中国9个长寿地区老年人尿砷水平与贫血的关联  

Association between urinary arsenic levels and anemia among older adults in nine longevity areas of China

作　　者：刘洋 吕跃斌 吴兵 魏源 陈晨[1] 周锦辉 赵峰[1] 李昕蔚 王君[1] 李峥 李成橙[1] 吉赛赛 李亚伟[1] 郭彦波 鞠爱鹏 薛锴 施小明[1] 俞琼[2] Liu Yang;Lyu Yuebin;Wu Bing;Wei Yuan;Chen Chen;Zhou Jinhui;Zhao Feng;Li Xinwei;Wang Jun;Li Zheng;Li Chengcheng;Ji Saisai;Li Yawei;Guo Yanbo;Ju Aipeng;Xue Kai;Shi Xiaoming;Yu Qiong(China CDC Key Laboratory of Environment and Population Health,National Institute of Environmental Health,Chinese Center for Disease Control and Prevention,Beijing 100021,China;School of Public Health,Jilin University,Changchun 130012,China)

机构地区：[1]中国疾病预防控制中心环境与人群健康重点实验室中国疾病预防控制中心环境与健康相关产品安全所,北京100021 [2]吉林大学公共卫生学院,长春130012

出　　处：《中华医学杂志》2022年第2期101-107,共7页National Medical Journal of China

基　　金：国家自然科学基金(82025030,81941023);国家重点研发计划(2018YFC2000400)。

摘　　要：目的探讨中国9个长寿地区老年人尿砷水平与贫血的关系。方法以2017—2018年参与老年健康生物标志物队列研究的1896名65岁及以上老年人为对象,采用自制问卷收集人口学特征和生活方式等资料,通过体格检查测定身高、体重、血压并计算体质指数(BMI),采集血液和尿液标本后分别检测血红蛋白(Hb)、血糖、血脂、血浆维生素B_(12)和尿砷等指标。将尿砷水平(μg/g肌酐)按四分位数分为Q_(1)(<18.7)、Q_(2)(18.7~34.5)、Q_(3)(34.6~69.5)和Q_(4)(≥69.6)等不同尿砷水平,分别采用多因素logistic回归模型和限制性立方样条拟合logistic回归模型分析尿砷水平与贫血的关系。结果研究对象年龄[M(Q_(1),Q_(3))]为83(74,92)岁,其中女性952名(50.21%),Hb含量[M(Q_(1),Q_(3))]为135(124,147)g/L,贫血患病率为24.89%(472例),尿砷水平几何均数和[M(Q_(1),Q_(3))]分别为37.5和34.6(18.7,69.6)μg/g肌酐。多因素logistic回归模型分析显示:调整年龄、性别、BMI、教育水平、吸烟、饮酒情况、居住地、经济水平、民族、维生素B_(12)缺乏情况、水产品和肉类食用频率、高血压、糖尿病和血脂异常患病情况等因素后,尿砷水平与贫血均呈正向关联[以Q_(1)组为参照,Q_(2)、Q_(3)和Q_(4)组的OR(95%CI)分别为1.73(1.20~2.50)、2.08(1.43~3.02)和1.52(1.02~2.28)]。限制性立方样条拟合logistic回归分析结果显示:尿砷水平与贫血存在非线性关联(P<0.001)。亚组分析显示:慢性病患病情况与尿砷水平具有负相乘交互作用[OR(95%CI):0.55(0.30~0.99)],未发现年龄、性别、居住地、吸烟和饮酒情况等与尿砷水平之间的相乘交互作用(均P>0.05)。未患慢性病、男性、乡村居住、吸烟和饮酒对象的尿砷水平与贫血呈正向关联[OR(95%CI)值分别为3.62(1.30~10.06)、2.46(1.34~4.52)、1.70(1.03~2.80)、2.21(1.01~4.82)和2.79(1.23~6.33)]。结论中国9个长寿地区老年人尿砷水平与贫血呈正向关联。Objective To investigate the association between urinary arsenic levels and anemia among older adults in nine longevity areas of China.Methods A total of 1896 subjects aged 65 years and above who participated in the Healthy Aging and Biomarkers Cohort Study(HABCS)in 2017-2018 were included.A self-made questionnaire was used to collect demographic characteristics,lifestyle and other information from the subjects.Through physical examination,data including height,weight and blood pressure were determined and body mass index(BMI)was calculated.Blood and urine samples were collected for the detection of hemoglobin(Hb),blood glucose,blood lipids,plasma vitamin B_(12) and urinary arsenic concentrations.The urinary arsenic levels were divided into four groups according to the quartiles of urinary arsenic concentrations(μg/g creatinine):Q_(1)(<18.7),Q_(2)(18.7-34.5),Q_(3)(34.6-69.5)and Q_(4)(≥69.6).Multivariate logistic regression model and restricted cubic spline fitting logistic regression model were used to analyze the association between urinary arsenic levels and anemia.Results The age of the 1896 subjects(M(Q_(1),Q_(3)))was 83(74,92)years,including 952 females(50.21%),and the concentration of Hb(M(Q_(1),Q_(3)))was 135(124,147)g/L.The prevalence of anemia was 24.89%(472 cases).The geometric mean and M(Q_(1),Q_(3))of urinary arsenic concentrations were 37.5 and 34.6(18.7,69.6)μg/g creatinine,respectively.Multivariate logistic regression model analysis showed that after adjusting for age,gender,BMI,education level,smoking and drinking status,residence,economic level,ethnicity,the status of vitamin B_(12) deficiency,consumption frequency of aquatic products and meat,the prevalence of hypertension,diabetes and dyslipidemia,urinary arsenic levels were positively associated with anemia(Taking group Q_(1) as a reference,OR(95%CI)values in Q_(2),Q_(3) and Q_(4) groups were 1.73(1.20-2.50),2.08(1.43-3.02)and 1.52(1.02-2.28),respectively).The results of restricted cubic spline fitting logistic regression analysis showed a

关 键 词：砷 重金属 贫血 老年人 横断面研究 

分 类 号：R556[医药卫生—血液循环系统疾病]