砷代谢与癌症、心血管疾病和糖尿病的关联：流行病学证据的系统综述

The Association of Arsenic Metabolism with Cancer, Cardiovascular Disease, and Diabetes: A Systematic Review of the Epidemiological Evidence.

作者信息

Kuo Chin-Chi, Moon Katherine A, Wang Shu-Li, Silbergeld Ellen, Navas-Acien Ana

机构信息

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA.

Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA.

出版信息

Environ Health Perspect. 2017 Aug 1;125(8):087001. doi: 10.1289/EHP577.

DOI:10.1289/EHP577

PMID:28796632

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5880251/

Abstract

BACKGROUND

The available evidence on the role of arsenic metabolism in individual susceptibility to the development of cancer, cardiovascular disease, and diabetes has not been formally and comprehensively reviewed.

OBJECTIVES

Our goal was to systematically investigate the association of arsenic metabolism with cancer, cardiovascular disease, and diabetes-related outcomes in epidemiologic studies. As a secondary objective, we characterized the variation of arsenic metabolism in different populations worldwide.

METHODS

We searched Medline/PubMed and EMBASE from inception to January 2016 and applied predetermined exclusion criteria. Compositional data analysis was used to describe the distribution of arsenic metabolism biomarkers and evaluate the association between arsenic exposure and metabolism.

RESULTS

Twenty-eight studies met the inclusion criteria, 12 on cancer, nine on cardiovascular disease, and seven on diabetes-related outcomes. The median (interquartile range) for mean iAs%, MMA%, and DMA% was 11.2 (7.8-14.9)%, 13.0 (10.4-13.6)%, and 74.9 (69.8-80.0)%, respectively. Findings across studies suggested that higher arsenic exposure levels were associated with higher iAs% and lower DMA% and not associated with MMA%. For cancer, most studies found a pattern of higher MMA% and lower DMA% associated with higher risk of all-site, urothelial, lung, and skin cancers. For cardiovascular disease, higher MMA% was generally associated with higher risk of carotid atherosclerosis and clinical cardiovascular disease but not with hypertension. For diabetes-related outcomes, the pattern of lower MMA% and higher DMA% was associated with higher risk of metabolic syndrome and diabetes.

CONCLUSIONS

Population level of iAs% and DMA%, but not MMA%, were associated with arsenic exposure levels. Overall, study findings suggest that higher MMA% was associated with an increased risk of cancer and cardiovascular disease, while lower MMA% was associated with an increased risk of diabetes and metabolic syndrome. Additional population-based studies and experimental studies are needed to further evaluate and understand the role of arsenic exposure in arsenic metabolism and the role of arsenic metabolism in disease development. https://doi.org/10.1289/EHP577.

摘要

背景

关于砷代谢在个体患癌、心血管疾病和糖尿病易感性中作用的现有证据尚未得到正式且全面的综述。

目的

我们的目标是在流行病学研究中系统地调查砷代谢与癌症、心血管疾病及糖尿病相关结局之间的关联。作为次要目标，我们描述了全球不同人群中砷代谢的差异。

方法

我们检索了从创刊至2016年1月的Medline/PubMed和EMBASE数据库，并应用了预先设定的排除标准。采用成分数据分析来描述砷代谢生物标志物的分布，并评估砷暴露与代谢之间的关联。

结果

28项研究符合纳入标准，其中12项关于癌症，9项关于心血管疾病，7项关于糖尿病相关结局。平均无机砷（iAs）%、一甲基砷（MMA）%和二甲基砷（DMA）%的中位数（四分位间距）分别为11.2（7.8 - 14.9）%、13.0（10.4 - 13.6）%和74.9（69.8 - 80.0）%。各项研究结果表明，较高的砷暴露水平与较高的iAs%和较低的DMA%相关，与MMA%无关。对于癌症，大多数研究发现MMA%较高而DMA%较低的模式与所有部位、尿路上皮、肺和皮肤癌的较高风险相关。对于心血管疾病，较高的MMA%通常与颈动脉粥样硬化和临床心血管疾病的较高风险相关，但与高血压无关。对于糖尿病相关结局，MMA%较低而DMA%较高的模式与代谢综合征和糖尿病的较高风险相关。

结论

人群中的iAs%和DMA%水平（而非MMA%）与砷暴露水平相关。总体而言，研究结果表明较高的MMA%与癌症和心血管疾病风险增加相关，而较低的MMA%与糖尿病和代谢综合征风险增加相关。需要更多基于人群的研究和实验研究来进一步评估和理解砷暴露在砷代谢中的作用以及砷代谢在疾病发展中的作用。https://doi.org/10.1289/EHP577