湖南某矿区职业人群金属/类金属暴露与肝功能指标异常的前瞻性研究

Association of metal/metalloids exposure with abnormal liver function among occupational population in a mining area of Hunan Province:a prospective study

目的 研究湖南某矿区职业人群多种金属/类金属的暴露水平与肝功能指标异常的关系,并探讨剂量-反应关系。方法 于2017年在湖南某矿区招募工人为研究对象,进行问卷调查、体格检查和实验室检测,获取研究对象人口学特征、体检结果、血浆和尿液中23种金属/类金属水平以及肝功能指标[总胆红素(total bilirubin, TBIL)、丙氨酸氨基转移酶(alanine amino transferase, ALT)、球蛋白(globulin, GLB)和γ-谷氨酰转肽酶(γ-glutamyl transferase, GGT)]等信息。并分别于2018、2019和2020年进行随访。采用Cox比例风险模型评估金属/类金属暴露水平与肝功能异常风险的关系,并使用限制性立方样条函数绘制剂量-反应关系曲线。结果 共纳入研究对象891名,≤45岁者576名(65.0%),男性832名(93.4%),冶炼工530名(59.5%)。调整年龄、性别、体质指数、工种、文化程度、吸烟、饮酒、饮食咸淡、心理压力、既往史(高血压、高血脂、糖尿病和冠心病)、定期锻炼和饮茶后,血钨(HR=4.90,95%CI 1.17~20.48)和尿钡(HR=1.07,95%CI 1.02~1.12)与TBIL水平异常升高发生风险呈正相关。血铊与ALT异常升高发生风险呈正相关(HR=11.15,95%CI 1.97~63.29)。结论 血浆钨元素和铊元素以及尿中钡元素是职业人群肝功能指标异常升高发生风险的危险因素。

OBJECTIVE To investigate the association of metals/metalloidsexposure with risk of liver disfunction among occupational population in Hunan Province,and to explore the potential dose-response relationship.METHODS In 2017,a miningarea in Hunan Province was chosen as the research site,and eligible workers wererecruited as study subjects.General demographic characteristics,levels of 23 metals/metalloids in plasma and urine,and liver function index(total bilirubin(TBIL),alanineamino transferase(ALT),globulin(GLB)andγ-glutamyl transferase(GGT))were obtained by questionnaire,physical examination and laboratory tests.Participants werefollowed up in 2018,2019 and 2020 respectively.Cox proportional risk model was used toevaluate the relationship between metal/metalloids exposure and risk of liver disfunction,and dose-response relationship curves were plotted by using the restricted cubic splinefunction.RESULTS A total of 891 employees were recruited in the study,576(65.0%)were aged≤45 years,832(93.4%)were male and 530(59.5%)worked assmelters.After adjusting various factors such as age,gender,BMI,type of work,education,smoking,alcohol consumption,diet,stress,medical history,exercise and teaconsumption,positive correlations were found between plasma tungsten(HR=4.90,95%CI 1.17-20.48)and urinary barium(HR=1.07,95%CI 1.02-1.12)levels withabnormally elevated TBIL levels.Additionally,a significant association was observedbetween plasma thallium and the risk of elevated ALT levels(HR=11.15,95%CI 1.97-63.29).CONCLUSION Plasma tungsten and thallium,along with barium found inurine,are risk factors for the development of abnormally elevated liver function indices inoccupational groups.