环境重金属联合暴露风险分层以及青少年肾脏健康的关联研究  

Study on risk stratification of combined exposure to environmental heavy metals and the association with renal health in adolescents

作　　者：张玲 翁雨洁 王峙 袁敏 ZHANG Ling;WENG Yujie;WANG Zhi;YUAN Min(Department of Health Data Science,School of Health Management,Anhui Medical University,Hefei 230032,Anhui,China;Department of Nephrology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu,China;Anhui Provincial Key Laboratory of Population Health and Eugenics,Hefei 230032,Anhui,China)

机构地区：[1]安徽医科大学卫生管理学院卫生健康数据科学系,安徽合肥230032 [2]苏州大学第二附属医院肾脏内科,江苏苏州215004 [3]人口健康与优生安徽省重点实验室,安徽合肥230032

出　　处：《右江民族医学院学报》2025年第1期124-131,共8页Journal of Youjiang Medical University for Nationalities

基　　金：国家自然科学基金项目(82073578);人口健康与优生安徽省重点实验室课题(JKYS20233);安徽省教育厅高校自然科学研究重点项目(2024AH050693)。

摘　　要：目的探讨青少年人群中多种重金属(砷、铅、镉、汞)联合暴露组及其与肾脏参数之间的关联。方法本研究数据来自美国国家健康和营养调查(NHANES)2009—2014的调查队列,涵盖2709名12~19岁青少年。通过无监督机器学习中的k-medoids聚类算法,根据尿液砷、铅、镉、汞和血液铅、镉、汞的浓度,将样本分为不同的暴露风险组。在控制人口学变量及其他关键协变量后,采用多重线性回归模型分析不同风险组的暴露与肾小球滤过率(eGFR)、血清尿酸(SUA)、尿白蛋白(UA)、血尿素氮(BUN)及收缩压(SBP)之间的关联。结果识别了血液和尿液中3种主要金属暴露组,发现金属联合暴露组与部分肾脏参数存在显著的关联性。对于血液中的金属,第一组人群的镉、汞和铅水平最低;第二组中汞浓度最高,其次是铅,而镉浓度最低;在第三组中,铅和镉的浓度高于汞,汞浓度处于最低水平。在第二组中,人群的血清尿酸(SUA)显著高于第一组,效应值为0.163(95%CI:0.066~0.261,P=0.001)。尿液金属的联合暴露组同样表现出显著差异。第一和第三组中4种尿液金属(砷、镉、汞、铅)分布相对均衡,但第三组的整体水平高于第一组。第二组中的金属浓度分布差异显著,砷、镉、汞的浓度依次递增,而铅的含量显著低于其他两种。根据尿液金属第二组人群的eGFR显著低于第一组,效应值为-12.893(95%CI:-18.905~-6.880,P<0.001);而第三组人群的eGFR显著高于第一组,效应值为7.195(95%CI:2.274~12.117,P=0.004)。此外,第三组人群的收缩压显著低于第一组,效应值为-1.411(95%CI:-2.807~-0.014,P=0.048)。结论血液和尿液中金属联合暴露组与部分肾脏参数之间有显著的关联性。高水平金属联合暴露组的人群有相对较低的eGFR和较高的血清尿酸值。Objective To explore the association between combined exposure groups of multiple heavy metals(arsenic,lead,cadmium,and mercury)and renal parameters in adolescents.Methods Data for this study were derived from the 2009—2014 National Health and Nutrition Examination Survey(NHANES)cohort,encompassing 2709 adolescents aged 12~19 years.Using the k-medoids clustering algorithm from unsupervised machine learning,samples were categorized into different exposure risk groups based on urine concentrations of arsenic,lead,cadmium,and mercury,as well as blood concentrations of lead,cadmium,and mercury.Multiple linear regression models were employed to analyze the associations between exposures in different risk groups and estimated glomerular filtration rate(eGFR),serum uric acid(SUA),urine albumin(UA),blood urea nitrogen(BUN),and systolic blood pressure(SBP)after controlling for demographic variables and other key covariates.Results Three primary metal exposure groups in blood and urine were identified,and significant associations were found between combined metal exposure groups and some renal parameters.For metals in blood,Group 1 had the lowest levels of cadmium,mercury,and lead;Group 2 had the highest mercury concentrations,followed by lead,with the lowest cadmium concentrations;and in Group 3,lead and cadmium concentrations were higher than mercury,with mercury at the lowest level.In Group 2,the SUA was significantly higher than that in Group 1,with an effect size of 0.163(95%CI:0.066~0.261,P=0.001).Combined exposure groups for urine metals also showed significant differences.Groups 1 and 3 had relatively balanced distributions of the four urine metals(arsenic,cadmium,mercury,and lead),but the overall levels in Group 3 were higher than in Group 1.In Group 2,there were significant differences in metal concentration distribution,with concentrations of arsenic,cadmium,and mercury increasing sequentially,while lead content was significantly lower than the other two metals.The eGFR of the urine metal Group 2 was significa

关 键 词：青少年 重金属联合暴露 k-medoids聚类 风险分层 肾脏参数 

分 类 号：R994.6[医药卫生—毒理学]