479,0.269,0.350; but no correlation in Ni (P>0.05).Conclusion:1. The main different elements of PM2.5were Co, Ni, Cu, As and Se between the nickel-contaminated area and control areas, there concentration were higher in the nickel-contaminated area than in the control areas. The incidence of adverse pregnancy outcome in nickel-contaminated area was significantly higher than in control areas; Ni may be the potential pathogenic element in the adverse pregnancy outcome caused by PM2.5.2. The higher levels of Co, Ni, Cu, As, Se in the body of pregnant women may be due to the exposure of elements in ambient PM2.5; placental barriers cannot effectively prevent Co, Ni, As, Se elements except Cu in PM2.5from transfering from mother to fetus, and nickel showed highly cumulative characteristics in the fetal. 【目录】镍污染区大气PM_(2.5)中几种元素对不良妊娠结局的 影响及胎盘屏障作用研究 中文摘要 3-7 Abstract 7-11 目录 12-14 前言 14-19 技术路线 19-20 第一章 镍污染区大气PM_(2.5) 中几种元素对不良妊娠结局的影响 20-38 1. 材料与方法 20-22 1.1 主要仪器和材料 20 1.2 研究地点的选择 20 1.3 采样时间 20 1.4 PM_(2.5)的采集和元素测定 20-21 1.5 资料的收集 21 1.6 研究方法 21 1.7 参照标准 21 1.8 统计学处理 21 1.9 质量控制 21-22 2 结果 22-33 2.1 PM_(2.5)及其中元素测定结 果 22-24 2.2 两地不良妊娠结局的总体发生情况 24-26 2.3 两地各种不良妊娠结局的发生情况 26-32 2.4 两地孕妇剖宫产率和流产率发生情况 32 2.5 两地孕妇妊娠合并症及产科并发症发生情况 32-33 3 讨论 33-37 4 结论 37-38 第二章 胎盘对PM_(2.5)中元素的屏障作用 38-46 1 材料与方法 38-39 1.1 主要仪器和材料 38 1.2 研究地点的选择 38 1.3 研究对象 38-39 1.4 生物样品的采集和测定 39 1.5 统计学处理 39 1.6 质量控制 39 2 结果 39-43 2.1 研究对象的基本信息 39-40 2.2 两地母血及脐带血中元素水平比较 40-41 2.3 两地母血与脐带血中元素水平比较 41 2.4 两地脐带血与母血中元素水平比值比较 41 2.5 两地母血与脐带血中元素水平的相关性分析 41-43 3 讨论 43-45 4 结论 45-46 参考文献 46-52 攻读学位期间的硏究成果 52-53 致谢 53-54 縮略词表 54-55