北大最新CMAJ文章 聚焦三聚氰胺奶粉后遗症

　　

生物通报道，来自北京大学生育健康所、石家庄元氏县妇幼保健中心、北京大学人口研究中心的科学家在三聚氰胺奶粉后遗症方面研究取得新进展，相关成果文章Urinary tract abnormalities in Chinese rural children who consumed melamine-contaminated dairy products: a population-based screening and follow-up study公布在CMAJ（加拿大医学杂志）上。

 

2008年，来自三鹿乳品集团的受到三聚氰胺污染的乳制品导致了中国儿童严重肾损伤的大暴发。三聚氰胺这种化工常用物质被故意加入到了牛奶中，从而“增加”其蛋白质含量。在69批受影响的产品中，11批是婴儿配方奶粉。

 

中国政府于2008年9月12日公布了这场暴发，并启动了产品召回、筛查和治疗受影响儿童的项目以及其他紧急响应。超过5万名儿童住院治疗，6人死于肾损伤。尽管已经认识到了与三聚氰胺有关的人类疾病，三聚氰胺的全部影响仍然是未知的。

 

该论文的作者之一、北京大学生育健康研究所的Jian-meng Liu博士说，“这些研究对象来自具有或许全世界最高的三聚氰胺接触量的自然人群，因此估计的疾病流行程度描绘了一个人群在接触大量三聚氰胺之后的肾损伤风险”。

 

该研究包括了三鹿集团所在并销售产品的石家庄市元氏县的8个镇。该研究对7933名儿童进行了超声波检查，这些儿童在2008年9月都不足3岁，他们的母亲生活在研究区域里。

 

研究发现，在接受筛查的儿童中，有一些表现出了肾结石和肿胀的证据，但是大多数都没有临床症状。受影响儿童的大多数随着时间的推移而从三聚氰胺的有毒效应中恢复，而不需要特别的治疗。然而，受影响儿童的12%存在肾异常，这表明需要进一步随访。文章作者说，“我们的结果表明需要对受影响儿童进行进一步随访，从而评估对儿童健康的可能的长期影响，包括肾功能，”

 

在同期发表的一篇评论文章中，香港中文大学的公共卫生及基层医疗学院的Jin-Ling Tang博士指出，三鹿婴儿奶粉的配方及其相关技术在宣布召回乳制品之前的大约8个月获得了一个著名的中国科学技术奖。这一事件凸显了在中国进行高质量的研究的障碍，这包括评估和奖励科研人员的方法；如何分配研究资助；中国科研在偶发但是被公开化的欺诈事件之后的负面形象；科研人员的语言能力有限；科研人员的工资与该国其他专业和职业相比较低，甚至还包括医学教育。

 

“很难在一件研究完成之后马上评估它的重要性和可靠性，”Tang博士写道。“发奖太快可能导致错误，正如三鹿婴儿奶粉的例子。”

 

他指出对于中国科研人员而言，重要的是在同行评议的国际期刊上发表论文从而在国际上竞争并做出贡献。

（生物通 小茜）

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生物通推荐原文检索

Urinary tract abnormalities in Chinese rural children who consumed melamine-contaminated dairy products: a population-based screening and follow-up study

Jian-meng Liu 1, Aiguo Ren 1, Lei Yang 1, Jinji Gao 2, Lijun Pei 3, Rongwei Ye 1, Quangang Qu 1, Xiaoying Zheng 3

1 The Peking University Institute of Reproductive and Child Health, Beijing, China

2 The Yuanshi County Center for Maternal and Child Health, Shijiazhuang, China

3 Peking University Institute of Population Research, Beijing, China

【Abstract 】

 

Background: Kidney damage related to consumption of melamine-contaminated dairy products by young children in China has been described. However, no studies have reported on the population-based prevalence of kidney damage among exposed children or on the condition of affected children after follow-up.

 

Methods: We conducted an ultrasound-based screening in September 2008 of 7933 children younger than 36 months of age who lived in a rural area in China where the dairy products most highly contaminated with melamine were sold. We monitored children who had evidence of nephrolithiasis or hydronephrosis at screening using renal ultrasonography after one, three and six months. We also collected information from the mothers of affected children about consumption of melamine-contaminated products between June and August 2008.

 

Results: The overall prevalence of urinary tract abnormalities among screened children was 0.61% (95% confidence interval [CI] 0.45%–0.80%). The mean exposure dose of melamine was estimated to be 116 (range 36–220) mg per day. Of the 48 affected children, 43 (89.6%) were asymptomatic, 2 had symptoms and were hospitalized, and 3 had symptoms but treatment had been not sought for them. Of the 46 children for whom six-month follow-up information was available, renal abnormalities persisted in 5 children and resolved in the remaining 41.

 

Interpretation: Among children who underwent screening, 0.61% showed ultrasonographic evidence of nephrolithiasis or hydronephrosis. Most of the affected children were asymptomatic. The majority of the affected children recovered from the toxic effects of melamine over time without specific treatment. Renal abnormalities remained in 12% of the affected children.