首页资讯积极推进儿童多源环境暴露的健康影响研究

积极推进儿童多源环境暴露的健康影响研究

来源：泰然健康网时间：2024年11月23日 23:40

摘要:儿童处于生长发育的关键时期, 器官和系统发育尚不成熟, 是受环境污染危害的脆弱人群。儿童时期的环境危害因子暴露是成人疾病发生的重要风险因素之一, 评估环境暴露对儿童健康带来的风险, 并采取积极的干预措施降低危害, 对于疾病早期预防控制具有重大意义。影响儿童健康的环境因素包括环境污染、气象因素、血铅和环境过敏原等, 多源环境暴露对儿童健康影响的研究结果, 可为制定有针对性的干预措施从而降低对儿童健康的损害提供科学参考。由于环境污染物种类繁多, 且新的污染物不断涌现, 今后应加强新兴污染物多源环境暴露对儿童健康的影响及可能作用机制研究。在此基础上开展干预研究, 降低环境因素暴露对儿童健康的损害。

关键词:环境暴露 / 健康状况 / 环境污染 / 儿童

Abstract:Children are at a critical stage of growth and development, with immature organ and system development, and are a vulnerable population to environmental pollution. Exposure to environmental hazards during childhood is an important risk factor for adult diseases, and assessing health risks posed by environmental pollutants to children and taking proactive interventions to reduce the risks are of great importance in the early prevention and control of diseases. Environmental factors affecting children's health include environmental pollution, meteorological factors, blood lead and environmental allergens in children, and the results are expected to provide scientific reference for formulating targeted interventions to reduce damage to children's health. Given wide range of environmental pollutants and emergence of new pollutants, we should strengthen research on impact of multi-source environmental exposure of emerging pollutants on children's health and its possible mechanisms in future. On the basis, intervention studies should be carried out to reduce damage of environmental factors on children's health.

随着工业和经济的发展，人们生活水平普遍提高，同时工业污染物的排放以及持续的能源和资源消耗也带来了严重的环境多介质复合污染问题[1]。从全球范围看，近30年来除SO2浓度有所下降，多数大气污染物浓度呈上升趋势[1]；全球水资源紧缺的同时，水源污染和饮水安全问题依然突出，尤其在发展中国家[1-2]；过量农药和化肥的使用以及大量新兴化学品释放进一步加重土壤污染[1-3]。我国环境污染形势也较为严峻，尽管通过环境污染治理取得了一定成效[4]，但重金属、农药、新型污染物等环境污染暴露问题较为突出，由此产生的对人群的健康危害成为党和政府高度重视、社会各界广泛关注的重大公共卫生问题。

1. 儿童环境暴露的健康易损性

儿童作为环境污染健康影响的脆弱群体，其健康危害是各界关注的焦点[2, 5]。研究显示，全球室内外空气污染及二手烟引起的肺炎和呼吸道疾病会致使每年57万名5岁以下儿童死亡[6-7]。环境持续污染造成儿童体内包括重金属和农药在内的各类无机、有机污染物负荷水平升高[5, 8]，可影响儿童智力发育[8-9]和成年后的神经行为[10]；内分泌干扰物等一些新兴污染物也不断通过各类环境介质进入生物体，严重影响儿童神经发育和人类生育能力[2]；另外，气候变化导致的极端天气事件和灾害事件也会显著影响儿童健康[11-12]。全球疾病负担研究显示，全球24%的死亡归因于环境因素，而28%的5岁以下儿童死亡归因于环境因素[13]。儿童的生理和行为特征决定其更易受环境影响，且在不同生长阶段暴露于不同环境污染物质，同一时期易遭受多源环境污染暴露。儿童由于尚处在生长阶段，其单位体重所需能量和水分远高于成人，导致单位体重的相对暴露量也高于成人[14]；儿童器官和系统发育尚不成熟，参与污染物代谢的酶活性较低，导致污染物在儿童体内半衰期远高于成人[15]；儿童爬行、触摸物品增多，通过手-口活动等行为使其暴露风险更高；儿童生长发育的“关键时间窗”使得儿童对环境暴露的反应更加敏感。至为重要的是，儿童时期的多源环境污染暴露是成人疾病发生的重要风险因素之一。

2. 儿童多源环境暴露健康影响研究的迫切性

目前，国内外学者开展了大量人群流行病学、动物实验和干预等研究，从不同角度揭示环境主要危险因素对儿童健康的影响，其中产前和儿童期环境污染暴露与儿童健康[16]、空气污染暴露与儿童脑发育[17]、气候变化与儿童健康[18]、儿童铅暴露的健康影响[19]、电子垃圾与儿童健康[20]、环境因素与儿童哮喘和过敏[21]、环境化学物与儿童肿瘤[22]等是学者普遍关注的热点。上述研究多以单一污染物作为儿童健康影响的环境暴露因素，且多为一次性调查的横断面研究，与当前多源环境污染暴露的现状不符。儿童处于快速生长发育阶段，他们的体格、生理和代谢处于快速变化中，且不同年龄阶段多源环境污染暴露的特征也在不断变化。同时，生长发育“关键时间窗”特征显示，不同年龄和不同发育阶段的儿童对多源环境污染暴露的敏感性存在差异。以上均提示需要开展基于多次随访的队列观察进行系统科学研究。我国已经进入人口老龄化和少子化并存的时代，儿童的健康直接关系到我国人口的整体健康水平和社会可持续发展程度，因此突破上述不足持续开展多源环境暴露与儿童健康研究显得尤为迫切，尤其应开展基于前瞻性队列探讨影响我国儿童健康的关键环境危险因素、综合效应和作用机制等方面的研究。

3. 影响儿童健康的重要环境因素

本期“环境暴露与儿童健康”栏目论文主要围绕PM2.5、血铅、高温以及环境过敏原等开展研究，探讨儿童校内PM2.5的暴露水平、高温对儿童急诊入院的影响、儿童血铅和过敏性疾病的主要影响因素，研究结果可为制定有针对性的干预措施提供参考依据。杨文静等[23]发现，佳木斯市学生2019年在校期间的春季学期和秋季学期PM2.5平均综合暴露量分别为28.48和31.87 μg/m3。在3月初出现一次严重大气污染，教室日均质量浓度达到237.00 μg/m3，高于《环境空气质量标准》(GB 3095—2012)[24]限值的2.16倍，提示应关注大气重污染天气并采取有效干预措施降低学生教室内的PM2.5污染。仲宇等[25]发现，2016—2018年夏季当日日平均温度每升高1 ℃，北京市0~14岁儿童因非意外总疾病、呼吸系统疾病入院风险分别增加1.21%(95%CI=0.80%~1.64%)，1.64%(95%CI=1.09%~2.20%)，0~4岁儿童因呼吸系统疾病急诊入院风险最大，5~9岁儿童因非意外总疾病急诊入院风险最大，提示高温对不同年龄组儿童的健康影响存在差别，在制定相关政策时应加以考虑。许宁等[26]发现，江苏省北部某市儿童血铅几何均数为25.80 μg/L，3名儿童血铅水平超过中国儿童血铅标准限值(100 μg/L)，“平时有啃咬铅笔的行为”和“家庭或学校周边有铅暴露环境”与儿童高血铅呈正相关，提示未来应采取有针对性的措施降低儿童血铅暴露水平。叶茂鑫等[27]发现，中重度鼻炎、有过敏性疾病家族史、霉菌、粉尘螨过敏为过敏性鼻炎继发哮喘的危险因素，其中粉尘螨致敏患儿发生哮喘的风险最高，提示环境过敏原和过敏体质是儿童哮喘的危险因素，应采取有效措施降低儿童哮喘发作的频率。

环境化学物质种类繁多，新的污染物还在不断出现，因此需要更多的研究并基于更高级别的科学证据推动我国的环境与儿童健康工作。期待更多科研人员加入到儿童新型污染物多源环境暴露及其健康影响的研究中来，为有针对性地制定干预措施和实施行动策略降低我国儿童多源环境暴露危害提供科学依据。

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