类风湿关节炎与血清镉浓度的关系：使用韩国国家健康和营养检查调查（KNHANES）数据的横断面研究。
Prevalence of rheumatoid arthritis in relation to serum cadmium concentrations: cross-sectional study using Korean National Health and Nutrition Examination Survey (KNHANES) data.
机构信息
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
出版信息
BMJ Open. 2019 Jan 3;9(1):e023233. doi: 10.1136/bmjopen-2018-023233.
OBJECTIVES
It has been suggested that exposure to heavy metal cadmium (Cd) may contribute to a high risk of developing rheumatoid arthritis (RA). This study was to investigate the association of RA prevalence and serum concentrations of Cd and other heavy metals through large survey data analysis.
DESIGN
A retrospective cross-sectional survey study.
SETTING
Large population survey in Korea.
PARTICIPANTS
53 829 subjects participated in Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2013.
INTERVENTIONS
Heavy metals were measured in different time periods of the survey programme which resulted in three different data sets for analysis: Cd, mercury (Hg) and lead (Pb) from 2008 to 2012 survey; serum manganese (Mn) and urine arsenic (As) from 2008 to 2009 survey; and serum zinc (Zn) from 2010 survey. RA prevalence and its associations with serum heavy metals were analysed using a general linear/logistic regression model of complex sample design.
RESULTS
Serum Cd was elevated in patients with RA (RA vs control: 1.30±0.07 µg/L vs 1.17±0.01 µg/L, p<0.01). There were no significant differences in urine levels of As or serum levels of Pb, Hg, Mn or Zn between patients with RA and controls. OR (95% CI) of RA prevalence according to 1 µg/L increase of serum Cd level was 1.28(95% CI 1.03 to 1.61). Prevalence of RA in women was increased with increasing quartiles of Cd levels, with a 19-fold difference in female RA prevalence between individuals in the lowest quartile of serum Cd level and those in the highest quartile (0.18% vs 3.42%). Cubic spline curve of prevalence OR showed increased risk of RA according to increased serum Cd level. Increased risk of RA in men was not observed with increased serum Cd levels.
CONCLUSION
There was an increased prevalence of RA in females associated with increased serum levels of Cd in the Korean population.
目的
有研究表明，重金属镉（Cd）暴露可能会增加罹患类风湿关节炎（RA）的风险。本研究通过大样本调查数据分析，探讨 RA 患病率与血清 Cd 及其他重金属浓度的相关性。
设计
回顾性横断面调查研究。
地点
韩国全国健康与营养调查（KNHANES）。
参与者
共有 53829 名参与者参加了 2008 年至 2013 年的韩国全国健康与营养调查。
干预措施
重金属的检测在调查项目的不同时间段进行，共产生了 3 组不同的数据进行分析：2008 年至 2012 年调查中 Cd、汞（Hg）和铅（Pb）的数据；2008 年至 2009 年调查中血清锰（Mn）和尿液砷（As）的数据；2010 年调查中血清锌（Zn）的数据。采用复杂样本设计的一般线性/逻辑回归模型分析 RA 患病率及其与血清重金属的关系。
结果
RA 患者血清 Cd 水平升高（RA 组 vs 对照组：1.30±0.07μg/L vs 1.17±0.01μg/L，p<0.01）。RA 患者与对照组的尿液 As 水平或血清 Pb、Hg、Mn 或 Zn 水平无显著差异。血清 Cd 水平每增加 1μg/L，RA 患病率的 OR（95%CI）为 1.28（95%CI 1.03 至 1.61）。女性 RA 患病率随血清 Cd 水平四分位升高而升高，血清 Cd 水平最低四分位与最高四分位女性 RA 患病率差异有统计学意义（0.18% vs 3.42%）。患病率 OR 的立方样条曲线显示，随着血清 Cd 水平的升高，RA 的发病风险增加。未观察到男性 RA 患病率随血清 Cd 水平升高而升高。
结论
在韩国人群中，女性 RA 患病率与血清 Cd 水平升高相关。
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