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PM2.5及其组分暴露对儿童注意力缺陷多动障碍的影响

Effects of exposure to PM2.5 and its components on attention deficit hyperactivity disorder in children

    摘要
  • 摘要:
    背景 尽管越来越多的证据表明长期暴露于大气细颗粒物（PM2.5）与儿童注意缺陷多动障碍（ADHD）之间存在关联，但结果尚不完全一致，且其组分影响尚不清楚。
    目的 探讨PM2.5及其组分暴露与儿童ADHD之间的关联，并明确其关键组分和敏感人群。
    方法 本研究于2016年5月—2018年5月在广东省广州、茂名两个城市开展了一项大型横断面调查，纳入52238名6~18岁儿童。根据《精神障碍诊断与统计手册（第5版）》（DSM-V）评估儿童和青少年的ADHD状况。根据学生家庭居住地址来匹配PM2.5及其组分黑碳（BC）、有机物质（OM）、硫酸根离子（SO42−）、硝酸根离子（NO3−）、铵根离子（NH4+），调查前4年（2013—2016）的年均浓度。采用广义线性混合模型，将城市作为随机项，将PM2.5及其组分及相应混杂因素作为固定项，探讨PM2.5及其组分暴露与ADHD之间的关联，并对年龄、性别、体育锻炼水平等个体特征进行亚组分析。
    结果 本研究儿童ADHD的患病率为4.1%，患病率男孩高于女孩，分别为5.1%和3.0%。研究期间PM2.5、SO42−、NO3−、NH4+、OM和BC的中位数质量浓度（后简称为浓度）分别为42.35、8.91、5.70、4.32、11.27和2.58 μg·m−3。PM2.5及其组分SO42−、OM和BC与ADHD呈正向相关，其浓度每增加一个四分位数间距（IQR），ADHD的患病风险分别为1.37（95%CI：1.25~1.50）、1.36（95%CI：1.24~1.49）、1.37（95%CI：1.25~1.50）和1.37（95%CI：1.24~1.50）,在ADHD-I和ADHD-C亚型中也观察到类似的结果。亚组分析结果显示，与大于12岁的儿童相比（OR=1.20，95%CI：1.06~1.36），小于等于12岁的儿童PM2.5长期暴露后ADHD的患病风险升高（OR=1.52，95%CI：1.34~1.73）。在额外调整早产和低出生体重之后，结果仍比较稳定。
    结论 PM2.5及其组分与儿童ADHD存在正向关联，且此关联存在年龄差异，年龄较小的儿童PM2.5长期暴露后ADHD的患病风险升高。

     

    Abstract:
    Background Although increasing evidence suggests an association between long-term exposure to fine particulate matter (PM2.5) and attention deficit hyperactivity disorder (ADHD) in children, the results are not fully consistent, and the effects of its components remain unclear.
    Objective To explore the association between exposure to PM2.5 and its components and ADHD in children, and to identify its key components and sensitive populations.
    Methods A large-scale cross-sectional survey was conducted in Guangzhou and Maoming cities, Guangdong Province, from May 2016 to May 2018. A total of 52238 children aged 6-18 years were enrolled. ADHD was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Annual average concentrations of PM2.5 and its components, including black carbon (BC), organic matter (OM), sulfate (SO42−), nitrate (NO3−), and ammonium (NH4+), were matched to participants’ residential addresses for the four years preceding the survey (2013–2016). We used generalized linear mixed models that included city as a random term and PM2.5 components and corresponding confounders as fixed terms to explore the association between PM2.5 and its components and ADHD, and conducted subgroup analyses of individual characteristics such as age, gender, and physical activity level.
    Results The prevalence of ADHD in children in this study was 4.1%, and the prevalence was higher in boys (5.1%) than in girls (3.0%). The median concentrations of PM2.5, SO42−, NO3−, NH4+, OM, and BC were 42.35, 8.91, 5.70, 4.32, 11.27, and 2.58 μg·m−3, respectively during the study period. PM2.5 and its components, including SO42−, OM, and BC, were positively associated with ADHD. For each interquartile range (IQR) increase in their concentrations, the risk of ADHD increased with odds ratios of 1.37 (95%CI: 1.25, 1.50) for PM2.5, 1.36 (95%CI: 1.24, 1.49) for SO42−, 1.37 (95%CI: 1.25, 1.50) for OM, and 1.37 (95%CI: 1.24, 1.50) for BC, respectively. Similar associations were observed in the ADHD-I and ADHD-C subtypes. The subgroup analysis results showed that compared with children older than 12 years (OR=1.20, 95%CI: 1.06, 1.36), the risk of ADHD was higher in children aged or younger than 12 years after long-term PM2.5 exposure (OR=1.52, 95%CI: 1.34, 1.73). The results remained robust after additional adjustment for preterm birth and low birth weight.
    Conclusions There is a positive association between PM2.5 and its components and ADHD in children. The association shows an age difference, with younger children having an elevated risk of ADHD after long-term exposure to PM2.5.

     

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