王阳灿, 唐艳, 周盛祥, 邓蜀湘, 陈立谋, 沈敏学, 杨飞. 血浆铀浓度与肝损伤关联性的病例-对照研究[J]. 环境与职业医学, 2022, 39(10): 1077-1082. DOI: 10.11836/JEOM22117
引用本文: 王阳灿, 唐艳, 周盛祥, 邓蜀湘, 陈立谋, 沈敏学, 杨飞. 血浆铀浓度与肝损伤关联性的病例-对照研究[J]. 环境与职业医学, 2022, 39(10): 1077-1082. DOI: 10.11836/JEOM22117
WANG Yangcan, TANG Yan, ZHOU Shengxiang, DENG Shuxiang, CHEN Limou, SHEN Minxue, YANG Fei. Case-control study of correlation between plasma uranium level and liver injury[J]. Journal of Environmental and Occupational Medicine, 2022, 39(10): 1077-1082. DOI: 10.11836/JEOM22117
Citation: WANG Yangcan, TANG Yan, ZHOU Shengxiang, DENG Shuxiang, CHEN Limou, SHEN Minxue, YANG Fei. Case-control study of correlation between plasma uranium level and liver injury[J]. Journal of Environmental and Occupational Medicine, 2022, 39(10): 1077-1082. DOI: 10.11836/JEOM22117

血浆铀浓度与肝损伤关联性的病例-对照研究

Case-control study of correlation between plasma uranium level and liver injury

  • 摘要: 背景

    铀暴露对人体具有多器官毒性,已有实验研究表明铀对肝脏具有损伤作用,但相关的人群研究未见报道。

    目的

    本研究旨在探讨铀内暴露与肝损伤的关联。

    方法

    选择湖南北部和南部的2个重金属污染代表性区域的常住居民为研究对象,采用1∶1配对病例-对照设计,根据肝损伤的诊断标准(在此次健康检查中丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素三个指标中两个或者两个以上的指标出现异常)以及病例和对照可比性的原则,各招募370名参与者。通过问卷调查、体格检查收集研究对象一般人口学特征和患病情况等信息。通过实验室检测的方法,测定血浆铀浓度及肝功能水平。采用Spearman相关分析血浆铀浓度与肝损伤指标的相关性,采用限制性立方样条分析血浆铀浓度与肝损伤的剂量-反应关系。根据自然对数(ln)转换后的对照组血浆铀浓度的四分位数值,将研究对象分为Q1~Q4四组(以Q1组为参照组),采用条件logistic回归分析血浆铀浓度与肝损伤之间的关联。

    结果

    病例组血浆铀浓度MP25P75)为10.89(6.78,18.53)ng·L−1,高于对照组的9.26(5.01,14.38)ng·L−1P<0.001)。Spearman相关分析结果表明,丙氨酸转氨酶和天冬氨酸转氨酶与血浆铀浓度呈正相关关系(rs=0.138,rs=0.167;P<0.001)。限制性立方样条模型显示随着血浆铀浓度的升高,肝损伤的发生风险也逐渐增大(总体效应P<0.001)。在调整了性别、年龄、吸烟情况、饮酒情况、高血压和高血脂患病情况等混杂因素后,条件logistic回归分析结果显示,血浆铀暴露水平Q2组、Q3组发生肝损伤的风险分别为Q1组的2.043倍(95%CI:1.135~3.680倍)和2.246倍(95%CI:1.238~4.075倍),Q4组发生肝损伤的风险为Q1组的3.536倍(95%CI:1.955~6.397倍)。

    结论

    血浆铀暴露与肝损伤有关联。该研究率先为铀内暴露和肝损伤可能存在的联系提供了一些人群层面的证据。

     

    Abstract: Background

    Exposure to uranium can result in multi-organ toxicity in humans. Some experimental studies have shown that uranium presents a damaging effect on liver, but no relevant population studies have been reported.

    Objective

    To investigate a potential association of plasma uranium exposure with liver injury.

    Methods

    The inhabitants of two representative areas of heavy metal pollution in northern and southern Hunan were selected as the research subjects. A total of 740 participants were recruited through 1∶1 paired case-control design based on a pre-determined diagnostic criterion for liver injury (defined as two or more anomalies among alanine aminotransferase, aspartate aminotransferase, and total bilirubin in the health examination) and the principle of case-control comparability. Information such as general demographic characteristics and medical history were collected through questionnaires and physical examination. Plasma uranium and liver function were determined by laboratory tests. Spearman correlation was applied to assess the association between plasma uranium concentration and liver injury indexes, and restricted cubic spline model was used to evaluate the dose-response relationship between plasma uranium concentration and liver injury. The participants were divided into four groups from Q1 to Q4 according to the quartile values of plasma uranium concentration of the control group after natural logarithmic transformation (with the Q1 group as the reference group), and the association between plasma uranium concentration and liver injury was evaluated by conditional logistic regression.

    Results

    The plasma uranium level in M (P25, P75) of the case group was 10.89 (6.78-18.53) ng·L−1, higher than that in the control group, 9.26 (5.01-14.38) ng·L−1 (P<0.001). The results of Spearman correlation analysis showed that alanine aminotransferase and aspartate aminotransferase were positively correlated with plasma uranium level (rs=0.138, rs=0.167; P<0.001). The restricted cubic spline model showed that the risk of liver injury increased with the increase of plasma uranium concentration (overall effect P<0.001). After adjusting for confounding factors such as gender, age, smoking, alcohol consumption, and prevalence of hypertension and hyperlipidemia, the results of conditional logistic regression analysis showed that the risks of liver injury in the Q2 group, the Q3 group, and the Q4 group were 2.043 (95%CI: 1.135-3.680), 2.246 (95%CI: 1.238-4.075), and 3.536 (95%CI: 1.955-6.397) times higher than that of the Q1 group respectively.

    Conclusion

    Plasma uranium exposure is associated with liver injury. This study is the first to provide population-level evidence of such an association.

     

/

返回文章
返回