我国18岁及以上成年人尿镍水平与胰岛素抵抗、胰岛功能及糖尿病的关联研究  

Association of urinary nickel levels with insulin resistance,islet function,and diabetes in adults aged 18 years and above in China

作　　者：曲英莉[1] 李峥 吉赛赛 孙琦[1] 李亚伟[1] 蔡嘉旖 张卓娜[1] 宋皓璨 张文丽[1] 赵峰[1] 朱英[1] 吕跃斌 曹兆进[1] 施小明[1] Qu Yingli;Li Zheng;Ji Saisai;Sun Qi;Li Yawei;Cai Jiayi;Zhang Zhuona;Song Haocan;Zhang Wenli;Zhao Feng;Zhu Ying;Lyu Yuebin;Cao Zhaojin;Shi Xiaoming(China CDC Key Laboratory of Environment and Population Health/National Institute of Environmental Health,Chinese Center for Disease Control and Prevention,Beijing 100021,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

出　　处：《中华流行病学杂志》2023年第11期1717-1723,共7页Chinese Journal of Epidemiology

基　　金：中国疾病预防控制中心环境所青年科学基金(2021YSRF03);国家卫生健康委员会公共卫生专项(131031108000160004)。

摘　　要：目的探讨中国≥18岁成年人体内尿镍暴露与胰岛素抵抗、胰岛功能及糖尿病的关联。方法从2017-2018年国家人体生物监测项目随机选取糖尿病患者500名为病例组,并按照1∶1的比例选择对照组。采集调查对象尿液和静脉血,检测尿镍及血清中FPG、空腹胰岛素等糖代谢指标,并采用稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β)和校正HOMA-β。采用多因素logistic回归模型分析尿镍与糖尿病患病风险的关联。采用多元线性回归模型计算尿镍水平与HOMA-IR、HOMA-β和校正HOMA-β的关联。结果病例组和对照组男女性别比1∶1。多因素logistic回归模型显示,在校正文化程度、吸烟状况、饮酒状况、大米摄入频率、肉类摄入频率、糖尿病家族史、BMI、TC、高血压及尿肌酐水平后,与尿镍水平T1组相比,T2、T3组糖尿病患病的OR值(95%CI)分别为1.36(0.98~1.89)和1.60(1.14~2.24);多元线性回归模型显示,尿镍水平与HOMA-IR升高存在正向关联,与尿镍水平T1组相比,T3组HOMA-IR的β值为0.12(95%CI:0.01~0.25),且尿镍水平每升高一个log转换单位(2.71μg/L),log转换后HOMA-IR的β值为0.06(95%CI:0.02~0.10)。尿镍水平与校正HOMA-β升高存在负向关联,与尿镍水平T1组相比,T3组校正HOMA-β的β值为-0.26(95%CI:-0.41~-0.11),且尿镍水平每升高一个log转换单位(2.71μg/L),log转换后校正HOMA-β的β值为-0.09(95%CI:-0.14~-0.04)。结论中国成年人尿镍暴露与胰岛素抵抗及糖尿病患病风险存在正向关联,与胰岛β细胞功能存在负向关联。Objective To investigate the effects of urinary nickel exposure on insulin resistance,islet function and diabetes risk in adults aged 18 years and above in China.Methods Based on the China National Human Biomonitoring from 2017 to 2018,a total of 500 diabetes patients were randomly selected as the case group,and the matched euglycemic control were selected by 1∶1 matching ratio.The urinary and venous blood samples of the subjects were collected,and the urinary nickel levels and serum glucose metabolism indexes such as fasting blood glucose and fasting insulin were detected,and the insulin resistance index(HOMA-IR),βcell function index(HOMA-β),and adjusted HOMA-βwere calculated by using homeostasis model assessment.A multivariate logistic regression model was used to analyze the association between urinary nickel level and diabetes risk.Multiple linear regression models were used to evaluate the association of urinary nickel level with HOMA-IR,HOMA-βand adjusted HOMA-β.Results The sex ratio of controls and cases was 1∶1.The multivariate logistic regression model showed that after adjusting for factors such as education level,smoking status,alcohol consumption,rice and meat intakes,family history of diabetes,BMI,total cholesterol level,hypertension,and urinary creatinine,compared with T1 group,the ORs of diabetes risk in the T2 and T3 groups were 1.36(95%CI:0.98-1.89)and 1.60(95%CI:1.14-2.24),respectively.The multiple linear regression model showed a positive association between urinary nickel levels and the elevated HOMA-IR,theβvalue of HOMA-IR in the T3 group was 0.12(95%CI:0.01-0.25)compared with the T1 group and each one-unit increase in the log-transformed urinary nickel level(2.71µg/L)was associated with a 0.06 elevation in HOMA-IR(95%CI:0.02-0.10).Meanwhile,the urinary nickel levels were negative associated with the adjusted HOMA-β,theβvalue of adjusted HOMA-βin the T3 group were-0.26 compared with the T1 group(95%CI:-0.41--0.11),and each one-unit increase in the log-transformed urinary nickel

关 键 词：胰岛素抵抗 胰岛功能 糖尿病 尿镍 

分 类 号：R587.1[医药卫生—内分泌]