基于NHANES数据库多金属暴露和桥本甲状腺炎的相关性分析

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摘要 目的: 本研究探讨尿液中重金属和桥本甲状腺炎（hashimoto's thyroiditis,HT）之间的潜在关系,为正常人群和HT人群的重金属暴露的预防和控制提供依据。方法: 基于2007―2012年美国国家健康和营养调查（NHANES）数据库,纳入5 011例同时具有尿重金属（镉、钴、钡、铅、铀）浓度指标和甲状腺过氧物酶抗体（TPOAb）或甲状腺球蛋白抗体（TgAb）数据的人群。采用逻辑回归模型探讨尿液中重金属与HT的关系,运用限制立方样条模型检查可能的非线性关联,将不同浓度的镉、钴、钡与HT的剂量-反应关系可视化,同时针对性别进行亚组分析。结果: HT患者的尿镉浓度（0.27 μg/L）显著高于正常人群（0.24 μg/L）,其余几种重金属浓度在HT分布中无统计学差异（P>0.05）。多因素Logistic回归显示,尿镉每上升一个四分位数,HT的患病风险增加23.7 %（OR=1.237,95 %CI：1.083~1.414）;尿钴每上升一个四分位数,HT的患病风险增加9.7 %（OR=1.097,95 %CI：1.021~1.177）;与尿钡浓度最低组（Q1）相比,尿钡浓度最高组（Q4）HT的患病风险降低48 %（OR=0.520,95 %CI：0.295~0.916）。但限制性三次样条回归结果显示三者与HT的患病率均无剂量反应关系。结论: 重金属（镉、钴、钡）暴露与HT有关。镉、钴可能是HT的危险因素,钡可能是HT的保护因素,镉、钴与女性患病相关性显著,为制定干预措施和健康促进指导提供证据,提高人们对重金属暴露的关注度。

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	李梦然
	张德洋
	周义斌
	方琪
	倪磊

关键词 ：桥本甲状腺炎, 金属暴露, 美国国家健康和营养调查数据库, 相关性分析

Abstract：Objective This study aimed to expore the potential relationship between heavy metals in urine and Hashimoto's thyroiditis （HT）,providing a basis for the prevention and control of heavy metal exposure in the general population and in those with HT. Methods Data included 5 011 cases with both urinary heavy metals （cadmium,cobalt,barium,lead,uranium）concentration indexes and thyroid peroxidase antibody （TPOAb）or thyroglobulin antibody （TgAb）from the 2007-2012 National Health and Nutrition Examination Survey （NHANES）（2007-2012）. Logistic regression models were used to explore the relationship between heavy metals in urine and HT,and restricted cubic spline models were used to examine possible nonlinear associations and to use restricted cubic spline models to visualize the dose-response relationship between different concentrations of cadmium,cobalt,and barium and HT. Furthermore,subgroup analyses were performed for gender. Results The urinary cadmium concentration in HT patinets （0.27 μg/L）was significantly higher than that in the normal population （0.24 μg/L）,while the concentrations of the other heavy metals showed no statistical difference in HT distribution. Multifactorial logistic regression showed that the risk of HT increased by 23.7 % for each quartile increase in urinary cadmium （OR=1.237,95 % CI 1.083-1.414）,and by 9.7% for each quartile increase in urinary cobalt （OR=1.097,95 % CI 1.021-1.177）. Compared to the group with the lowest urinary barium concentration （Q1）,the group with the highest urinary barium concentration （Q4）had a 48 % reduction of the risk of HT （OR=0.520,95 % CI 0.295-0.916）. However,the results of restricted cubic spline regression showed no dose-response relationship between the three and the prevalence of HT. Conclusion Exposure to heavy metals （cadmium,cobalt,barium）is associated with HT. Cadmium and cobalt may serve as potential risk factors for HT,while barium may have a protective effect against the disease. Cadmium and cobalt may be more pronounced in women. This provides the evidence for the development of intervention and health promotion guidelines,raising awareness of heavy metal exposure.

Key words： Hashimoto's thyroiditis metal exposure national health and nutrition examination survey correlation analysis

收稿日期: 2024-01-11

基金资助:全国肿瘤科学研究2023年度肿瘤整体评估课题“CACA指南肿瘤整体评估中医评估量表优化研究”（ZGKAXH-ZLZTPG-202312001）

通讯作者: 倪磊,E-mail：nilei0108@163.com

引用本文:

李梦然, 张德洋, 周义斌, 方琪, 倪磊. 基于NHANES数据库多金属暴露和桥本甲状腺炎的相关性分析[J]. 湖南师范大学学报(医学版), 2024, 21(4): 73-80. LI Mengran, ZHANG Deyang, ZHOU Yibin, WANG Zhaoyi, NI Lei. Correlation Analysis of Metal Exposure and Hashimoto's Thyroiditis based on NHANES Database. HuNan ShiFan DaXue XueBao(YiXueBan), 2024, 21(4): 73-80.

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http://yxb.hunnu.edu.cn/CN/ 或 http://yxb.hunnu.edu.cn/CN/Y2024/V21/I4/73

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