美国成年人的环境镉和铅暴露与年龄相关性黄斑变性：2005 年至 2008 年全国健康和营养调查。
Environmental cadmium and lead exposures and age-related macular degeneration in U.S. adults: the National Health and Nutrition Examination Survey 2005 to 2008.
机构信息
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Division of Preventive Medicine, Brigham & Women׳s Hospital, Harvard Medical School and Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Center for Translational Medicine, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
出版信息
Environ Res. 2014 Aug;133:178-84. doi: 10.1016/j.envres.2014.05.023. Epub 2014 Jun 21.
Age-related macular degeneration (AMD) is a complex disease resulting from the interplay of genetic predisposition and environmental exposures, and has been linked to oxidative stress and inflammatory mechanisms. Lead and cadmium can accumulate in human retinal tissues and may damage the retina through oxidative stress, and may thereby play a role in the development of AMD. We examined associations between blood lead, blood cadmium, and urinary cadmium concentrations and the presence of AMD in 5390 participants aged 40 years and older with blood lead and blood cadmium measures and a subsample of 1548 with urinary cadmium measures in the 2005-2008 National Health and Nutrition Examination Surveys. AMD was identified by grading retinal photographs with a modification of the Wisconsin Age-Related Maculopathy Grading System. The weighted prevalence of AMD was 6.6% (n=426). Controlling for age, gender, race/ethnicity, education and body mass index, adults in the highest blood cadmium quartile had higher odds of AMD compared to the lowest quartile (odds ratio [OR], 1.56; 95% CI, 1.02-2.40), with a significant trend across quartiles (p-trend=0.02). After further adjustment for pack-years of cigarette smoking, estimates were somewhat attenuated (OR, 1.43; 95% CI, 0.91-2.27; p-trend=0.08). Similar associations were found with urinary cadmium. The association between urinary cadmium and AMD was stronger in non-Hispanic whites (NHW) than in non-Hispanic blacks (NHB) (OR, 3.31; 95% CI, 1.37-8.01 for levels above versus below the median among NHW; OR,1.45; 95% CI, 0.40-5.32 for levels above versus below the median among NHB; p-interaction=0.03). We found no association between blood lead levels and AMD. Higher cadmium body burden may increase risk of AMD, particularly among non-Hispanic white individuals; however, additional studies are needed before firm conclusions can be drawn.
年龄相关性黄斑变性（AMD）是一种复杂的疾病，由遗传易感性和环境暴露相互作用引起，与氧化应激和炎症机制有关。铅和镉可以在人视网膜组织中积累，并通过氧化应激损害视网膜，从而可能在 AMD 的发展中发挥作用。我们在 2005-2008 年全国健康和营养调查中，对 5390 名年龄在 40 岁及以上的参与者进行了血液铅和血液镉测量，并对其中 1548 名参与者进行了尿液镉测量，检查了血液铅、血液镉和尿液镉浓度与 AMD 之间的关系。AMD 通过威斯康星年龄相关性黄斑变性分级系统的修改来确定视网膜照片的分级。AMD 的加权患病率为 6.6%（n=426）。在控制年龄、性别、种族/民族、教育程度和体重指数后，与最低四分位数相比，血液镉四分位最高的成年人 AMD 的几率更高（比值比[OR]，1.56；95%可信区间[CI]，1.02-2.40），四分位数间呈显著趋势（趋势检验 p=0.02）。进一步调整吸烟包年数后，估计值略有减弱（OR，1.43；95%CI，0.91-2.27；趋势检验 p=0.08）。尿液镉也存在类似的相关性。尿液镉与 AMD 的关系在非西班牙裔白种人（NHW）中强于非西班牙裔黑人（NHB）（OR，3.31；95%CI，1.37-8.01，在 NHW 中，高于中位数与低于中位数者相比；OR，1.45；95%CI，0.40-5.32，在 NHB 中，高于中位数与低于中位数者相比；交互作用检验 p=0.03）。我们没有发现血液铅水平与 AMD 之间的关联。更高的镉体负荷可能会增加 AMD 的风险，尤其是在非西班牙裔白种人当中；然而，在得出确定的结论之前，还需要开展更多的研究。
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