铝暴露对作业工人执行和视空间认知功能的影响
Impact of aluminum exposure on executive and visuospatial cognitive functions of workers
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摘要:
目的 探讨铝暴露对作业工人执行和视空间认知功能的影响及轻度认知功能障碍可能的影响因素。
方法 选取山西省某大型铝厂838名作业工人，采用电感耦合等离子体质谱法测量其血浆中铝质量浓度作为内暴露指标，并根据其中位数（M）值将研究对象分为低铝暴露组和高铝暴露组。采用画钟试验评价其执行和视空间认知功能，筛查在执行和视空间认知功能方面产生损害的轻度认知功能障碍可能者。采用非条件logistic回归分析血浆铝暴露水平与执行和视空间认知功能损害的关系及轻度认知功能障碍可能的影响因素。
结果 研究对象的血浆铝M（P25，P75）为15.22（8.26，27.02）μg/L，执行和视空间障碍的检出率为31.0%。低铝暴露组画钟试验总分（3.00±0.91）高于高铝暴露组（2.78±1.00）（P=0.001）。高铝暴露（相对于低铝暴露）（OR=1.779，P=0.001）、电解铝作业工龄超过1年（相对于不足1年）（OR=2.012，P < 0.001）、吸烟（OR=1.489，P=0.018）、高中文化水平（相对于初中及以下文化水平）（OR=0.689，P=0.034）、大专及以上文化水平（相对于初中及以下文化水平）（OR=0.339，P=0.001）与发生轻度认知功能障碍的风险相关。
结论 铝暴露可能引起作业工人执行和视空间认知功能损害。高铝暴露、作业工龄超过1年、吸烟可能是轻度认知功能障碍的危险因素，而受教育水平高可能是其保护因素。
Abstract:Objective To evaluate the impact of aluminum exposure on executive and visuospatial cognitive functions of workers and the influencing factors of potential mild cognitive impairment.
Methods A total of 838 workers selected from a large aluminum factory in Shanxi Province were measured for plasma aluminum mass concentration as an internal exposure indicator by inductively coupled plasma-mass spectrometry, and then divided into low and high aluminum exposure groups by the median (M) of plasma aluminum level. The subjects were asked to execute clock-drawing test (CDT) to evaluate their executive and visuospatial cognitive functions and to screen patients with potential mild cognitive impairment in executive and visuospatial functions. Non-conditional logistic regression analysis was used to explore the relationship between plasma aluminum level and executive and visuospatial cognitive impairment and the influencing factors of potential mild cognitive impairment.
Results The average M (P25, P75) of plasma aluminum of the subjects was 15.22 (8.26, 27.02) μg/L, and the positive rate of cognitive impairment in executive and visuospatial functions was 31.0%. The total score of clock-drawing test in the low aluminum exposure group (3.00±0.91) was higher than that in the high aluminum exposure group (2.78±1.00) (P=0.001). High aluminum exposure (versus low aluminum exposure) (OR=1.779, P=0.001), more than one year of electrolytic aluminum related working age (versus less than one year) (OR=2.012, P < 0.001), smoking (OR=1.489, P=0.018), high school education (versus middle school education and below) (OR=0.689, P=0.034), and college education (versus middle school education and below) (OR=0.339, P=0.001) were associated with mild cognitive impairment.
Conclusion Aluminum exposure may cause cognitive impairment in executive and visuospatial functions. High aluminum exposure, more than one year of related working age, and smoking may be risk factors, but high education level may be a protective factor of mild cognitive impairment.
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