血浆铝浓度和受教育水平交互作用对认知功能的影响  

The interaction between plasma aluminum concentration and schooling year on cognitive function

作　　者：马黎 敏薛颖君 李晓艳 王姗姗 张静思 牛侨 Ma Limin;Xue Yingjun;Li Xiaoyan;Wang Shanshan;Zhang Jingsi;Niu Qiao(Department of Occupational Health,School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Section of Occupational Medicine,Department of Special Medicine,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学公共卫生学院劳动卫生学教研室,太原030001 [2]山西医科大学特种医学专业职业病学方向,太原030001

出　　处：《中华劳动卫生职业病杂志》2025年第1期25-31,共7页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：国家自然科学基金项目(81372968)。

摘　　要：目的探讨工人血浆铝浓度水平与受教育水平的交互作用对认知功能的影响,为早期识别其损害效应提供依据。方法于2014年10至12月,选取山西省某大型铝生产企业1114名铝作业工人作为研究对象,用电感耦合等离子体质谱法测量其血浆铝浓度作为内暴露指标,根据血浆铅浓度三分位数将研究对象分为低、中、高铝暴露组;用《职工健康调查表》收集工人一般情况资料,《简易精神状态量表》与画钟试验评价其认知功能。采用非条件logistic回归拟合相乘模型、叉生分析拟合相加模型,分析血浆铝浓度与受教育水平之间的交互作用。结果工人平均血浆铝浓度为21.68(10.51,45.78)μg/L。认知功能受损的检出率为19.9%。认知功能表现的保护因素为高教育水平、已婚(P<0.05),危险因素为血浆铝浓度、年龄(P<0.05)。调整年龄、婚姻状况、收入水平、受教育水平、吸烟、饮酒等混杂因素后,多重线性回归模型和logistic回归模型均显示,血浆铝浓度与认知功能受损之间存在剂量反应关系,随着血浆铝浓度的升高,发生认知功能损害的风险增加(P_(趋势)<0.05);血浆铝浓度与低受教育水平之间存在相乘交互作用(AOR=2.15,95%CI:1.10~4.19)和相加交互作用(RERI=5.38,95%CI:2.60~8.16;AP=0.65,95%CI:0.51~0.80;S=3.88,95%CI:2.00~7.56)。结论铝暴露与认知功能损害之间存在着剂量反应关系,高铝暴露与低受教育水平之间存在交互作用,二者共同作用时,可使认知功能损害的发生风险增加。Objective To explore the effect of the interaction between plasma aluminum concentration and schooling year on cognitive function,it provides the basis for early identification of its damaging effect.MethodsFrom October to December,2014,1114 on-the-job aluminum exposed workers in a large aluminum factory in Shanxi Province were investigated.The plasma aluminum concentrations were measured by inductively coupled plasma-mass spectrometry(ICP-MS)as an internal exposure indicator.The subjects were divided into low,medium,and high aluminum exposure group based on the blood lead concentration levels.The general information was collected with a self-designed questionnaire,and their cognitive function was evaluated with the mini-mental state examination and the clock drawing test.The interaction between plasma aluminum concentration level and education level was analyzed by using unconditional logistic regression fitting multiplication model and cross analysis fitting addition model.ResultsThe average level of plasma aluminum of the subjects was 21.68(10.51,45.78)μg/L.The detection rate of cognitive impairment was 19.9%.The influencing factors of cognitive function were plasma aluminum concentration,age,education level and marital status,among which high schooling year,and being married were the protective factors(all P<0.05),plasma aluminum concentration,and age were the risk factors(all P<0.05);After adjusting the confounding factors,such as age,marital status,schooling year,income level,smoking,and drinking,logistic regression model and the multiple linear regression model showed that there was a dose response relationship between plasma aluminum concentration and cognitive impairment.With the increase of plasma aluminum concentration,the score gradually decreased,and the risk of cognitive impairment increased(P_(trend)<0.05);There were multiplicative interaction(AOR=2.15,95%CI:1.10-4.19)and additive interaction(RERI=5.38,95%CI:2.60-8.16;AP=0.65,95%CI:0.51-0.80;S=3.88,95%CI:2.00-7.56)between plasma aluminum concentra

关 键 词：铝 血浆 交互分析 受教育水平 认知功能 简易精神状态量表 画钟试验 

分 类 号：R135[医药卫生—劳动卫生]