本文選題：尿鎘 + 心血管疾病　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:了解一般人群慢性鎘(Cadmium,Cd)暴露和血管內(nèi)皮功能的現(xiàn)狀及其影響因素,同時通過分析尿鎘(Urine cadmium,UCd)濃度和血管內(nèi)皮功能損害發(fā)生風(fēng)險的關(guān)系,為評價慢性低濃度Cd暴露對一般人群血管內(nèi)皮功能的影響提供流行病學(xué)證據(jù)。方法:本課題以廣西某鉛鋅廢棄礦區(qū)周邊區(qū)域及相鄰鄉(xiāng)鎮(zhèn)非污染區(qū)域為研究現(xiàn)場,招募當(dāng)?shù)爻赡昃用褡鳛楸菊n題的研究對象。采用現(xiàn)況研究設(shè)計,以問卷調(diào)查的形式收集研究對象的一般社會人口學(xué)資料、吸煙史、飲酒史、現(xiàn)患疾病和近期藥物使用情況等;現(xiàn)場測量研究對象的身高、體重、血壓和肱動脈血流介導(dǎo)的血管舒張功能(Flow-mediated dilatation,FMD)水平;收集研究對象的血液標(biāo)本和尿液標(biāo)本,測定血清葡萄糖、血清總膽固醇、血清甘油三酯、血清高密度脂蛋白膽固醇、血清低密度脂蛋白膽固醇、血清C反應(yīng)蛋白、血清肌酐和UCd、尿肌酐含量。本研究統(tǒng)計分析均按性別分層:首先,對研究對象在不同特征層面的UCd濃度和FMD水平進(jìn)行統(tǒng)計描述。第二,應(yīng)用簡單線性回歸和多重線性回歸分析分別探索UCd濃度的關(guān)聯(lián)因素和FMD水平的關(guān)聯(lián)因素。第三,運用多因素Logistic回歸模型分析UCd濃度和血管內(nèi)皮功能損害(FMD7%)的線性劑量-反應(yīng)關(guān)系。第四,運用限制性二次樣條模型探討UCd濃度和血管內(nèi)皮功能損害的非線性劑量-反應(yīng)關(guān)系。最后,分析UCd濃度與年齡、民族、高血壓等特征變量對血管內(nèi)皮功能損害發(fā)生風(fēng)險的交互作用。結(jié)果:1、本研究共702名研究對象,平均年齡為54.4±0.4歲,ucd濃度中位數(shù)為1.25μg/g肌酐[四分位數(shù)間距(interquartilerange,iqr):3.50μg/g肌酐],fmd水平中位數(shù)為8.5%(iqr:5.1%)。其中男性241例,ucd濃度中位數(shù)為1.04μg/g肌酐(iqr:3.07μg/g肌酐),fmd水平中位數(shù)為7.4%(iqr:4.2%),血管內(nèi)皮功能損害的占45.2%;女性461例,ucd濃度中位數(shù)為1.38μg/g肌酐(iqr:3.96μg/g肌酐),fmd水平中位數(shù)為9.3%(iqr:5.2%),血管內(nèi)皮功能損害的占26.7%。2、多重線性回歸分析顯示:對于ucd濃度,在男性中的關(guān)聯(lián)因素為民族、年齡、吸煙狀態(tài)、高密度脂蛋白膽固醇水平;而在女性中的關(guān)聯(lián)因素為民族、年齡。對于fmd水平,在男性中的關(guān)聯(lián)因素為肱動脈基礎(chǔ)徑、年齡、體質(zhì)指數(shù)、總膽固醇水平;在女性中的關(guān)聯(lián)因素為肱動脈基礎(chǔ)徑、絕經(jīng)狀態(tài)、民族。3、ucd濃度與血管內(nèi)皮功能損害的線性劑量-反應(yīng)關(guān)系研究結(jié)果顯示:在全混雜因素調(diào)整模型中,男性ucd濃度最高等分與最低等分相比,血管內(nèi)皮功能損害的發(fā)生風(fēng)險比值比(oddsratio,or)為2.65[95%可信區(qū)間(confidenceinterval,ci):1.08,6.52]。女性ucd濃度最高等分與最低等分相比,血管內(nèi)皮功能損害的發(fā)生風(fēng)險or=0.53(95%ci:0.28,1.00)。在男性和女性中,ucd濃度和血管內(nèi)皮功能損害線性劑量-反應(yīng)關(guān)系均無統(tǒng)計學(xué)意義(線性趨勢檢驗p0.05)。4、ucd濃度與血管內(nèi)皮功能損害的非線性劑量-反應(yīng)關(guān)系研究結(jié)果顯示:調(diào)整了一般社會人口學(xué)資料、心血管疾病危險因素等混雜因素后,男性血管內(nèi)皮功能損害發(fā)生風(fēng)險在整個ucd濃度范圍內(nèi)呈現(xiàn)總體上升趨勢,在ucd低濃度范圍內(nèi),血管內(nèi)皮功能損害的發(fā)生風(fēng)險隨著ucd濃度的升高呈上升趨勢。女性血管內(nèi)皮功能損害發(fā)生風(fēng)險在整個ucd濃度范圍內(nèi)呈現(xiàn)總體下降趨勢,在ucd低濃度范圍內(nèi),血管內(nèi)皮功能損害的發(fā)生風(fēng)險隨ucd濃度的升高呈下降趨勢,隨后曲線有所回升。5、交互作用的分析結(jié)果顯示:無論在男性還是女性群體中,年齡、民族、吸煙(男性)、絕經(jīng)狀態(tài)(女性)、高血壓、脂質(zhì)紊亂、血糖、體質(zhì)指數(shù)、C反應(yīng)蛋白和UCd濃度之間對血管內(nèi)皮功能損害發(fā)生風(fēng)險的交互作用均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、本研究男性、女性群體的慢性Cd暴露整體均處于低水平現(xiàn)狀,男性、女性中分別有45.2%、26.7%的群體存在血管內(nèi)皮功能損害。2、UCd濃度在男性和女性中均與年齡和民族有關(guān)。此外,吸煙是男性UCd濃度的重要影響因素。男性和女性FMD水平的共同影響因素為肱動脈基礎(chǔ)徑。此外,絕經(jīng)是女性FMD水平降低的一個重要危險因素。3、低濃度Cd暴露和血管內(nèi)皮功能損害未呈現(xiàn)顯著的線性劑量-反應(yīng)關(guān)系,但在低水平范圍內(nèi)可使男性血管內(nèi)皮功能損害的發(fā)生風(fēng)險上升,而在女性中,慢性Cd暴露水平的增加仍無此效應(yīng)。非線性劑量-反應(yīng)關(guān)系曲線進(jìn)一步說明了慢性Cd暴露對血管內(nèi)皮功能損害存在性別差異。4、本研究無論在男性還是女性群體中均未發(fā)現(xiàn)特征變量與UCd濃度之間對血管內(nèi)皮功能損害發(fā)生風(fēng)險存在交互作用。
[Abstract]:Objective: to understand the current status and influencing factors of chronic cadmium (Cadmium, Cd) exposure and vascular endothelial function in general population, and to provide epidemiological evidence for evaluating the effect of chronic low concentration Cd exposure on the vascular endothelial function of a population by analyzing the relationship between urinary cadmium (Urine cadmium, UCd) concentration and the risk of vascular endothelial dysfunction. Methods: this subject took the surrounding area of a lead-zinc mining area in Guangxi and the non polluted areas of neighboring villages and towns as the research site, and recruited adult residents as the subject of this study. The current situation was designed to collect the general sociodemographic data of the subjects, smoking history, drinking history, diseases and recent years. Drug use, etc.; measurement of the height, weight, blood pressure and Flow-mediated dilatation, FMD level of the brachial artery blood flow, blood samples and urine specimens of the subjects, the serum glucose, serum total cholesterol, serum triglycerides, serum high density lipoprotein cholesterol, and blood were measured. Low density lipoprotein cholesterol (LDL), serum C reactive protein, serum creatinine and UCd, and urinary creatinine content. The statistical analysis of this study was based on gender stratification. First, the UCd concentration and FMD level of the subjects were described at different characteristics. Second, a simple linear regression and multiple linear regression analysis were used to explore the correlation of UCd concentration. Association factors and association factors of FMD level. Third, the linear dose response relationship of UCd concentration and vascular endothelial dysfunction (FMD7%) was analyzed by multiple factor Logistic regression model. Fourth, the non linear dose response relationship between UCd concentration and vascular endothelial dysfunction was investigated by the restrictive two spline model. Finally, the concentration and year of UCd were analyzed. The interaction of age, age, national, hypertension and other characteristic variables on vascular endothelial dysfunction. Results: 1, the average age of 702 subjects was 54.4 + 0.4 years, the median of UCD concentration was 1.25 mu g/g creatinine (interquartilerange, IQR), 3.50, g/g creatinine, and the median of FMD was 8.5% (iqr:5.1%). In 241 male cases, the median of UCD concentration was 1.04 mu g/g creatinine (iqr:3.07 mu g/g creatinine), the median of FMD level was 7.4% (iqr:4.2%), the vascular endothelial dysfunction accounted for 45.2%, and the median of the UCD concentration was 1.38 mu g/g creatinine (iqr:3.96 Mu creatinine), the FMD level was 9.3% (iqr:5.2%), the vascular endothelial dysfunction accounted for the multiple lines. The regression analysis showed that for UCD concentration, the association factors among men were ethnic, age, smoking, and HDL cholesterol levels, and the factors associated with women were ethnic, age. And for the FMD level, the association factors in men were the brachial artery base, age, body mass index, total cholesterol level, and the level of total cholesterol in women; The results of a linear dose response study of brachial artery base diameter, menopause, national.3, UCD concentration and vascular endothelial dysfunction showed that the risk ratio Ratio of vascular endothelial dysfunction (oddsratio, or) was 2.65[95% credible in the full confounding factor adjustment model compared with the lowest bisection in the male UCD concentration adjustment model. Interval (confidenceinterval, CI): the risk of vascular endothelial dysfunction was or=0.53 (95%ci:0.28,1.00) at the highest concentration of UCD in 1.08,6.52]. women compared with the lowest level. In both male and female, the linear dose response relationship between UCD concentration and vascular endothelial dysfunction was not statistically significant (linear trend test P0.05).4, UCD concentration and The results of a nonlinear dose response study of vascular endothelial dysfunction showed that the risk of vascular endothelial dysfunction in men showed an overall upward trend in the UCD concentration range after adjusting the general social demographic data and the risk factors for cardiovascular disease, and the vascular endothelial dysfunction within the UCD low concentration range. The risk of injury occurred with the increase of UCD concentration. The risk of vascular endothelial dysfunction in women showed a general decline in the whole UCD concentration range. The risk of vascular endothelial dysfunction decreased with the increase of UCD concentration in the low concentration range of UCD, and then the curve rebounded.5, and the interaction was divided. The results showed that the interaction between age, nationality, smoking (male), menopause (male), menopause (female), hypertension, lipid disorder, blood glucose, body mass index, C reactive protein and UCd concentration had no statistical significance on the risk of vascular endothelial dysfunction (P0.05). Conclusion: 1, this study was the male and female group. Chronic Cd exposure was at a low level as a whole, and 45.2% of men and 26.7% of women had vascular endothelial dysfunction in.2. UCd concentration was associated with age and nationality in both male and female. In addition, smoking was an important factor in male UCd concentration. The common influence factors of male and female FMD levels were the brachial artery base. In addition, menopause is an important risk factor for the decrease of FMD level in women,.3, the low concentration of Cd exposure and vascular endothelial dysfunction do not show a significant linear dose response relationship, but the risk of vascular endothelial dysfunction can be increased in a low level, but the increase of chronic Cd exposure is still not the case in women. Effect. The nonlinear dose response curve further illustrates that there is a gender difference in vascular endothelial dysfunction in chronic Cd exposure. This study has not found that there is an interaction between the risk of vascular endothelial dysfunction and the risk of vascular endothelial dysfunction in both male and female groups, both in male and female groups.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R114

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