血浆锰、砷和铅浓度与肝功能异常的关联  

Associations of plasma manganese,arsenic,and lead concentrations with liver function abnormalities

作　　者：陈沁霖 尤小敏 肖飏 尹瑜 璩静丽 唐瑞 袁瑜 CHEN Qin-lin;YOU Xiao-min;XIAO Yang;YIN Yu;QU Jing-li;TANG Rui;YUAN Yu(School of Public Health,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学公共卫生学院,武汉430030

出　　处：《环境卫生学杂志》2024年第12期959-968,共10页JOURNAL OF ENVIRONMENTAL HYGIENE

基　　金：国家重点研发计划(2022YFE0209900)。

摘　　要：目的探究血浆锰、砷和铅浓度与肝功能异常的关联。方法本研究为前瞻性队列研究,纳入基于东风-同济队列的4344人。通过问卷调查、体格检查和实验室检查收集研究对象的社会人口学特征、生活行为方式及健康状况等信息,并使用电感耦合等离子体质谱仪和自动生化分析仪进行血浆金属浓度及肝功能指标水平的测定。建立多因素Logistic回归模型分析血浆金属与肝功能异常风险比值比(odds ratio,OR),通过限制性立方样条曲线(restricted cubic spline,RCS)评估血浆金属浓度与肝功能血清学指标间的剂量-反应关系。建立广义线性模型探究锰、砷和铅对总胆红素水平的交互作用。结果肝功能异常定义为肝功能血清学指标大于或等于实验室的临床上限值,异常者1444人(占比33.24%)。将血浆锰、砷和铅按浓度三分位,多因素Logistic回归模型显示,血浆锰、砷和铅高浓度组研究对象总胆红素异常风险分别是低浓度组的1.56(95%CI:1.31~1.87)、1.87(95%CI:1.58~2.22)和1.87(95%CI:1.57~2.22)倍。RCS分析结果显示,血浆锰和砷与总胆红素和直接胆红素水平呈非线性关联(P回归<0.001,P非线性<0.05),血浆铅与直接胆红素水平呈正向的剂量-反应关系(P回归<0.001,P非线性>0.05)。交互作用分析结果显示,锰-砷和砷-铅在总胆红素异常方面存在正向交互作用(P<0.05),低血浆锰-低血浆砷组的总胆红素水平均值(标准误)为13.42(0.20)μmol/L,而高血浆锰-高血浆砷组的总胆红素水平均值(标准误)为15.86(0.20)μmol/L。结论血浆锰、砷和铅浓度与肝功能异常风险的关联具有统计学意义,并且血浆铅与直接胆红素异常的风险呈正向线性关联。Objective To investigate the association of plasma concentrations of manganese,arsenic,and lead with abnormal liver function.Methods A prospective cohort study was conducted with a total of 4344 individuals from the Dongfeng-Tongji cohort.The study collected information on the sociodemographic characteristics,lifestyle behaviors,and health status of the participants through questionnaires,physical examinations,and laboratory tests.Plasma metal concentrations and liver function indicators were measured using inductively coupled plasma mass spectrometry and an automatic biochemical analyzer,respectively.A multivariable logistic regression model was established to calculate the odds ratios(OR s)of plasma metals for the occurrence of abnormal liver function.Restricted cubic spline(RCS)curves were employed to assess the dose-response relationships between plasma metal concentrations and serum liver function indicators.Additionally,a generalized linear model was employed to explore the interaction of manganese,arsenic,and lead and their impact on total bilirubin levels.Results Liver function abnormalities,defined as serum liver function indicators equal to or greater than the clinical upper limits,were observed in 1444(33.24%)participants.In the multivariable logistic regression model,compared with the lowest tertile,the highest tertiles of plasma manganese,arsenic,and lead were associated with an increased risk of total bilirubin abnormalities,with OR s(95%confidence interval)of 1.56(1.31-1.87),1.87(1.58-2.22),and 1.87(1.57-2.22),respectively.RCS analyses indicated nonlinear associations of plasma manganese and arsenic with total and direct bilirubin levels(P-overall<0.001,P-nonlinear<0.05),while plasma lead demonstrated a positive dose-response relationship with direct bilirubin concentration(P-overall<0.001,P-nonlinear>0.05).Interaction analysis demonstrated significant positive interactions between manganese-arsenic and arsenic-lead with respect to total bilirubin abnormalities(P<0.05).The mean(standard error)total

关 键 词：锰 砷 铅 肝功能 队列研究 

分 类 号：R12[医药卫生—环境卫生学]