Haswell-Elkins Melissa, Satarug Soisungwan, O'Rourke Peter, Moore Michael, Ng Jack, McGrath Victor, Walmby Maria
North Queensland Health Equalities Promotion Unit, School of Medicine, University of Queensland, Cairns, Qld 4870, Australia.
Environ Res. 2008 Mar;106(3):379-83. doi: 10.1016/j.envres.2007.10.004. Epub 2007 Nov 28.
Indigenous people of the Torres Strait (Australia) have greater potential for cadmium exposure and renal damage than other Australians due to high cadmium in some traditional seafood and a high prevalence of Type 2 diabetes, hypertension, smoking, and obesity. This study explored associations between albuminuria and an index of cadmium exposure (urinary cadmium excretion) in the presence and absence of Type 2 diabetes.
Two population-based, cross-sectional studies were undertaken in the Torres Strait to obtain data on body mass index (BMI), blood pressure, chronic disease, smoking, urinary cadmium, and albumin creatinine ratio (ACR).
Age- and BMI-adjusted urinary cadmium levels were significantly higher (p<0.01) among people with diabetes and albuminuria (n=22, geometric mean (GM) 1.91 microg Cd/g creatinine) compared to those with diabetes and normal ACR (n=21, GM 0.74 microg Cd/g creatinine). Urinary cadmium was also strongly associated (p<0.001) with ACR among people with diabetes in regression models and remained significant after controlling for age, sex, BMI, smoking status, and hypertension (or continuous systolic and diastolic measurements).
While the study has methodological limitations and the nature of the association is unclear, the striking dose-dependent links between markers of cadmium exposure and of Type 2 diabetic nephropathy highlight the need for further definitive research on the health effects of cadmium in the presence of diabetes.
由于某些传统海产品中镉含量高以及2型糖尿病、高血压、吸烟和肥胖的高患病率，托雷斯海峡（澳大利亚）的原住民比其他澳大利亚人有更大的镉暴露和肾脏损害风险。本研究探讨了在有和没有2型糖尿病的情况下蛋白尿与镉暴露指数（尿镉排泄）之间的关联。
在托雷斯海峡进行了两项基于人群的横断面研究，以获取关于体重指数（BMI）、血压、慢性病、吸烟、尿镉和白蛋白肌酐比值（ACR）的数据。
与患有糖尿病且ACR正常的人群（n = 21，几何均值（GM）0.74微克镉/克肌酐）相比，患有糖尿病和蛋白尿的人群（n = 22，GM 1.91微克镉/克肌酐）经年龄和BMI调整后的尿镉水平显著更高（p<0.01）。在回归模型中，尿镉与糖尿病患者的ACR也密切相关（p<0.001），在控制年龄、性别、BMI、吸烟状况和高血压（或连续的收缩压和舒张压测量值）后仍具有显著性。
虽然该研究存在方法学局限性且关联性质尚不清楚，但镉暴露标志物与2型糖尿病肾病标志物之间显著的剂量依赖性联系突出表明，需要对糖尿病存在情况下镉对健康的影响进行进一步的确切研究。
