Wang Jierui, Wang Weixuan, Zheng Gang, Shi Fan, Wu Shouling, Zhang Yanshu
School of Public Health, North China University of Science and Technology, 21 Bohai Road, Cao Fei Dian, Tangshan, Hebei 063210, China.
Department of Rheumatic Disease, Kailuan General Hospital, 57 Xinhua East Road, Tangshan, Hebei 063000, China.
Postgrad Med J. 2025 Mar 16;101(1194):321-329. doi: 10.1093/postmj/qgae154.
Associations between exposure to single metals and cognitive impairment or related outcomes have been reported in many previous studies. However, co-exposure to more than one metal is common situation. In recent years, studies on the effects of exposure to multiple metals on cognitive impairment or related outcomes have increased, but remain very limited, with a focus on populations with occupational exposure to metals, children, and adolescents. The potential relationships between exposure to metal mixtures and risk of cognitive impairment in adults remain to be clarified.
To determine the associations between blood metal mixtures and cognitive impairment risk.
Inductively coupled plasma mass spectrometry (ICP-MS) was utilized to detect the blood levels of lead (Pb), iron (Fe), copper (Cu), calcium (Ca), magnesium (Mg), and zinc (Zn). Multivariable logistic regression and Bayesian kernel machine regression (BKMR) models were employed to assess the relationships of exposure to these blood metal mixtures with the risk of cognitive impairment.
It was found that four metals (Pb, Fe, Cu, and Mg) were positively correlated with cognitive impairment in each single metal model. The association of Pb and Cu remained significant after adjusting for these six metals, with the odds ratios (95% confidence intervals) in the highest quartiles of 9.51 (4.41-20.54, p-trend <0.01) and 4.87 (2.17-10.95, p-trend <0.01), respectively. The BKMR models indicated that co-exposure levels of Ca, Cu, Fe, Mg, Pb, and Zn were related to increased risk of cognitive impairment at ≥25th percentile compared with median, and Pb and Cu mainly contributed to the joint effect. In addition, the interaction effects of Mg and Pb/Pb and Cu on the risk of cognitive impairment were observed.
Co-exposure of six metals (Pb, Fe, Cu, Ca, Mg, and Zn) increased the risk of cognitive impairment in Chinese adults, with Pb and Cu likely to have greater impact. Potential interaction effects of Mg and Pb, Pb and Cu on the risk of cognitive impairment may exist.
此前许多研究报告了单一金属暴露与认知障碍或相关结果之间的关联。然而，同时暴露于多种金属是常见情况。近年来，关于多种金属暴露对认知障碍或相关结果影响的研究有所增加，但仍然非常有限，主要集中在职业性金属暴露人群、儿童和青少年。金属混合物暴露与成年人认知障碍风险之间的潜在关系仍有待阐明。
确定血液中金属混合物与认知障碍风险之间的关联。
采用电感耦合等离子体质谱法（ICP-MS）检测血液中铅（Pb）、铁（Fe）、铜（Cu）、钙（Ca）、镁（Mg）和锌（Zn）的水平。使用多变量逻辑回归和贝叶斯核机器回归（BKMR）模型评估这些血液金属混合物暴露与认知障碍风险之间的关系。
在每个单一金属模型中发现四种金属（Pb、Fe、Cu和Mg）与认知障碍呈正相关。在对这六种金属进行调整后，Pb和Cu的关联仍然显著，最高四分位数的优势比（95%置信区间）分别为9.51（4.41 - 20.54，p趋势<0.01）和4.87（2.17 - 10.95，p趋势<0.01）。BKMR模型表明，与中位数相比，Ca、Cu、Fe、Mg、Pb和Zn的共同暴露水平在≥第25百分位数时与认知障碍风险增加有关，且Pb和Cu主要促成了这种联合效应。此外，观察到Mg与Pb/Pb与Cu对认知障碍风险的交互作用。
六种金属（Pb、Fe、Cu、Ca、Mg和Zn）的共同暴露增加了中国成年人认知障碍的风险，其中Pb和Cu可能影响更大。Mg与Pb、Pb与Cu对认知障碍风险可能存在潜在的交互作用。
