人群重金属混合暴露与肝功能的关联研究

Study on Association between Mixed Heavy Metal Exposure and Liver Function in the Population

为探索单一及混合重金属暴露与肝功能的关联,为重金属暴露的健康效应提供证据,于2016—2018年在辽宁省的重金属污染区进行了横断面研究,共纳入了1 266名调查对象。收集了调查对象的血液样本和问卷信息,检测了血液样本中的铬(Cr)、镉(Cd)、钒(V)、锰(Mn)、铅(Pb)浓度用来代表调查对象的金属暴露,同时检测了血液样本中9种肝功能指标丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、天冬氨酸转氨酶与丙氨酸转氨酶之比(AST/ALT)、白蛋白(ALB)、球蛋白(GLB)、白蛋白与球蛋白之比(ALB/GLB)、总蛋白(TP)、总胆红素(TBIL)、直接胆红素(DBIL)的水平。首先采用一般线性回归模型探索单一重金属暴露与肝功能标志物的关联,进一步采用加权分位数和(WQS)回归与Quantile g-computation模型分析重金属混合暴露与肝功能标志物的关联并计算每种金属的贡献占比。研究发现,重金属Cr、Cd、V、Mn、Pb单一及混合暴露均与AST/ALT、GLB、TBIL、DBIL存在正向关联,而与ALB、ALB/GLB、TP存在负向关联(P<0.05)。其中,V在混合重金属暴露对AST/ALT、GLB、TBIL的总体效应中贡献占比最大,Cr在混合重金属暴露对ALB/GLB、DBIL的总体效应中贡献占比最大,而Mn和Cd分别在混合重金属暴露对ALB、TP的总体效应中有最大的贡献占比。单一及混合重金属暴露均与肝功能标志物存在关联,可能导致肝功能损伤,其中V在正向关联中贡献最大,而Cr、Cd在负向关联中贡献最大。

To explore the association of individual and mixed heavy metal exposure with liver function,and to provide evidence for the health effects of heavy metal exposure,a cross-sectional study was conducted in heavy metal polluted areas in Liaoning province from 2016 to 2018,and a total of 1266 participants were included.Participants′blood samples and questionnaire information were collected,and the concentrations of chromium(Cr),cadmium(Cd),vanadium(V),manganese(Mn)and lead(Pb)in blood samples were detected to represent participants′metal exposure.At the same time,9 liver function indicators including alanine aminotransferase(ALT),aspartate aminotransferase(AST),the ratio of AST to ALT(AST/ALT),albumin(ALB),globulin(GLB),the ratio of ALB to GLB(ALB/GLB),total protein(TP),total bilirubin(TBIL)and direct bilirubin(DBIL)were detected in the blood samples.Firstly,a general linear regression model was used to explore the association between individual heavy metal exposure and liver function biomarkers.Furthermore,weighted quantile sum(WQS)regression and Quantile g-computation model were used to analyze the association between mixed heavy metal exposure and liver function biomarkers,and the contribution proportion of each metal was calculated.Research results found that individual and mixed exposure to heavy metals Cr,Cd,V,Mn and Pb were positively associated with AST/ALT,GLB,TBIL and DBIL,while were negatively associated with ALB,ALB/GLB and TP(P<0.05).Among them,V had the largest contribution in the overall effects of mixed heavy metal exposure on AST/ALT,GLB and TBIL,Cr had the largest contribution in the overall effects of mixed heavy metal exposure on ALB/GLB and DBIL,while Mn and Cd had the greatest contribution to overall effects of mixed heavy metal exposure on ALB and TP,respectively.Both individual and mixed heavy metal exposure were significantly associated with liver function biomarkers,which may lead to liver function damage.Among them,V contributed the most in the positive association,while Cr and Cd contributed the most in the negative association.