目的 探讨多金属暴露与代谢综合征(MS)发病风险的关联,为预防高危人群MS发生发展提供理论支持.方法 纳入2017年8月到2018年5月在唐山开滦队列中的男性人群为研究对象,在3所附属医院共选取361例MS患者和1109例经年龄频数匹配的非代谢综合征者(non-MS)进行的病例对照研究.采用logistic回归分析分别评估单一金属元素与MS之间的风险关联;基于自适应弹性网回归方法量化多金属暴露时与MS之间的综合效应.结果 MS组中血钙、铜和镁浓度显著低于对照组(P<0.05),但硒浓度高于对照组(P<0.01).在对可能的混杂进行校正后,金属元素第三分位组与第一分位组的MS比值比分别为:钙[0.52(95％CI:0.38,0.71),P<0.001]、硒[1.80(95％CI:1.32,2.44),P<0.001]和铜[0.60(95％CI:0.44,0.83),P<0.01].与MS为U型关系的金属元素以第二分位组为参照组,比值比分别为:铁[第一分位组1.40(95％CI:1.03,1.92),P<0.05;第三分位组1.51(95％CI:1.10,2.06),P<0.01]和镁[第一分位组1.83(95％CI:1.34,2.51),P<0.001;第三分位组1.50(95％CI:1.09,2.08),P<0.05].同时,金属元素共同暴露时,MS的发生风险显著增加[4.12(95％CI:2.63,6.47),P<0.001].结论 铁紊乱、低钙、低铜、高镁和高硒是MS发生的独立危险因素,且多金属共同暴露时,MS的风险更高.

Objective To investigate the association between whole blood iron, copper and their interaction with cardiovascular diseases (CVD). Methods A cohort-based case control study was conducted. Cases were 93 males with CVD in the Kailuan cohort who participated in the follow-up in 3 hospitals in 2017-2018. During the same period, 372 males with non-CVD who were 1∶4 individual matched by age and labor type were selected as controls. The concentration of blood iron and copper was determined by inductively coupled plasma mass spectrometry. Conditional logistic regression models were used to estimate the association between blood iron and copper and CVD, respectively and elastic-Net regression models to estimates interaction between the two metals and CVD. Results The whole blood iron concentration in the cases was significantly higher than the controls, while blood copper concentration was lower than the controls (both P＜0.001). After adjusting for age, smoking, drinking, overweight, hypertension, diabetes, anemia, hyperlipidemia, and high sensitivity C-reactive protein, the participants with higher iron increase 3.17 times (OR=4.17, 95% CI: 2.23-7.79, P＜0.001) risk of CVD than those with lower iron, and those with lower copper increase 3.26 times (OR=4.26, 95% CI: 1.73-10.45, P＜0.01) risk than those with the higher copper. Adaptive Elastic-net regression analysis showed that it under the simultaneous exposure of higher iron and lower copper, the risk of CVD with environment risk score ＞0.232 was 8.96 times (OR=8.96, 95% CI: 4.47-17.95, P＜0.001) than the score ≤0.232. Conclusions Higher iron and copper deficiency may be independent risk factors for CVD. Environment risk score could be a good indicator of simultaneous exposure of blood iron and copper, which should have a better predictive value of CVD.