长期镉暴露人群肾损伤效应的流行病学调查  

Long-term effect of cadmium exposure on residents＇ renal dysfunction：An epidemiologic study

作　　者：张蕴蕊[1] 梁旭霞[2] 陈文才[2] 王晶[2] 黄琼 陈子慧 王萍 黄芮 胡曙光[2] 李志学[1] 汤柳英[2] 王桂安 杨菲 李筱薇 赵云峰 杨杏芬 吴永宁 

机构地区：[1]暨南大学医学院,广州510632 [2]广东省疾病预防控制中心卫生化验所 [3]营养与食品安全所 [4]公共卫生研究院 [5]国家食品安全风险评估中心食品安全风险评估重点实验室

出　　处：《中华预防医学杂志》2015年第7期638-643,共6页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金（81273102）;卫生公益性行业科研专项（201302005）;广东省自然科学基金（S2011010004984）

摘　　要：目的：调查长期镉暴露对人群肾功能的影响。方法采用分层随机抽样与整群抽样结合的方法，于2011年4月至2012年8月在我国广东省粤北地区选取在某高镉区居住15年以上的40周岁以上人群作为暴露组，共167名。采用整群分层随机抽样法选择年龄〉40周岁、居住时间在15年以上且经济条件相近、生活饮食习惯相似、居住环境镉暴露较低的人群作为对照组，共145名。通过问卷调查和现场体检了解其健康状况；采用四分法抽取调查对象食用的大米和主要蔬菜品种，采集晨尿；测定大米、蔬菜和人尿镉含量，以及尿中肾损伤标志物[N-乙酰-β-氨基葡萄糖甘酶（N-acety1-β-glucosaminidase，NAG）、β2-微球蛋白（β2-microglobulin，β2-MG）、视黄醇结合蛋白（retinol binding protein，RBP）]和尿肌酐水平；应用Pearson相关分析和多元回归分析探讨调查对象年龄、尿镉水平及各标志物之间的关系。结果暴露组大米、蔬菜镉含量中位数分别为0.75、0.10 mg/kg，均高于对照组（0.07和0.01 mg/kg），差异均有统计学意义（Z值分别为-6.32、-7.84，P值均〈0.001）。暴露组人群的尿镉含量中位数为8.29μg/g肌酐，高于对照组（2.03μg/g肌酐），差异有统计学意义（Z＝-11.39， P〈0.001）。40～49、50～59、≥60岁年龄组中暴露组人群的尿镉含量中位数分别为7.22、8.71、13.10μg/g肌酐，均高于对照组（1.80、2.04、2.05μg/g肌酐），差异均有统计学意义（Z值分别为-5.22、-7.41、-7.14， P值均〈0.001）。暴露组男、女尿镉含量中位数分别为5.12、12.36μg/g肌酐，均高于对照组（1.79、2.16μg/g肌酐），差异均有统计学意义（Z值分别为-7.68和-9.03，P值均〈0.001）。暴露组人群尿β2-MG和RBP水平中位数分别为0.21、0.04 mg/g肌酐，均高于对照组（0.05、0.00 mg/g肌酐），差异均有统计学意义（Z值分别为-7.08和-9.65，P值均〈0.001）。PeObjective To study long-term effect on renal function exposed to environmental cadmium. Methods Stratified random sampling and cluster sampling method of epidemiological investigations were carried out in northern Guangdong province between April, 2011 and August, 2012 . A total of 167 residents who lived in high cadmium exposure area for more than 15 years, aged above 40 were selected in exposed group. Moreover, A total of 145 residents who had similar living and economic conditions and lived in local for more than 15 years, aged above 40 were selected in control group. We used health questionnaires and medical examinations in order to acquire their health status. Home-harvested rice and vegetables were collected using quartering method for detection of cadmium level . Urine specimens of residents were collected for detection of cadmium level and creatinine as well as renal dysfunction biomarkers, namely, N-acetyl-beta-D-glucosamidase（NAG）, β2-microglobulin（β2-MG）, and retinol binding protein（RBP）, respectively. The analysis of spearman rank correlation and multiple regression were used to investigate the relationships between age, urinary cadmium levels and renal injury biomarkers. Results The cadmium levels in rice and vegetables of exposed group were 0.75 and 0.10 mg/kg, both were significantly higher than 0.07 and 0.01 mg/kg in the control group （Z values were-6.32 and-7.84, all P values〈0.001）. The urinary cadmium level of exposed group was 8.29μg/g＆#183;cr, which was higher than that of the control group 2.03μg/g＆#183;cr with significant difference（Z value was-11.39, P〈0.001）. After stratified the total population by age, the urinary cadmium level in 40-49 years, 50-59 years and≥60 years subgroups were 7.22, 8.71, and 13.10μg/g＆#183;cr, which both were significantly higher than 1.80, 2.04, and 2.05μg/g＆#183;cr in the control group （Z values were-5.22,-7.41, and-7.14, all P values〈0.001）. After stratified the total population by gender , the urinary cadmium leve

关 键 词：镉 肾机能不全 环境暴露 Β2-MG RBP 

分 类 号：R692[医药卫生—泌尿科学]