铝氟的交互作用对铝厂作业工人总体认知功能的影响

何璐阳; 张靖琦; 李娟; 李百春; 孙宇涵; 弓宇娟; 路小婷; 宋静; 牛侨; 王林平

doi:10.11836/JEOM22503

铝氟的交互作用对铝厂作业工人总体认知功能的影响

Effect of aluminum-fluoride interactions on overall cognitive function of aluminum plant workers

摘要

摘要:
背景铝、氟具有神经毒性，单独铝暴露与作业工人的总体认知功能密切相关，关于铝、氟交互作用对认知功能的影响目前尚不清楚。
目的探讨血铝和尿氟的交互作用对铝厂作业工人总体认知功能的影响。
方法采用整群抽样方法，选取山西省某市铝业集团公司电解车间230名作业工人为调查对象，采用电感耦合等离子体质谱法（ICP-MS）测定血浆铝含量，采用离子选择电极法测定尿氟。将研究对象血铝浓度根据中位数（M）分为低血铝组和高血铝组，尿氟浓度根据临床有关标准限值（0.272~2.160 mg·L⁻¹）以2.160 mg·L⁻¹为界分为低尿氟组和高尿氟组。采用《蒙特利尔认知评估量表北京版》（MoCA-BJ）评估工人总体认知功能。采用logistic回归模型分析血铝、尿氟与轻度认知功能障碍（MCI）之间的关系，包括相乘交互作用分析和关联性分析；采用R语言拟合血铝、尿氟对MCI的相加交互作用模型并计算交互作用指数（S）、交互作用超额相对危险度（RERI）和交互作用归因比（API）等交互作用指标。
结果 230名作业工人中，血铝浓度中位数（P₂₅，P₇₅）为40.11（25.16，58.89）µg·L⁻¹，尿氟异常者104例，异常率45.2%。血铝和尿氟的交互作用对铝厂作业工人总体认知功能的影响存在相乘交互作用（OR=7.783，95%CI：1.377~43.991），不存在相加交互作用（RERI=0.030，95%CI：−0.498~0.559；API=0.018，95%CI：−0.279~0.316；S=1.049，95%CI：0.519~2.118）。多因素logistic回归分析结果显示，在调整不同影响因素后，既有高血铝又有高尿氟人群患MCI的风险是低血铝低尿氟人群的12.105（95%CI：2.802~52.287）倍。
结论职业性高浓度血铝和高浓度尿氟是认知功能障碍的危险因素，两者同时存在会增加作业工人MCI的发生风险，存在相乘交互作用。

Abstract:
Background Aluminum and fluoride are neurotoxic, and aluminum exposure alone is closely related to the overall cognitive function of operational workers. It is unclear about the effect of aluminum and fluoride interactions on cognitive function.
Objective To evaluate a potential interaction effect of blood aluminum and urinary fluoride on the overall cognitive function of workers working in an aluminum plant.
Methods Using cluster sampling, 230 workers in the electrolysis workshop of an aluminum group company in Shanxi Province were selected, and plasma aluminum concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) and urinary fluoride by ion-selective electrode. The study participants were divided into a low blood aluminum group and a high blood aluminum group according to the median (M) of blood aluminum concentration, and a low urinary fluoride group and a high urinary fluoride group by a predetermined cutoff point (2.160 mg·L⁻¹). The Montreal Cognitive Assessment-Beijing (MoCA-BJ) was used to assess overall cognitive function of the workers. Logistic regression model was used to analyze the relationship between blood aluminum, urinary fluoride, and mild cognitive impairment (MCI), including multiplicative interaction analysis and correlation analysis; R language was used to fit an additive interaction model of blood aluminum and urinary fluoride on MCI and to calculate synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (API).
Results Among the 230 operational workers, the median blood aluminum concentration (P₂₅, P₇₅) was 40.11 (25.16, 58.89) µg·L⁻¹, and there were 104 cases of abnormal urinary fluoride, with an abnormality rate of 45.2%. There was a multiplicative interaction (OR=7.783, 95%CI: 1.377, 43.991) and no additive interaction (RERI=0.030, 95%CI: −0.498, 0.559; API=0.018, 95%CI: −0.279, 0.316; S=1.049, 95%CI: 0.519, 2.118) for the effect between blood aluminum and urinary fluoride on overall cognitive function of the workers. The logistic regression analysis showed that the risk of MCI was 12.105 (95%CI: 2.802, 52.287) times higher in workers with both high blood aluminum and high urinary fluoride than in those with low blood aluminum and low urinary fluoride, after adjusting for selected influencing factors.
Conclusion Occupational exposure related high blood aluminum and high urinary fluoride are risk factors for cognitive dysfunction, and the coexistence of both indicators increases the risk of MCI in workers with occupational aluminum exposure, with a multiplicative interaction.

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