Maruzeni Shoko, Nishijo Muneko, Nakamura Koshi, Morikawa Yuko, Sakurai Masaru, Nakashima Motoko, Kido Teruhiko, Okamoto Rie, Nogawa Kazuhiro, Suwazono Yasushi, Nakagawa Hideaki
Department of Public Health, Kanazawa Medical University, Uchinada 920-0293, Japan.
Environ Health. 2014 Mar 15;13(1):18. doi: 10.1186/1476-069X-13-18.
We aimed to investigate the mortality and causes of deaths of inhabitants with renal dysfunction induced by cadmium (Cd) exposure caused by heavy environmental contamination.
We conducted a 26-year follow-up survey targeting 7529 inhabitants of the Cd-polluted Jinzu River basin and 2149 controls from non-polluted areas who participated in urinary examinations for proteinuria and glucosuria conducted in 1979 to 1984. When the residents were divided into 4 groups, no finding group, glucosuria group, proteinuria group, glucoproteinuria group, mortality risk ratios for all and specific causes of these groups in the polluted area were compared with that of controls without glucosuria and/or proteinuria after adjustments for age at baseline, smoking status, and history of hypertension using Cox's proportional hazard model.
The mortality risk ratios for all causes of proteinuria and glucoproteinuria in men and glucosuria, proteinuria, and glucoproteinuria in women of the polluted areas significantly increased compared with those of the controls with no urinary findings. Respiratory, renal, and cardiovascular diseases and diabetes in men, and all diseases except cerebrovascular diseases in women contributed toward an increased mortality of exposed glucoproteinuria groups, which involved chronic Cd toxicosis with renal tubular dysfunction. In women, the mortality risks for cancer of the colon and rectum, uterus and kidney and urinary tract were significantly higher in the exposed proteinuria and glucoproteinuria groups, suggesting associations between renal damage and cancer risk. In exposed women, the no finding group and glucoproteinuria group also showed increased mortality from ischemic heart diseases, indicating that all exposed women may be at risk for ischemic heart diseases. Although the control glucosuria and/or proteinuria group also showed high mortality for diabetes and renal diseases, the increased risk ratio for renal disease mortality was much higher in exposed subjects with urinary findings, particularly in women.
These findings indicate that inhabitants with renal effects caused by Cd exposure had a poor life prognosis over long-term observation in both genders. Particularly in women, renal tubular dysfunction indicated by glucoproteinuria may increase mortality from cancer, ischemic heart diseases, and renal diseases.
我们旨在调查因严重环境污染导致镉（Cd）暴露引起肾功能障碍的居民的死亡率和死亡原因。
我们对7529名居住在Cd污染的荏原河流域的居民以及2149名来自无污染地区的对照者进行了为期26年的随访调查，这些对照者参与了1979年至1984年进行的蛋白尿和糖尿的尿液检查。当居民被分为4组，即无异常发现组、糖尿组、蛋白尿组、糖蛋白尿组时，使用Cox比例风险模型对基线年龄、吸烟状况和高血压病史进行调整后，将污染地区这些组的全因死亡率和特定病因死亡率风险比与无糖尿和/或蛋白尿的对照组进行比较。
与无尿液异常发现的对照组相比，污染地区男性蛋白尿和糖蛋白尿的全因死亡率风险比以及女性糖尿、蛋白尿和糖蛋白尿的全因死亡率风险比显著增加。男性的呼吸道疾病、肾脏疾病、心血管疾病和糖尿病，以及女性除脑血管疾病外的所有疾病，导致了暴露于糖蛋白尿组的死亡率增加，该组涉及伴有肾小管功能障碍的慢性镉中毒。在女性中，暴露于蛋白尿和糖蛋白尿组的结肠直肠癌、子宫癌、肾癌和尿路癌的死亡率风险显著更高，表明肾脏损害与癌症风险之间存在关联。在暴露的女性中，无异常发现组和糖蛋白尿组的缺血性心脏病死亡率也有所增加，表明所有暴露的女性可能都有患缺血性心脏病的风险。尽管对照的糖尿和/或蛋白尿组的糖尿病和肾脏疾病死亡率也很高，但有尿液异常发现的暴露受试者中肾脏疾病死亡率的增加风险比要高得多，尤其是在女性中。
这些发现表明，长期观察发现，Cd暴露导致肾脏出现问题的居民无论男女，生活预后都较差。特别是在女性中，糖蛋白尿所表明的肾小管功能障碍可能会增加癌症、缺血性心脏病和肾脏疾病的死亡率。
