Analysis on the Blood Lead Levels and It’s Association with Hypertension in 176 Non-occupational Adult Patients
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摘要:
目的 调查非职业性成人血铅水平及其分布特点,分析血铅超标的影响因素和其与高血压患病情况的关系。 方法 采用石墨炉原子吸收光谱法检测血铅浓度,同时采用问卷调查的方式收集影响血铅水平的潜在因素和高血压的患病情况。采用秩和检验、卡方检验、Logistic回归,限制性立方样条 ( restrictive cubic spline,RCS) 的Logistic回归模型的方法分析血铅超标的影响因素和其与高血压患病的关系。 结果 非职业性成人血铅含量中位数和四分位间距(M±Q)为(0.031±0.020) mg/L,血铅超标率为13.07%。单因素Logistic回归分析结果显示:非职业性成人年龄>60岁比年龄≤60岁血铅超标的概率降低88%(P < 0.05);饮酒比不饮酒的血铅超标的概率增加3.014倍(P < 0.05);血铅超标将导致高血压的患病率增加2.87倍(P < 0.05);限制性立方样条模型结合多因素Logistic回归分析结果显示:血铅超标将会导致高血压发生的概率增加7.66倍(P < 0.05),当血铅值≥0.031 mg/L,血铅常用对数值(lgpb)与高血压间存在明显的非线性剂量-反应关系(整体关联性检验χ2 = 10.26,P = 0.001,非线性检验χ2 = 8.87,P = 0.012),并随血铅含量的增加,高血压患病率呈明显上升趋势。 结论 非职业性成人血铅水平超标将增加高血压的患病率,高危人群应定期体检,加强对铅超标高危因素的认识,减少接触,减轻血铅超标的损害。 Abstract:Objective To investigate the blood lead level and its distribution in non-occupational adults, and to analyze the association of excessive blood lead with hypertension. Methods The concentration of lead in blood was detected by GFAAS, and the potential factors affecting blood lead level and the prevalence of hypertension were collected by questionnaire. Rank sum test, chi-square test, Logistic regression, and the restrictive Cubic Spline (RCS) of Logistic regression were used to analyze the influencing factors of excess lead in blood and its association with hypertension. Results The median and quartile spacing (M±Q) of blood lead levels in non-occupational adults was (0.031±0.020) mg/L, and the blood lead exceedance rate was 13.07%. The results of univariate logistic regression analysis showed that the probability of excessive blood lead in non-occupational adults aged > 60 years was 88% lower than that in those aged ≤60 years (P < 0.05); the probability of excessive blood lead in alcohol consumption was 3.014 times higher than that in non-alcohol consumption (P < 0.05); and excessive blood lead would lead to 2.87 times higher prevalence of hypertension (P < 0.05). Restricted cubic spline model combined with the multi-factor logistic regression analysis results show that the incidence of blood lead levels will increase the probability of hypertension by 7.66 times. When the blood lead level was ≥0.031 mg/L, there was a significant nonlinear dose-response relationship between the common logarithm of blood lead (lgpb) and hypertension (global correlation test χ2 = 10.26, P = 0.001, nonlinear test χ2 = 8.87, P = 0.012), and the prevalence of hypertension showed a significant increase with the increase of blood lead content. Conclusion Excessive blood lead level in non-occupational adults will increase the prevalence of hypertension. High risk groups should have regular physical examination, strengthen the understanding of high risk factors of excessive lead, reduce exposure, and reduce the damage of excessive blood lead. -
Key words:
- Non-occupational adults /
- Blood Lead /
- Hypertension /
- RCS
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表 1 不同血铅水平范围血铅超标分布情况
Table 1. Distribution of excessive blood lead in different blood lead levels
血铅值(mg/L) n 范围 M Q 百分比(%) 0.001~0.099 153 0.001~0.093 0.028 0.026 86.93 0.100~0.199 15 0.101~0.192 0.140 0.066 8.52 0.200~0.249 4 0.220~0.246 0.245 0.020 2.27 0.250~0.449 4 0.260~0.385 0.312 0.115 2.27 ≥0.450 0 - - - - ≥0.100 23 0.101~0.385 0.170 0.124 13.07 合计 176 0.001~0.385 0.031 0.020 100 表 2 不同性别非职业性成人血铅水平及血铅超标情况分析
Table 2. Analysis of blood lead level and excessive blood lead in non-occupational adults of different genders
性别 n 血铅值(mg/L) Z P 血铅超标情况 χ2 P 范围 M Q n 百分比(%) 男 149 0.002~0.385 0.031 0.031 −1.28 0.202 19 12.75 0.759 0.485 女 27 0.001~0.245 0.028 0.049 4 14.81 表 3 不同年龄段非职业性成人血铅水平及血铅超标差异情况分析
Table 3. Analysis of differences in blood lead level and excessive blood lead in non-occupational adults of different ages
年龄(岁) n 血铅值(mg/L) H P 血铅超标情况 χ2 P 范围 M Q n 百分比(%) 20~40 23 0.013~0.353 0.052 0.113 16.454 < 0.001* 8 34.78 18.438 < 0.001* 41~60 65 0.001~0.385 0.036 0.042 12 18.46 61~85 88 0.002~0.260 0.027 0.023 3 3.41 合计 176 0.001~0.385 0.0305 0.020 23 13.07 *P < 0.05。 表 4 非职业性成人血铅超标影响因素的单因素Logistic回归分析
Table 4. One-way logistic regression analysis of factors influencing non-occupational adult blood lead overload
变量 血铅正常 血铅超标 χ2 P OR(95%CI) 性别 女 23 4 男 130 19 0.09 0.770 1.19(0.37~3.82) 年龄 ≤60岁 68 20 >60岁 85 3 10.97 0.001* 0.12(0.03~0.42) 抽烟 否 48 10 是 105 13 1.31 0.253 0.59 (0.24~1.45) 饮酒 否 130 15 是 23 8 5.01 0.025* 3.01(1.15~7.92) *P < 0.05。 表 5 非职业性成人血铅超标与高血压发患病情况的单因素Logistic回归分析
Table 5. One-way Logistic regression analysis of excessive blood lead and hypertension in non-occupational adults
血铅 n 高血压(n) 高血压患病率(%) χ2 P OR(95%CI) 未超标 153 14 9.15 超标 23 9 39.13 4.91 0.027* 2.87(1.13~7.29) *P < 0.05。 表 6 非职业性成人血铅超标与高血压患病情况的多因素Logistic回归分析
Table 6. Multifactorial logistic regression analysis of blood lead exceedance and prevalence of hypertension in non-occupational adults
变量 β值 标准误 Wald值 P OR(95%CI) 年龄(>60岁) 1.762 0.518 11.59 0.001* 5.83(2.11~16.07) 血铅超标 2.036 0.614 11.00 0.001* 7.66(2.30~25.52) 常数 −2.709 0.473 32.79 < 0.001* *P < 0.05。 -
[1] 王娟,孙敏,龙云芳. 铅接触工人职业健康情况的调查分析[J]. 工业卫生与职业病,2022,48(2):144-146. [2] 申媛,吴学文,孙虹. 铅神经毒性相关基因多态性的研究进展[J]. 环境与健康杂志,2017,34(2):178-180. [3] Al Osman M,Yang F,Massey I Y. Exposure routes and health effects of heavy metals on children[J]. Biometals,2019,32(4):563-573. doi: 10.1007/s10534-019-00193-5 [4] 职业性慢性铅中毒的诊断: GBZ 37—2015[S]. 北京: 中国标准出版社, 2016. [5] 林丹红,谢军花,杨春英,等. 23037例儿童和成人血铅水平及中毒率分析[J]. 中国卫生检验杂志,2021,31(13):1641-1643. [6] GBD 2017 risk factor collaborators. Global,regional,and national comparative risk assessment of 84 behavioural,environmental and occupational,and metabolic risks or clusters of risks for 195 countries and territories,1990-2017: A systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet,2018,392(10159):1923-1994. doi: 10.1016/S0140-6736(18)32225-6 [7] 万欣宇,罗辉,黄莞莞,等. 广州地区2018年—2021年儿童血铅水平及其与红细胞参数的关系[J]. 中国卫生检验杂志,2023,33(1):98-101. [8] Rosin A. The Long-term consequences of exposure to lead[J]. The Israel Medical Association Journal:IMAJ,2009,11(11):689-694. [9] 李依玲,闫贻忠,刘佳琳,等. 中国2017年成人膳食来源铅暴露所致心血管疾病疾病负担分析[J]. 中国公共卫生,2022,38(5):557-562. doi: 10.11847/zgggws1137343 [10] 田昊渊,庞妍,阎波,等. 辽宁省一般人群血和尿中铅水平研究[J]. 中国工业医学杂志,2016,29(1):8-11. [11] 张敏莉,顾小红. 成人600例血铅检测结果分析[J]. 重庆医学,2014,43(4):480-481. [12] 任兰,陈诹. 铅对孕妇健康影响的研究进展[J]. 职业与健康,2017,33(11):1568-1572. [13] 张红兵,黄亚铖,张恒东. 2018年江苏省9707名铅接触劳动者血铅水平分析[J]. 职业卫生与应急救援,2020,38(5):471-473. [14] 蔡畅. 油漆职业人群的血铅水平及其健康状况的流行病学研究[D]. 长沙: 中南大学硕士学位论文, 2013. [15] 赵秋妮,张恒东,陈林,等. 某蓄电池厂工人血铅水平及其与血锌原卟啉的相关性[J]. 环境与职业医学,2017,34(4):311-315. [16] 顾明华,吕玲,章敏华,等. 上海市2012-2017年非传统严重铅污染行业作业人员血铅水平及影响因素[J]. 劳动医学,2018,35(9):816-820. [17] 金武,窦建瑞,朱道建,等. 长期低浓度铅负荷对人体心血管功能的影响[J]. 工业卫生与职业病,2020(1):26-30. [18] Scinicariello F,Abadin H G,Murray H E. Association of low-level blood lead and blood pressure in NHANES 1999–2006[J]. Environmental Research,2011,111(8):1249-1257. doi: 10.1016/j.envres.2011.08.011 [19] Zeqiri N,Zeqiri S,Skenderaj S. Blood pressure evaluation at the workers exposed to lead[J]. Medical Archives,2012,66(2):92-93. doi: 10.5455/medarh.2012.66.92-93 [20] Glenn B S,Bandeen-Roche K,Lee B K,et al. Changes in systolic blood pressure associated with lead in blood and bone[J]. Epidemiology,2006,17(5):538-544. doi: 10.1097/01.ede.0000231284.19078.4b [21] 郭恩谊,李金凤,付志斌,等. 铅作业工人早期铅损害监测指标研究[J]. 职业与健康,2017,33(4):448-451. [22] 曹艳梅,孔玉林,刘杰. 职业性铅超标对人群健康效应的研究[J]. 中华劳动卫生职业病杂志,2018,036(12):943-946. [23] 郭新峰,陈文强. 不同铅接触水平对作业人员血压,血脂的影响[J]. 中国工业医学杂志,2021,34(3):243-245. [24] 《中国高血压防治指南》修订委员会. 中国高血压防治指南2018年修订版[J]. 心脑血管病防治,2019,19(1):1-44.