老年人日常生活活动能力障碍与重金属浓度的关联

李珽君; 蔡建升; 李瑞英; 肖洁; 叶泽严; 程宇骞; 刘哲; 张志勇

doi:10.11836/JEOM24085

老年人日常生活活动能力障碍与重金属浓度的关联

Associations between disorders in activities of daily living and heavy metal concentrations in elderly people

摘要

摘要:
背景重金属可能在老年人日常生活活动能力（ADL）障碍的环境危险因素中起重要作用。
目的本研究旨在探讨老年人血浆中锌、砷、镉、铅、锰和铜6种重金属的含量与ADL障碍的关联。
方法 2018—2019年对广西壮族自治区恭城瑶族自治县1412名农村老年人进行了一项横断面调查，采用电感耦合等离子体质谱法（ICP-MS）检测血浆金属浓度，根据三分位数分为3组（T1~T3），以T1组为参照。采用ADL量表评估调查对象ADL障碍情况。采用logistic回归和限制立方样条模型（RCS）估计优势比（OR）和95%置信区间（CI）来评估重金属与ADL障碍患病率之间的关联。
结果研究对象平均年龄为（68.52±5.92）岁，女性825人（58.4%），男性587人（41.6%）。其中372人（26.34%）存在ADL障碍，ADL障碍者多为女性（74.3%）。总人群logistic回归分析结果显示，与T1组（≤0.15 µg·L⁻¹）相比，镉水平T2组（0.15~0.25 µg·L⁻¹）发生ADL障碍的风险较高（OR=1.552，95%CI：1.086~2.134）。按性别分层后，与T1组（≤868.12 µg·L⁻¹）相比，男性血浆铜水平T3组（＞1019.58 µg·L⁻¹）发生ADL障碍的风险较低（OR=0.481，95%CI：0.232~0.998）。与T1组（≤0.15 µg·L⁻¹）相比，女性血浆镉水平T2组（0.15~0.25 µg·L⁻¹）发生ADL障碍的风险较高（OR=1.758，95%CI：1.182~2.616）。RCS分析结果表明，男性ADL障碍风险与铜呈非线性相关（P_非线性=0.011，P_整体＜0.05）。
结论高浓度的镉与ADL障碍的发生风险呈正相关，而高浓度的铜与男性ADL障碍的发生风险呈负相关。

Abstract:
Background Heavy metals may play an important role in environmental risk factors associated disorders of activities of daily living (ADL) in older adults.
Objective To investigate the associations between plasma levels of six heavy metals (zinc, arsenic, cadmium, lead, manganese, and copper) and ADL disorders in older adults.
Methods A cross-sectional survey was conducted from 2018 to 2019 among 1412 rural elderly people in Gongcheng Yao Autonomous County, Guangxi Zhuang Autonomous Region. The plasma metal concentrations were detected by inductively coupled plasma mass spectrometry (ICP-MS), and subsequently classified into three groups (T1-T3) based on tertiles, with the T1 group as the reference. The samples were assessed for ADL disorders using the ADL scale. Logistic regression and restricted cubic spline model (RCS) were used to estimate the odds ratio (OR) and 95% confidence interval (CI) to assess the associations between heavy metals and the prevalence of reporting ADL disorders.
Results The mean age of the study population was (68.52 ± 5.92) years, 825 (58.4%) female and 587 (41.6%) male. Of these, 372 (26.34%) subjects reported ADL disorders, and most of them were female (74.30%). The results of logistic regression showed that the participants in the cadmium T2 group (0.15-0.25 µg·L⁻¹) had a higher risk of ADL disorders compared to the T1 group (≤0.15 μg·L⁻¹) (OR=1.552, 95%CI: 1.086, 2.134). After stratification by sex, the relative risk of ADL disorders was lower in the plasma copper T3 group (>1019.58 µg·L⁻¹) compared to the T1 group (≤868.12 μg·L⁻¹) in men (OR=0.481, 95%CI: 0.232, 0.998). The relative risk of ADL disorders was higher in the plasma cadmium T2 group (0.15-0.25 µg·L⁻¹) compared to the T1 group (≤0.15 μg·L⁻¹) in women (OR=1.758, 95%CI: 1.182, 2.616). The RCS results showed that the risk of ADL disorders in men was nonlinearly associated with copper (P_nonlinear=0.011, P_overall<0.05).
Conclusion High levels of cadmium are positively associated with the risk of reporting ADL disorders, while high levels of copper are negatively associated with the risk of reporting ADL disorders in men.

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