铅镉联合职业性暴露水平与高尿酸血症的关联

Association between combined occupational exposure level of lead and cadmium and hyperuricemia

目的分析铅镉联合职业性暴露水平对尿酸代谢的影响,为该类人员高尿酸血症(hyperuricemia)的职业防护提供依据。方法选择304名铅镉联合职业暴露工人,采用病例对照研究,以是否患有高尿酸血症为标准将工人分为病例组和对照组,检测两组工人的尿酸、血铅和尿镉水平,采用秩和检验分析两组间差异及血铅、尿镉水平与尿酸水平之间的相关性。用二元logistic回归模型分析血铅、尿镉的暴露水平对高尿酸血症的影响。结果高尿酸血症组与非高尿酸血症组血铅、尿镉水平比较差异均有统计学意义(均P<0.05)。二元logistic回归模型显示血铅高暴露组发生高尿酸血症的风险是低暴露组的2.04倍,OR(95%CI)=2.460(1.102,4.207),尿镉高暴露组发生高尿酸血症的风险是低暴露组的2.46倍,OR(95%CI)=2.460(1.132,5.344)。血铅与尿镉对高尿酸血症有相乘交互作用(P<0.05)。结论血铅、尿镉水平、工龄与尿酸水平呈正相关,血铅水平是高尿酸血症的独立危险因素,铅镉的高暴露会导致高尿酸症患病风险显著上升,血铅、尿镉水平对高尿酸血症的有相乘交互作用。

Objective To analyze the effects of combined occupational exposure to lead and cadmium on uric acid metabo⁃lism,and to provide basis for occupational protection against hyperuricemia.Methods 304 workers exposed to lead and cadmium were selected and divided into case group and control group according to whether they had hyperuricemia or not.The levels of uric acid,blood lead and urinary cadmium were tested in the two groups.The rank sum test was used to ana⁃lyze the differences between the two groups and the correlations among the levels of blood lead,urinary cadmium and uric acid.The effects of blood lead and urinary cadmium exposure on hyperuricemia were analyzed by binary logistic regression model.Results There were significant differences in the levels of blood lead and urinary cadmium between hyperuricemia group and non-hyperuricemia group(P<0.05).The binary logistic regression model showed that the risk of hyperuricemia in the high blood lead exposure group was 2.04 times higher than that in the low blood lead exposure group,OR(95%CI)=2.460(1.102,4.207),and the risk of hyperuricemia in the high urinary cadmium exposure group was 2.46 times higher than that in the low urinary cadmium exposure group,OR(95%CI)=2.460(1.32,5.344).Blood lead and urinary cadmi⁃um had a multiplicative interaction with hyperuricemia(P<0.05).Conclusion The levels of blood lead and urinary cad⁃mium,as well as the length of service,are positively correlated with the level of uric acid.The level of blood lead is an in⁃dependent risk factor for hyperuricemia.High exposure to blood lead and urinary cadmium can significantly increase the risk of hyperuricemia.The levels of blood lead and urinary cadmium have a multiplicative interaction with hyperuricemia.