铜、锌、砷暴露水平与结节性甲状腺肿患病关系病例对照研究

张寒双; 何家镠; 李国傲; 赵欢欢; 朱振宇; 朱金亮; 胡明军; 黄芬

doi:10.11847/zgggws1134924

铜、锌、砷暴露水平与结节性甲状腺肿患病关系病例对照研究

Association of urinary copper, zinc and arsenic with nodular goiter: a population-based case-control study

摘要

摘要:
目的了解铜（Cu）、锌（Zn）、砷（As）3种重金属暴露水平与结节性甲状腺肿患病的关系，为结节性甲状腺肿的防治策略提供科学依据。
方法采用病例对照研究方法，将2016年9月 — 2019年3月在安徽省肿瘤医院头颈外科住院的373例结节性甲状腺肿患者作为病例组及按病例组同性别、年龄（± 2岁）进行1 : 1个体匹配的373名2019年皖江队列中的健康人群作为对照组进行问卷调查和实验室检测。
结果病例组结节性甲状腺肿患者和对照组健康人群Zn、As、Cu暴露水平分别为312.16（98.65～500.19）和340.40（99.41～580.54）、30.44（4.36～88.30）和23.75（3.67～81.82）、6.13（2.36～11.00）和10.36（6.27～16.95）µg/g；2组人群比较，病例组结节性甲状腺肿患者Cu暴露水平低于对照组健康人群（Z = – 6.625，P < 0.001），2组人群Zn和As暴露水平差异均无统计学意义（均P > 0.05）。在调整了性别、年龄、婚姻状况、吸烟情况、被动吸烟情况、饮酒情况、每日睡眠时间、体质指数、空腹血糖水平、总胆固醇水平、甘油三酯水平、高密度脂蛋白胆固醇水平、Zn暴露水平和As暴露水平等混杂因素后，多因素条件logistic回归分析结果显示，Cu暴露水平第三四分位数和最高四分位数人群结节性甲状腺肿的患病风险分别为最低四分位数人群的0.73倍（OR = 0.73，95 % CI = 0.54～0.98）和0.56倍（OR = 0.56，95 % CI = 0.39～0.81）；Cu暴露水平最高四分位数男性人群结节性甲状腺肿的患病风险为最低四分位数男性人群的0.42倍（OR = 0.42，95 % CI = 0.19～0.97）；Zn和As暴露水平与结节性甲状腺肿患病均无统计性关联（均P > 0.05）。
结论人群Cu暴露水平与结节性甲状腺肿患病呈负相关。

Abstract:
Objective To examine the relationship between urinary copper (Cu), zinc (Zn) and arsenic (As) and the incidence of nodular goiter and to provide evidences for nodular goiter prevention and treatment.
Methods The cases of the study were 373 pathologically diagnosed nodular goiter patients hospitalized in the Department of Head and Neck Surgery of Anhui Cancer Hospital from September 2016 through March 2019; while, the controls were 1 : 1 individually gender- and age (± 2 years)-matched healthy people selected from a cohort study conducted in Anhui province. Face-to-face questionnaire interviews and laboratory tests were carried out among the participants.
Results Significantly lower morning urinary Cu (median µg/g; 25th quartile, 75th quartile) was detected in the cases compared to that in the controls (6.13; 2.36, 11.00 vs. 10.36; 6.27, 16.95; Z = – 6.625; P < 0.001); while, no significant differences between the cases and the controls were detected in morning urinary Zn (312.16; 98.65, 500.19 vs. 340.40; 99.41, 580.54) and As (30.44; 4.36, 88.30 vs. 23.75; 3.67, 81.82) (both P > 0.05). After adjusting for confounding factors such as gender, age, marital status, smoking, passive smoking, alcohol consumption, daily sleep time, body mass index, fasting blood glucose, serum total cholesterol, serum triglyceride, serum high density lipoprotein cholesterol, urinary Zn and urinary As, the results of multivariate logistic regression analysis showed that higher urinary Cu was associated with a decreased risk of nodular goiter (the third quartile Q3 – the highest quartile Q4 vs. the lowest quartile Q1: odds ratio OR = 0.73, 95% confidence interval 95% CI: 0.54 – 0.98; Q4 vs. Q1: OR = 0.56, 95% CI: 0.39 – 0.81; and Q4 vs. Q1: OR = 0.42, 95% CI: 0.19 – 0.97 only for male participants); the analyses did not revealed significant correlations between urinary Zn and As and nodular goiter incidence (all P > 0.05).
Conclusion Urinary Cu concentration may reversely associated with nodular goiter incidence in Chinese people.

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