全血铁和铜与心血管疾病关联的基于队列的病例对照研究  

A cohort-based case control study on the association between the whole blood iron and copper with cardiovascular diseases

作　　者：黄仙 吴寿岭[3] 陈朔华 孙园园 张迪[2] 郭淑霞[1] 王丽[2] HUANG Xian;WU Shou-ling;CHEN Shuo-hua;SUN Yuan-yuan;ZHANG Di;GUO Shu-xia;WANG Li(Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi 832000;Department of Epidemiology and Health Statistics, Institute of Basic Medical Sciences CAMS, School of Basic Medicine PUMC, Beijing 100005;Department of Cardiology, Kailuan General Hospital, Tangshan 063000;Health Care Center, Kailuan Group,Tangshan 063000, China)

机构地区：[1]石河子大学医学院预防医学系,新疆石河子832000 [2]中国医学科学院基础医学研究所北京协和医学院基础学院流行病与卫生统计学系,北京100005 [3]开滦总医院心内科,河北唐山063000 [4]开滦(集团)公司员工健康保障中心,河北唐山063000

出　　处：《基础医学与临床》2021年第5期709-714,共6页Basic and Clinical Medicine

基　　金：中国科学院医学科学创新基金(2016-I2M-3-001)。

摘　　要：目的探究全血铁和全血铜及其交互作用与心血管疾病(CVD)发生的关系。方法采用基于队列的病例对照研究设计,选择2017年至2018年开滦集团队列人群中在3所定点医院随访的全部93例心血管疾病CVD男性患者为病例组,同期与病例按照年龄、工作类型1∶4个体匹配的372名非心血管疾病(non-CVD)男性人群为对照组;采用电感耦合等离子体质谱仪分析方法检测全血中铁和铜的含量。使用条件logistic回归模型分别评估全血铁和铜对心血管疾病CVD的单独效应,采用自适应弹性网络方法构建全血铁与铜的环境风险评分作为共同暴露,并进一步估计该评分与心血管疾病CVD之间的关联。结果病例组中的全血铁水平明显高于对照组,而全血铜水平低于对照组(P<0.001)。在校正年龄、吸烟、饮酒、超重、高血压、糖尿病、贫血、高血脂症和高敏C反应蛋白后,相比于低血铁组,高血铁组发生CVD心血管疾病的风险增加了3.17倍(OR=4.17,95%CI:2.23~7.79,P<0.001),低血铜组发生CVD心血管疾病的风险比高血铜组增加了3.26倍(OR=4.26,95%CI:1.73~10.45,P<0.01)。风险评分>0.232组发生心血管病的风险是风险评分≤0.232组的8.96倍(OR=8.96,95%CI:4.47~17.95,P<0.001)。结论高血铁和铜缺乏可能是CVD心血管病的独立危险因素;环境风险评分可作为评价血铁和铜共同暴露的指标,对CVD心血管疾病的风险预测价值更大。Objective To investigate the association between whole blood iron,copper and their interaction with cardiovascular diseases(CVD).Methods A cohort-based case control study was conducted.Cases were 93 males with CVD in the Kailuan cohort who participated in the follow-up in 3 hospitals in 2017-2018.During the sameperiod,372 males with non-CVD who were 1∶4 individual matched by age and labor type were selected as controls.The concentration of blood iron and copper was determined by inductively coupled plasma mass spectrometry.Conditional logistic regression models were used to estimate the association between blood iron and copper and CVD,respectively and elastic-Net regression models to estimates interaction between the two metals and CVD.Results The whole blood iron concentration in the cases was significantly higher than the controls,while blood copper concentration was lower than the controls(both P<0.001).After adjusting for age,smoking,drinking,overweight,hypertension,diabetes,anemia,hyperlipidemia,and high sensitivity C-reactive protein,the participants with higher iron increase 3.17 times(OR=4.17,95%CI:2.23-7.79,P<0.001)risk of CVD than those with lower iron,and those with lower copper increase 3.26 times(OR=4.26,95%CI:1.73-10.45,P<0.01)risk than those with the higher copper.Adaptive Elastic-net regression analysis showed that it under the simultaneous exposure of higher iron and lower copper,the risk of CVD with environment risk score>0.232 was 8.96 times(OR=8.96,95%CI:4.47-17.95,P<0.001)than the score≤0.232.Conclusions Higher iron and copper deficiency may be independent risk factors for CVD.Environment risk score could be a good indicator of simultaneous exposure of blood iron and copper,which should have a better predictive value of CVD.

关 键 词：全血铁 全血铜 心血管疾病(CVD) 病例对照研究 

分 类 号：R181.3[医药卫生—流行病学]