Nursing Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, China.
School of Nursing, University of South China, Hengyang 421001, China.
Toxins (Basel). 2023 Feb 10;15(2):144. doi: 10.3390/toxins15020144.
Evidence has shown that exposure to environmental pollutants such as microcystins (MCs), arsenic (As), and cadmium (Cd) can lead to the occurrence and development of chronic kidney disease (CKD). There is a synergistic effect between MCs and Cd. However, the combined effect of MCs and As exposures on CKD remains unclear. In Hunan province, China, 135 controls and 135 CKD cases were enrolled in a case-control study. Serum MCs, plasma As and Cd concentrations were measured for all participants. We investigated the association between MCs/As and CKD risk using conditional logistic regression. The additive model explored the interaction effect, and the Bayesian kernel machine regression (BKMR) models investigated the combined effects of MCs, As, and Cd on CKD. The results showed that MCs and As were significantly associated with CKD risk. Participants in the highest MCs concentration had a 4,81-fold increased risk of CKD compared to those in the lowest quartile (95% confidence interval [CI]: 1,96 to 11,81). The highest quartile of As concentrations corresponded to an adjusted odds ratio of 3.40 (95% CI: 1.51, 7.65) relative to the lowest quartile. MCs/As and CKD risk exhibited significant dose-response correlations (all for trend < 0.01). In addition, a positive interaction effect of MCs and As on CKD was also reported. The CKD risk due to interaction was 2.34 times (95% CI: 0.14, 4.54) relative to the CKD risk without interaction, and the attributable proportion of CKD due to interaction among individuals with both exposures was 56% (95% CI: 0.22, 0.91). In the BKMR, the combined effect of MCs, As, and Cd was positively associated with CKD. In conclusion, both MCs and As are independent risk factors for CKD, exerting a synergistic effect between them. Combined exposure to MCs, As, and Cd can increase the risk of CKD.
已有证据表明，接触微囊藻毒素（MCs）、砷（As）和镉（Cd）等环境污染物会导致慢性肾病（CKD）的发生和发展。MCs 和 Cd 之间存在协同作用。然而，MCs 和 As 暴露对 CKD 的联合作用尚不清楚。在中国湖南省，一项病例对照研究纳入了 135 名对照和 135 名 CKD 病例。所有参与者均测量了血清 MCs、血浆 As 和 Cd 浓度。我们使用条件逻辑回归调查了 MCs/As 与 CKD 风险之间的关联。加性模型探索了相互作用效应，贝叶斯核机器回归（BKMR）模型调查了 MCs、As 和 Cd 对 CKD 的联合作用。结果表明，MCs 和 As 与 CKD 风险显著相关。与最低四分位数相比，MCs 浓度最高的参与者 CKD 风险增加了 4.81 倍（95%置信区间 [CI]：1.96 至 11.81）。最高四分位数的 As 浓度对应于调整后的比值比为 3.40（95%CI：1.51，7.65），与最低四分位数相比。MCs/As 和 CKD 风险呈显著剂量反应相关性（所有 趋势检验 P 值均<0.01）。此外，还报道了 MCs 和 As 对 CKD 的阳性相互作用效应。与无相互作用相比，由于相互作用导致的 CKD 风险增加了 2.34 倍（95%CI：0.14，4.54），且个体同时接触 MCs 和 As 时，由于相互作用导致的 CKD 归因比例为 56%（95%CI：0.22，0.91）。在 BKMR 中，MCs、As 和 Cd 的联合作用与 CKD 呈正相关。总之，MCs 和 As 都是 CKD 的独立危险因素，它们之间存在协同作用。MCs、As 和 Cd 的联合暴露会增加 CKD 的风险。
