中华预防医学杂志
中華預防醫學雜誌
중화예방의학잡지
CHINESE JOURNAL OF
2015年
7期
638-643
,共6页
张蕴蕊%梁旭霞%陈文才%王晶%黄琼%陈子慧%王萍%黄芮%胡曙光%李志学%汤柳英%王桂安%杨菲%李筱薇%赵云峰%杨杏芬%吴永宁
張蘊蕊%樑旭霞%陳文纔%王晶%黃瓊%陳子慧%王萍%黃芮%鬍曙光%李誌學%湯柳英%王桂安%楊菲%李篠薇%趙雲峰%楊杏芬%吳永寧
장온예%량욱하%진문재%왕정%황경%진자혜%왕평%황예%호서광%리지학%탕류영%왕계안%양비%리소미%조운봉%양행분%오영저
镉%肾机能不全%环境暴露%β2-MG%RBP
鎘%腎機能不全%環境暴露%β2-MG%RBP
력%신궤능불전%배경폭로%β2-MG%RBP
Cadmium%Renal insufficiency%Environmental exposure%β2-MG%RBP
目的：调查长期镉暴露对人群肾功能的影响。方法采用分层随机抽样与整群抽样结合的方法，于2011年4月至2012年8月在我国广东省粤北地区选取在某高镉区居住15年以上的40周岁以上人群作为暴露组，共167名。采用整群分层随机抽样法选择年龄>40周岁、居住时间在15年以上且经济条件相近、生活饮食习惯相似、居住环境镉暴露较低的人群作为对照组，共145名。通过问卷调查和现场体检了解其健康状况；采用四分法抽取调查对象食用的大米和主要蔬菜品种，采集晨尿；测定大米、蔬菜和人尿镉含量，以及尿中肾损伤标志物[N-乙酰-β-氨基葡萄糖甘酶（N-acety1-β-glucosaminidase，NAG）、β2-微球蛋白（β2-microglobulin，β2-MG）、视黄醇结合蛋白（retinol binding protein，RBP）]和尿肌酐水平；应用Pearson相关分析和多元回归分析探讨调查对象年龄、尿镉水平及各标志物之间的关系。结果暴露组大米、蔬菜镉含量中位数分别为0.75、0.10 mg/kg，均高于对照组(0.07和0.01 mg/kg)，差异均有统计学意义（Z值分别为-6.32、-7.84，P值均<0.001）。暴露组人群的尿镉含量中位数为8.29μg/g肌酐，高于对照组(2.03μg/g肌酐)，差异有统计学意义（Z＝-11.39， P<0.001）。40~49、50~59、≥60岁年龄组中暴露组人群的尿镉含量中位数分别为7.22、8.71、13.10μg/g肌酐，均高于对照组(1.80、2.04、2.05μg/g肌酐)，差异均有统计学意义（Z值分别为-5.22、-7.41、-7.14， P值均<0.001）。暴露组男、女尿镉含量中位数分别为5.12、12.36μg/g肌酐，均高于对照组(1.79、2.16μg/g肌酐)，差异均有统计学意义（Z值分别为-7.68和-9.03，P值均<0.001）。暴露组人群尿β2-MG和RBP水平中位数分别为0.21、0.04 mg/g肌酐，均高于对照组(0.05、0.00 mg/g肌酐)，差异均有统计学意义（Z值分别为-7.08和-9.65，P值均<0.001）。Pearson相关分析显示，尿中NAG、β2-MG和RBP与尿镉呈正相关，相关系数分别为0.57、0.49、0.21；与年龄也呈正相关，相关系数分别为0.22、0.26、0.23（P值均<0.001）。多元线性回归分析显示，调整年龄的影响后，尿镉对NAG、β2-MG和RBP变化影响较高，β'值分别是0.57、0.49和0.20（P值均<0.001）。结论长期以镉污染大米和蔬菜为膳食主要来源的人群体内镉负荷增加，出现肾功能损伤，表现为尿中早期肾小管损伤标志物水平的增加。
目的：調查長期鎘暴露對人群腎功能的影響。方法採用分層隨機抽樣與整群抽樣結閤的方法，于2011年4月至2012年8月在我國廣東省粵北地區選取在某高鎘區居住15年以上的40週歲以上人群作為暴露組，共167名。採用整群分層隨機抽樣法選擇年齡>40週歲、居住時間在15年以上且經濟條件相近、生活飲食習慣相似、居住環境鎘暴露較低的人群作為對照組，共145名。通過問捲調查和現場體檢瞭解其健康狀況；採用四分法抽取調查對象食用的大米和主要蔬菜品種，採集晨尿；測定大米、蔬菜和人尿鎘含量，以及尿中腎損傷標誌物[N-乙酰-β-氨基葡萄糖甘酶（N-acety1-β-glucosaminidase，NAG）、β2-微毬蛋白（β2-microglobulin，β2-MG）、視黃醇結閤蛋白（retinol binding protein，RBP）]和尿肌酐水平；應用Pearson相關分析和多元迴歸分析探討調查對象年齡、尿鎘水平及各標誌物之間的關繫。結果暴露組大米、蔬菜鎘含量中位數分彆為0.75、0.10 mg/kg，均高于對照組(0.07和0.01 mg/kg)，差異均有統計學意義（Z值分彆為-6.32、-7.84，P值均<0.001）。暴露組人群的尿鎘含量中位數為8.29μg/g肌酐，高于對照組(2.03μg/g肌酐)，差異有統計學意義（Z＝-11.39， P<0.001）。40~49、50~59、≥60歲年齡組中暴露組人群的尿鎘含量中位數分彆為7.22、8.71、13.10μg/g肌酐，均高于對照組(1.80、2.04、2.05μg/g肌酐)，差異均有統計學意義（Z值分彆為-5.22、-7.41、-7.14， P值均<0.001）。暴露組男、女尿鎘含量中位數分彆為5.12、12.36μg/g肌酐，均高于對照組(1.79、2.16μg/g肌酐)，差異均有統計學意義（Z值分彆為-7.68和-9.03，P值均<0.001）。暴露組人群尿β2-MG和RBP水平中位數分彆為0.21、0.04 mg/g肌酐，均高于對照組(0.05、0.00 mg/g肌酐)，差異均有統計學意義（Z值分彆為-7.08和-9.65，P值均<0.001）。Pearson相關分析顯示，尿中NAG、β2-MG和RBP與尿鎘呈正相關，相關繫數分彆為0.57、0.49、0.21；與年齡也呈正相關，相關繫數分彆為0.22、0.26、0.23（P值均<0.001）。多元線性迴歸分析顯示，調整年齡的影響後，尿鎘對NAG、β2-MG和RBP變化影響較高，β'值分彆是0.57、0.49和0.20（P值均<0.001）。結論長期以鎘汙染大米和蔬菜為膳食主要來源的人群體內鎘負荷增加，齣現腎功能損傷，錶現為尿中早期腎小管損傷標誌物水平的增加。
목적：조사장기력폭로대인군신공능적영향。방법채용분층수궤추양여정군추양결합적방법，우2011년4월지2012년8월재아국광동성월북지구선취재모고력구거주15년이상적40주세이상인군작위폭로조，공167명。채용정군분층수궤추양법선택년령>40주세、거주시간재15년이상차경제조건상근、생활음식습관상사、거주배경력폭로교저적인군작위대조조，공145명。통과문권조사화현장체검료해기건강상황；채용사분법추취조사대상식용적대미화주요소채품충，채집신뇨；측정대미、소채화인뇨력함량，이급뇨중신손상표지물[N-을선-β-안기포도당감매（N-acety1-β-glucosaminidase，NAG）、β2-미구단백（β2-microglobulin，β2-MG）、시황순결합단백（retinol binding protein，RBP）]화뇨기항수평；응용Pearson상관분석화다원회귀분석탐토조사대상년령、뇨력수평급각표지물지간적관계。결과폭로조대미、소채력함량중위수분별위0.75、0.10 mg/kg，균고우대조조(0.07화0.01 mg/kg)，차이균유통계학의의（Z치분별위-6.32、-7.84，P치균<0.001）。폭로조인군적뇨력함량중위수위8.29μg/g기항，고우대조조(2.03μg/g기항)，차이유통계학의의（Z＝-11.39， P<0.001）。40~49、50~59、≥60세년령조중폭로조인군적뇨력함량중위수분별위7.22、8.71、13.10μg/g기항，균고우대조조(1.80、2.04、2.05μg/g기항)，차이균유통계학의의（Z치분별위-5.22、-7.41、-7.14， P치균<0.001）。폭로조남、녀뇨력함량중위수분별위5.12、12.36μg/g기항，균고우대조조(1.79、2.16μg/g기항)，차이균유통계학의의（Z치분별위-7.68화-9.03，P치균<0.001）。폭로조인군뇨β2-MG화RBP수평중위수분별위0.21、0.04 mg/g기항，균고우대조조(0.05、0.00 mg/g기항)，차이균유통계학의의（Z치분별위-7.08화-9.65，P치균<0.001）。Pearson상관분석현시，뇨중NAG、β2-MG화RBP여뇨력정정상관，상관계수분별위0.57、0.49、0.21；여년령야정정상관，상관계수분별위0.22、0.26、0.23（P치균<0.001）。다원선성회귀분석현시，조정년령적영향후，뇨력대NAG、β2-MG화RBP변화영향교고，β'치분별시0.57、0.49화0.20（P치균<0.001）。결론장기이력오염대미화소채위선식주요래원적인군체내력부하증가，출현신공능손상，표현위뇨중조기신소관손상표지물수평적증가。
Objective To study long-term effect on renal function exposed to environmental cadmium. Methods Stratified random sampling and cluster sampling method of epidemiological investigations were carried out in northern Guangdong province between April, 2011 and August, 2012 . A total of 167 residents who lived in high cadmium exposure area for more than 15 years, aged above 40 were selected in exposed group. Moreover, A total of 145 residents who had similar living and economic conditions and lived in local for more than 15 years, aged above 40 were selected in control group. We used health questionnaires and medical examinations in order to acquire their health status. Home-harvested rice and vegetables were collected using quartering method for detection of cadmium level . Urine specimens of residents were collected for detection of cadmium level and creatinine as well as renal dysfunction biomarkers, namely, N-acetyl-beta-D-glucosamidase(NAG), β2-microglobulin(β2-MG), and retinol binding protein(RBP), respectively. The analysis of spearman rank correlation and multiple regression were used to investigate the relationships between age, urinary cadmium levels and renal injury biomarkers. Results The cadmium levels in rice and vegetables of exposed group were 0.75 and 0.10 mg/kg, both were significantly higher than 0.07 and 0.01 mg/kg in the control group (Z values were-6.32 and-7.84, all P values<0.001). The urinary cadmium level of exposed group was 8.29μg/g·cr, which was higher than that of the control group 2.03μg/g·cr with significant difference(Z value was-11.39, P<0.001). After stratified the total population by age, the urinary cadmium level in 40-49 years, 50-59 years and≥60 years subgroups were 7.22, 8.71, and 13.10μg/g·cr, which both were significantly higher than 1.80, 2.04, and 2.05μg/g·cr in the control group (Z values were-5.22,-7.41, and-7.14, all P values<0.001). After stratified the total population by gender , the urinary cadmium level of male and female were 5.12 and 12.36μg/g · cr, which both were significantly higher than 1.79 and 2.16 μg/g · cr in the control group (Z values were-7.68 and-9.03, all P values<0.001). Comparing the differences of renal dysfunction biomarkers (NAG, β2-MG, RBP) between two groups. The level of urinaryβ2-MG and RBP of exposed group were 0.21 and 0.04μg/g · cr, which were higher than 0.05 and 0.00 μg/g · cr of the control group with significant difference(Z value was-7.08 and-9.65, all P values<0.001). Pearson correlation analysis showed that NAG,β2-MG and RBP were positively correlated with urinary cadmium and age, the correlation coefficients were 0.57,0.49,0.21and 0.22, 0.26, 0.23 respectively (all P values<0.001). After adjusting the effect of age, it was appeared that urinary cadmium levels contributed most to the alteration of NAG, β2-MG and RBP, the standardized regression coefficients were 0.57, 0.49 and 0.20 (all P values<0.001), and suggested that the cadmium body burden was one of the most important factors for renal dysfunction. Conclusion Residents, who had cadmium contaminated rice and vegetables for a long time, would take the risk of increasing body burden of cadmium and urinary early biomarkers of renal tubular injury that referred to occurrence of renal dysfunction.
