慢性低水平镉暴露与血管内皮功能损害的关系研究

发布时间：2018-06-16 19:36

本文选题：尿镉 + 心血管疾病　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:了解一般人群慢性镉(Cadmium,Cd)暴露和血管内皮功能的现状及其影响因素,同时通过分析尿镉(Urine cadmium,UCd)浓度和血管内皮功能损害发生风险的关系,为评价慢性低浓度Cd暴露对一般人群血管内皮功能的影响提供流行病学证据。方法:本课题以广西某铅锌废弃矿区周边区域及相邻乡镇非污染区域为研究现场,招募当地成年居民作为本课题的研究对象。采用现况研究设计,以问卷调查的形式收集研究对象的一般社会人口学资料、吸烟史、饮酒史、现患疾病和近期药物使用情况等;现场测量研究对象的身高、体重、血压和肱动脉血流介导的血管舒张功能(Flow-mediated dilatation,FMD)水平;收集研究对象的血液标本和尿液标本,测定血清葡萄糖、血清总胆固醇、血清甘油三酯、血清高密度脂蛋白胆固醇、血清低密度脂蛋白胆固醇、血清C反应蛋白、血清肌酐和UCd、尿肌酐含量。本研究统计分析均按性别分层:首先,对研究对象在不同特征层面的UCd浓度和FMD水平进行统计描述。第二,应用简单线性回归和多重线性回归分析分别探索UCd浓度的关联因素和FMD水平的关联因素。第三,运用多因素Logistic回归模型分析UCd浓度和血管内皮功能损害(FMD7%)的线性剂量-反应关系。第四,运用限制性二次样条模型探讨UCd浓度和血管内皮功能损害的非线性剂量-反应关系。最后,分析UCd浓度与年龄、民族、高血压等特征变量对血管内皮功能损害发生风险的交互作用。结果:1、本研究共702名研究对象,平均年龄为54.4±0.4岁,ucd浓度中位数为1.25μg/g肌酐[四分位数间距(interquartilerange,iqr):3.50μg/g肌酐],fmd水平中位数为8.5%(iqr:5.1%)。其中男性241例,ucd浓度中位数为1.04μg/g肌酐(iqr:3.07μg/g肌酐),fmd水平中位数为7.4%(iqr:4.2%),血管内皮功能损害的占45.2%;女性461例,ucd浓度中位数为1.38μg/g肌酐(iqr:3.96μg/g肌酐),fmd水平中位数为9.3%(iqr:5.2%),血管内皮功能损害的占26.7%。2、多重线性回归分析显示:对于ucd浓度,在男性中的关联因素为民族、年龄、吸烟状态、高密度脂蛋白胆固醇水平;而在女性中的关联因素为民族、年龄。对于fmd水平,在男性中的关联因素为肱动脉基础径、年龄、体质指数、总胆固醇水平;在女性中的关联因素为肱动脉基础径、绝经状态、民族。3、ucd浓度与血管内皮功能损害的线性剂量-反应关系研究结果显示:在全混杂因素调整模型中,男性ucd浓度最高等分与最低等分相比,血管内皮功能损害的发生风险比值比(oddsratio,or)为2.65[95%可信区间(confidenceinterval,ci):1.08,6.52]。女性ucd浓度最高等分与最低等分相比,血管内皮功能损害的发生风险or=0.53(95%ci:0.28,1.00)。在男性和女性中,ucd浓度和血管内皮功能损害线性剂量-反应关系均无统计学意义(线性趋势检验p0.05)。4、ucd浓度与血管内皮功能损害的非线性剂量-反应关系研究结果显示:调整了一般社会人口学资料、心血管疾病危险因素等混杂因素后,男性血管内皮功能损害发生风险在整个ucd浓度范围内呈现总体上升趋势,在ucd低浓度范围内,血管内皮功能损害的发生风险随着ucd浓度的升高呈上升趋势。女性血管内皮功能损害发生风险在整个ucd浓度范围内呈现总体下降趋势,在ucd低浓度范围内,血管内皮功能损害的发生风险随ucd浓度的升高呈下降趋势,随后曲线有所回升。5、交互作用的分析结果显示:无论在男性还是女性群体中,年龄、民族、吸烟(男性)、绝经状态(女性)、高血压、脂质紊乱、血糖、体质指数、C反应蛋白和UCd浓度之间对血管内皮功能损害发生风险的交互作用均无统计学意义(P0.05)。结论:1、本研究男性、女性群体的慢性Cd暴露整体均处于低水平现状,男性、女性中分别有45.2%、26.7%的群体存在血管内皮功能损害。2、UCd浓度在男性和女性中均与年龄和民族有关。此外,吸烟是男性UCd浓度的重要影响因素。男性和女性FMD水平的共同影响因素为肱动脉基础径。此外,绝经是女性FMD水平降低的一个重要危险因素。3、低浓度Cd暴露和血管内皮功能损害未呈现显著的线性剂量-反应关系,但在低水平范围内可使男性血管内皮功能损害的发生风险上升,而在女性中,慢性Cd暴露水平的增加仍无此效应。非线性剂量-反应关系曲线进一步说明了慢性Cd暴露对血管内皮功能损害存在性别差异。4、本研究无论在男性还是女性群体中均未发现特征变量与UCd浓度之间对血管内皮功能损害发生风险存在交互作用。
[Abstract]:Objective: to understand the current status and influencing factors of chronic cadmium (Cadmium, Cd) exposure and vascular endothelial function in general population, and to provide epidemiological evidence for evaluating the effect of chronic low concentration Cd exposure on the vascular endothelial function of a population by analyzing the relationship between urinary cadmium (Urine cadmium, UCd) concentration and the risk of vascular endothelial dysfunction. Methods: this subject took the surrounding area of a lead-zinc mining area in Guangxi and the non polluted areas of neighboring villages and towns as the research site, and recruited adult residents as the subject of this study. The current situation was designed to collect the general sociodemographic data of the subjects, smoking history, drinking history, diseases and recent years. Drug use, etc.; measurement of the height, weight, blood pressure and Flow-mediated dilatation, FMD level of the brachial artery blood flow, blood samples and urine specimens of the subjects, the serum glucose, serum total cholesterol, serum triglycerides, serum high density lipoprotein cholesterol, and blood were measured. Low density lipoprotein cholesterol (LDL), serum C reactive protein, serum creatinine and UCd, and urinary creatinine content. The statistical analysis of this study was based on gender stratification. First, the UCd concentration and FMD level of the subjects were described at different characteristics. Second, a simple linear regression and multiple linear regression analysis were used to explore the correlation of UCd concentration. Association factors and association factors of FMD level. Third, the linear dose response relationship of UCd concentration and vascular endothelial dysfunction (FMD7%) was analyzed by multiple factor Logistic regression model. Fourth, the non linear dose response relationship between UCd concentration and vascular endothelial dysfunction was investigated by the restrictive two spline model. Finally, the concentration and year of UCd were analyzed. The interaction of age, age, national, hypertension and other characteristic variables on vascular endothelial dysfunction. Results: 1, the average age of 702 subjects was 54.4 + 0.4 years, the median of UCD concentration was 1.25 mu g/g creatinine (interquartilerange, IQR), 3.50, g/g creatinine, and the median of FMD was 8.5% (iqr:5.1%). In 241 male cases, the median of UCD concentration was 1.04 mu g/g creatinine (iqr:3.07 mu g/g creatinine), the median of FMD level was 7.4% (iqr:4.2%), the vascular endothelial dysfunction accounted for 45.2%, and the median of the UCD concentration was 1.38 mu g/g creatinine (iqr:3.96 Mu creatinine), the FMD level was 9.3% (iqr:5.2%), the vascular endothelial dysfunction accounted for the multiple lines. The regression analysis showed that for UCD concentration, the association factors among men were ethnic, age, smoking, and HDL cholesterol levels, and the factors associated with women were ethnic, age. And for the FMD level, the association factors in men were the brachial artery base, age, body mass index, total cholesterol level, and the level of total cholesterol in women; The results of a linear dose response study of brachial artery base diameter, menopause, national.3, UCD concentration and vascular endothelial dysfunction showed that the risk ratio Ratio of vascular endothelial dysfunction (oddsratio, or) was 2.65[95% credible in the full confounding factor adjustment model compared with the lowest bisection in the male UCD concentration adjustment model. Interval (confidenceinterval, CI): the risk of vascular endothelial dysfunction was or=0.53 (95%ci:0.28,1.00) at the highest concentration of UCD in 1.08,6.52]. women compared with the lowest level. In both male and female, the linear dose response relationship between UCD concentration and vascular endothelial dysfunction was not statistically significant (linear trend test P0.05).4, UCD concentration and The results of a nonlinear dose response study of vascular endothelial dysfunction showed that the risk of vascular endothelial dysfunction in men showed an overall upward trend in the UCD concentration range after adjusting the general social demographic data and the risk factors for cardiovascular disease, and the vascular endothelial dysfunction within the UCD low concentration range. The risk of injury occurred with the increase of UCD concentration. The risk of vascular endothelial dysfunction in women showed a general decline in the whole UCD concentration range. The risk of vascular endothelial dysfunction decreased with the increase of UCD concentration in the low concentration range of UCD, and then the curve rebounded.5, and the interaction was divided. The results showed that the interaction between age, nationality, smoking (male), menopause (male), menopause (female), hypertension, lipid disorder, blood glucose, body mass index, C reactive protein and UCd concentration had no statistical significance on the risk of vascular endothelial dysfunction (P0.05). Conclusion: 1, this study was the male and female group. Chronic Cd exposure was at a low level as a whole, and 45.2% of men and 26.7% of women had vascular endothelial dysfunction in.2. UCd concentration was associated with age and nationality in both male and female. In addition, smoking was an important factor in male UCd concentration. The common influence factors of male and female FMD levels were the brachial artery base. In addition, menopause is an important risk factor for the decrease of FMD level in women,.3, the low concentration of Cd exposure and vascular endothelial dysfunction do not show a significant linear dose response relationship, but the risk of vascular endothelial dysfunction can be increased in a low level, but the increase of chronic Cd exposure is still not the case in women. Effect. The nonlinear dose response curve further illustrates that there is a gender difference in vascular endothelial dysfunction in chronic Cd exposure. This study has not found that there is an interaction between the risk of vascular endothelial dysfunction and the risk of vascular endothelial dysfunction in both male and female groups, both in male and female groups.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R114

【参考文献】