血清重金属与胃癌发病风险的巢式病例对照研究

A nested case-control study on the serum heavy metals and the risk of gastric cancer

目的探究血清铜、钴和铅3种重金属对胃癌发病的影响。方法以金昌队列为数据平台,收集2014—2020年队列3次随访期间新发的148例胃癌患者为病例组,按照性别、年龄±2岁进行1∶4个体匹配获得592例同期对照。通过条件Logistic回归模型和限制性立方样条法探讨血清3种重金属与胃癌发病的关系及剂量-反应关系。结果多因素条件Logistic回归分析结果表明,与血清铜水平[100.00,853.14]μg·L^(-1)组相比,≥990.63μg·L^(-1)组胃癌发生风险增加了108%(OR=2.08,95%CI:[1.18,3.66]);与血清钴水平≤0.20μg·L^(-1)组相比,[0.21,0.35]μg·L^(-1)和≥0.36μg·L^(-1)组的胃癌风险分别增加了730%(OR=8.30,95%CI:[4.48,15.35])和883%(OR=9.83,95%CI:[5.14,18.79]);与血清铅水平≤4.00μg·L^(-1)组相比,≥4.01μg·L^(-1)组胃癌发生风险增加了108%(OR=2.08,95%CI:[1.29,3.35])。另外,血清铜、钴和铅水平与胃癌发病风险间均存在剂量-反应关系。结论血清铜、钴和铅是胃癌发病的危险因素,应定期监测人群血清重金属水平。

Objective To investigate the effects of serum copper,cobalt and lead on the risk of gastric cancer.Methods Using the Jinchang cohort as the data platform,a total of 148 newly diagnosed gastric cancer patients during the three follow-up periods from 2014 to 2020 were collected as the case group,and 592 controls were obtained by 1∶4 individual matching according to the same gender and age(±2 years).Conditional Logistic regression model was used to explore the relationship between the serum levels of three heavy metals and the risk of gastric cancer.Restricted cubic spline method was used to analyze the dose-response relationship between the two.Results Multivariate conditional Logistic regression analysis showed that the risk of gastric cancer increased by 108%(OR=2.08,95%CI:[1.18,3.66])in serum copper level of≥990.63μg·L^(-1)compared with serum copper level of[100.00,853.14]μg·L^(-1).Compared to serum cobalt level of 0.20μg·L^(-1),the risk of gastric cancer increased by 730%(OR=8.30,95%CI:[4.48,15.35])and 883%(OR=9.83,95%CI:[5.14,18.79])in serum cobalt levels of[0.21,0.35]μg·L^(-1)and≥0.36μg·L^(-1),respectively.And compared to serum lead level of≤4.00μg·L^(-1),the risk of gastric cancer increased by 108%(OR=2.08,95%CI:[1.29,3.35])when serum lead level≥4.01μg·L^(-1).There was a dose-response relationship between serum copper,cobalt and lead levels and the risk of gastric cancer.Conclusion This study found serum copper,cobalt and lead were risk factors for gastric cancer.The serum levels of heavy metals should be regularly monitored in the population.