镉污染区居民尿镉与死亡率的关系：日本一项为期 22 年的随访研究。

Relationship between urinary cadmium and mortality in habitants of a cadmium-polluted area: a 22-year follow-up study in Japan.

机构信息

National Office of Cancer Prevention and Control, Cancer Institute & Hospital, Cancer Institute, Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Chin Med J (Engl). 2011 Nov;124(21):3504-9.

PMID:22340168

Abstract

BACKGROUND

Several studies have suggested that the exposure to cadmium (Cd) increased mortalities from renal diseases, cardiovascular diseases and malignant neoplasm, including lung cancer and prostate cancer among inhabitants living in Cd-polluted areas and factory workers. This study aimed to assess the influence of environmental exposure to Cd on long term outcome of inhabitants living in an area polluted by Cd.

METHODS

A 22-year follow-up study was conducted with 3119 inhabitants (1403 men and 1716 women) living in the Cd polluted Kakehashi River basin in Japan. The subjects were divided into 4 groups according to the amount of urinary Cd level (< 3.0 µg/g creatinine (Cr), 3.0 - 4.9 µg/g Cr, 5.0 - 9.9 µg/g Cr, and ≥ 10.0 µg/g Cr). Mortality was calculated by the person-years method. Hazards ratios (HR) and 95% confidence intervals (CI) were assessed by the Cox's proportional hazard model.

RESULTS

Compared with urinary Cd < 3.0 µg/g Cr group, the HR of 5.0 - 9.9 µg/g Cr and ≥ 10.0 µg/g Cr groups were significantly increased after adjustment for age in both sexes: 1.24 (95%CI 1.01 - 1.51) and 1.48 (95%CI 1.17 - 1.90) for men; 1.64 (95%CI 1.17 - 2.28) and 1.78 (95%CI 1.27 - 2.50) for women. The most frequent cause of death was malignant neoplasm in men and cardiovascular diseases in women. The significant increase in mortality risk for cardiovascular diseases was observed in the subjects with ≥ 10 µg/g Cr in both sexes: 1.79 for men (95%CI 1.02 - 3.12) and 2.38 for women (95%CI 1.11 - 5.07). When the subjects were divided into 2 categories (< 20 µg/g Cr and ≥ 20 µg/g Cr), the HR of the urinary Cd ≥ 20 µg/g Cr group for nephritis and nephrosis were 4.82 (95%CI 1.07 - 21.61) in men and 7.92 (95%CI 1.77 - 35.33) in women, respectively. The significant increase was not observed for malignant neoplasm.

CONCLUSION

These results suggest a dose-response relationship between Cd body burden and mortality for cardiovascular diseases, cerebrovascular diseases and nephritis and nephrosis.

摘要

背景

多项研究表明，居住在镉污染地区的居民和工厂工人接触镉会增加因肾脏疾病、心血管疾病和恶性肿瘤（包括肺癌和前列腺癌）导致的死亡率。本研究旨在评估环境镉暴露对生活在镉污染地区居民的长期预后的影响。

方法

对日本镉污染的柿桥河流域的 3119 名居民（男性 1403 名，女性 1716 名）进行了为期 22 年的随访研究。根据尿镉水平（<3.0µg/g 肌酐（Cr）、3.0-4.9µg/g Cr、5.0-9.9µg/g Cr 和≥10.0µg/g Cr）将受试者分为 4 组。死亡率通过人年法计算。通过 Cox 比例风险模型评估风险比（HR）和 95%置信区间（CI）。

结果

与尿镉<3.0µg/g Cr 组相比，男性中 5.0-9.9µg/g Cr 和≥10.0µg/g Cr 组在调整年龄后，心血管疾病的 HR 显著增加：1.24（95%CI 1.01-1.51）和 1.48（95%CI 1.17-1.90）；女性中为 1.64（95%CI 1.17-2.28）和 1.78（95%CI 1.27-2.50）。男性中最常见的死因是恶性肿瘤，女性中则是心血管疾病。在两性中≥10µg/g Cr 的受试者中，心血管疾病的死亡率风险显著增加：男性为 1.79（95%CI 1.02-3.12），女性为 2.38（95%CI 1.11-5.07）。当将受试者分为 2 组（<20µg/g Cr 和≥20µg/g Cr）时，男性尿镉≥20µg/g Cr 组的肾炎和肾病综合征的 HR 为 4.82（95%CI 1.07-21.61），女性为 7.92（95%CI 1.77-35.33）。恶性肿瘤未观察到显著增加。