Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China; Department of Nephrology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai 200032, China.
Institute of Radiation Medicine, Fudan University, 2094 Xietu Road, Shanghai 200032, China.
Ecotoxicol Environ Saf. 2019 May 30;173:429-435. doi: 10.1016/j.ecoenv.2019.01.121. Epub 2019 Feb 21.
Both cadmium (Cd) and lead (Pb) exposure can induce kidney damage. However, the effects of combined exposure to Cd and Pb on renal function at environmental levels have not been fully clarified. In this study we investigated the renal function in a Chinese population co-exposed to Cd and Pb. A total of 331 subjects (215 women and 116 men), living in either a control or a polluted area, were included in this study. Cd and Pb in blood and urine (BCd, BPb, UCd, and UPb), and kidney effect markers including urinary N-acetyl-β-D-glucosaminidase (UNAG) and estimated glomerular filtration rate (eGFR), were determined, and the association between exposure markers and renal effect biomarkers were analyzed. The exposure levels in the polluted area were significantly higher than in the control area (all p < 0.01). The eGFR of subjects in the polluted area was decreased compared with that in the control area (p < 0.01). The subjects with high BCd/BPb (BCd ≥ 2 μg/L, BPb ≥ 100 μg/L) or high UCd/UPb (UCd ≥ 3 μg/g creatinine, UPb ≥ 10 μg/g creatinine) showed higher UNAG and UALB levels compared with other subgroups (p < 0.01). The probability of having elevated UNAG in subjects with high BCd/BPb was greater than those with low BCd/BPb [odds ratio (OR) = 2.6, 95% confidence interval (CI): 1.4-4.7), low BCd/high BPb (OR =3.1, 95% CI: 1.4-6.6), and high BCd/low BPb (OR = 1.7, 95% CI: 0.9-3.2). The OR of subjects with low UCd and high UPb, high UCd and low UPb, and high UCd/UPb were 2.9 (95% CI: 1.4-5.7), 3.3 (95% CI: 1.5-7.2), and 7.7 (95% CI: 4.0-14.7), respectively, compared with those with low UCd/UPb. The risk of decrease in eGFR was also higher in subjects with high UCd/UPb than for those with low UCd/UPb (OR = 7.2, 95% CI: 0.8-62.2). Our data demonstrate that Cd and Pb exposure, alone or in combination, are associated with renal impairment. In addition, co-exposure to Pb and Cd propagates the renal tubular dysfunction compared with Cd or Pb exposure alone.
镉（Cd）和铅（Pb）暴露均可导致肾脏损伤。然而，环境水平下 Cd 和 Pb 联合暴露对肾功能的影响尚未完全阐明。本研究旨在调查中国人群中 Cd 和 Pb 联合暴露对肾功能的影响。
共纳入 331 名受试者（215 名女性和 116 名男性），分别居住在对照区和污染区。检测血和尿中的 Cd 和 Pb（BCd、BPb、UCd 和 UPb）以及肾效应标志物，包括尿 N-乙酰-β-D-氨基葡萄糖苷酶（UNAG）和估算肾小球滤过率（eGFR），并分析暴露标志物与肾效应生物标志物之间的关系。
污染区的暴露水平明显高于对照区（均 P < 0.01）。与对照区相比，污染区受试者的 eGFR 降低（P < 0.01）。与其他亚组相比，BCd/BPb 较高（BCd ≥ 2μg/L，BPb ≥ 100μg/L）或 UCd/UPb 较高（UCd ≥ 3μg/g 肌酐，UPb ≥ 10μg/g 肌酐）的受试者 UNAG 和 UALB 水平更高（P < 0.01）。与低 BCd/BPb 相比，高 BCd/BPb（OR = 2.6，95%置信区间（CI）：1.4-4.7）、低 BCd/高 BPb（OR = 3.1，95% CI：1.4-6.6）和高 BCd/低 BPb（OR = 1.7，95% CI：0.9-3.2）的受试者发生 UNAG 升高的可能性更大。与低 UCd/UPb 相比，低 UCd 和高 UPb、高 UCd 和低 UPb 以及高 UCd/UPb 的受试者 OR 分别为 2.9（95% CI：1.4-5.7）、3.3（95% CI：1.5-7.2）和 7.7（95% CI：4.0-14.7）。高 UCd/UPb 的受试者 eGFR 下降的风险也高于低 UCd/UPb（OR = 7.2，95% CI：0.8-62.2）。
本研究数据表明，Cd 和 Pb 单独或联合暴露与肾损伤有关。此外，与单独 Cd 或 Pb 暴露相比，Pb 和 Cd 的联合暴露会加重肾小管功能障碍。
