美国成年人镉暴露与肝功能的关系：一项横断面研究。
Association Between Cadmium Exposure and Liver Function in Adults in the United States: A Cross-sectional Study.
机构信息
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea.
出版信息
J Prev Med Public Health. 2021 Nov;54(6):471-480. doi: 10.3961/jpmph.21.435. Epub 2021 Nov 30.
OBJECTIVES
Cadmium is widely used, leading to extensive environmental and occupational exposure. Unlike other organs, for which the harmful and carcinogenic effects of cadmium have been established, the hepatotoxicity of cadmium remains unclear. Some studies detected correlations between cadmium exposure and hepatotoxicity, but others concluded that they were not associated. Thus, we investigated the relationship between cadmium and liver damage in the general population.
METHODS
In total, 11 838 adult participants from National Health and Nutrition Examination Survey 1999-2015 were included. Urinary cadmium levels and the following liver function parameters were measured: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TB), and alkaline phosphatase (ALP). Linear and logistic regression analyses were performed to assess the associations between urinary cadmium concentrations and each liver function parameter after adjusting for age, sex, race/ethnicity, annual family income, smoking status, alcohol consumption status, physical activity, and body mass index.
RESULTS
The covariate-adjusted results of the linear regression analyses showed significant positive relationships between log-transformed urinary cadmium levels and each log-transformed liver function parameter, where beta±standard error of ALT, AST, GGT, TB, and ALP were 0.049±0.008 (p<0.001), 0.030±0.006 (p<0.001), 0.093±0.011 (p<0.001), 0.034±0.009 (p<0.001), and 0.040±0.005 (p<0.001), respectively. Logistic regression also revealed statistically significant results. The odds ratios (95% confidence intervals) of elevated ALT, AST, GGT, TB, and ALP per unit increase in log-transformed urinary cadmium concentration were 1.360 (1.210 to 1.528), 1.307 (1.149 to 1.486), 1.520 (1.357 to 1.704), 1.201 (1.003 to 1.438), and 1.568 (1.277 to 1.926), respectively.
CONCLUSIONS
Chronic exposure to cadmium showed positive associations with liver damage.
目的
镉的应用广泛，导致其在环境中和职业环境中大量暴露。与其他器官不同，其他器官中镉的有害和致癌作用已得到证实，而镉对肝脏的毒性作用仍不清楚。一些研究检测到镉暴露与肝毒性之间存在相关性，但其他研究则得出两者无关联的结论。因此，我们在普通人群中研究了镉与肝损伤之间的关系。
方法
本研究共纳入了 1999 年至 2015 年全国健康与营养调查（NHANES）中的 11838 名成年参与者。测量了尿镉水平和以下肝功能参数：丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）、总胆红素（TB）和碱性磷酸酶（ALP）。在调整年龄、性别、种族/民族、年家庭收入、吸烟状况、饮酒状况、身体活动和体重指数后，采用线性和逻辑回归分析评估尿镉浓度与每个肝功能参数之间的关系。
结果
调整协变量后的线性回归分析结果显示，log 转换后的尿镉水平与每个 log 转换后的肝功能参数呈显著正相关，其中 ALT、AST、GGT、TB 和 ALP 的β±标准误分别为 0.049±0.008（p<0.001）、0.030±0.006（p<0.001）、0.093±0.011（p<0.001）、0.034±0.009（p<0.001）和 0.040±0.005（p<0.001）。逻辑回归也显示出具有统计学意义的结果。log 转换后尿镉浓度每增加一个单位，ALT、AST、GGT、TB 和 ALP 升高的比值比（95%置信区间）分别为 1.360（1.210 至 1.528）、1.307（1.149 至 1.486）、1.520（1.357 至 1.704）、1.201（1.003 至 1.438）和 1.568（1.277 至 1.926）。
结论
慢性镉暴露与肝损伤呈正相关。
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