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Article(id=1241771803585089562, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405471, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1716998400000, receivedDateStr=2024-05-30, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773991068979, onlineDateStr=2026-03-20, pubDate=1729785600000, pubDateStr=2024-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773991068979, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773991068979, creator=13701087609, updateTime=1773991068979, updator=13701087609, issue=Issue{id=1241771801366299468, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773991068450, creator=13701087609, updateTime=1773991676896, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774353457681403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774353457681404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3649, endPage=3656, ext={EN=ArticleExt(id=1241771804025491485, articleId=1241771803585089562, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Gender-specific association between urinary metal and urinary metal in Bouyei population in Qiannan region, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

The primary objective of this study was to investigate the potential correlation between the presence of 22 metals in urine and the risk of developing gallstones in Bouyei population in qiannan region, ultimately aiming to furnish a scientific foundation for early preventative measures and targeted interventions.

Methods

From July 2018 to August 2019, a baseline survey was conducted among residents aged 30 to 79 years in Qiannan Bouyei and Miao Autonomous Prefecture using multistage stratified cluster sampling, including questionnaires, physical examination and ICP-MS to detect urine metal concentration. Urinary metal concentrations were divided into four groups (Q1, Q2, Q3, Q4), and binary logistic regression model was used to analyze the relationship between single metal and gallstone risk. At the same time, the dose-response relationship between metal concentration and gallstone risk was investigated by using restricted cubic splines.

Results

The gallstone detection rate of Bouyei population was 8.825%. After adjusting for covariates, binary logistic regression analysis revealed that in the male group, compared to the Q1 group, there was a positive association between gallstone risk and selenium in the Q2 group (OR=1.894, 95%CI: 1.046-3.431), Se in the Q3 group (OR=1.912, 95%CI: 1.053-3.472), and Fe in the Q3 group (OR=1.827, 95%CI: 1.040-3.210). In the female group, Al in the Q3 group (OR=1.460, 95%CI: 1.050-2.028) was positively associated with gallstone risk, while Na in the Q4 group (OR=0.654, 95%CI: 0.452-0.948) was negatively associated with gallstone risk, with a dose-response relationship observed.

Conclusion

There is a significant correlation between the concentration of certain metals in urine and the risk of gallstones. In the Bouyei female population in particular, urinary aluminum and urinary sodium concentrations have a significant impact on gallstone formation, providing possible directions for future prevention and treatment strategies.

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目的

本研究旨在探究黔南布依族人群尿液中22种金属元素与胆结石风险的关联，提供科学依据以促进早期的预防和干预措施。

方法

2018年7月至2019年8月，在黔南布依族苗族自治州，采用多阶段分层整群抽样对30至79岁居民进行基线调查，其中包括了问卷、体检和ICP-MS检测尿液金属元素浓度。将尿金属浓度分为四组(Q1、Q2、Q3、Q4)，并运用二元logistic回归模型分析单个金属元素与胆结石风险的关系。同时，通过应用限制性立方样条分析，进一步深入分析了金属元素浓度与胆结石风险之间的剂量-反应关系。

结果

布依族总人群的胆结石检出率为8.825%。二元logistic回归模型结果显示，调整协变量后，在男性群体中，以Q1组为参考组，硒Q2组(OR=1.894，95%CI: 1.046～3.431)；硒Q3组(OR=1.912，95%CI: 1.053～3.472)；铁Q3组(OR=1.827，95%CI: 1.040～3.210)与胆结石患病风险呈正相关。在女性群体中，以Q1组为参考组，铝Q3组(OR=1.460，95%CI: 1.050～2.028)与胆结石患病风险呈正相关；钠Q4组(OR=0.654，95%CI: 0.452～0.948)与胆结石患病风险呈负相关，且存在剂量反应关系。

结论

尿液中特定金属元素的浓度与胆结石风险存在显著的相关性。特别是在布依族女性群体中，尿铝和尿钠的浓度对胆结石的形成具有显著的影响，为未来的预防和治疗策略提供了可能的方向。

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洪峰, E-mail :
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=rKYR7COVbiS2/0gxxSzl/w==, magXml=wOMGs7KX3jjdjr3x0cmDbw==, pdfUrl=null, pdf=NPM2Z3vB4cGrVrFy+9MEJw==, pdfFileSize=2723852, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=ZJS1hgpC8MWE0eLPRgIvEQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=xgau8n760dRJC5hrpZZYWQ==, mapNumber=null, authorCompany=null, fund=null, authors=

周恩慧（1999—），女，硕士在读，研究方向：环境与遗传流行病学

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周恩慧（1999—），女，硕士在读，研究方向：环境与遗传流行病学

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周恩慧（1999—），女，硕士在读，研究方向：环境与遗传流行病学

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keyword=布依族)], refs=[Reference(id=1241771815194923386, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2024, volume=22, issue=8, pageStart=1586, pageEnd=1595, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Wang X, Yu W, Jiang G, journalName=Clinical Gastroenterology and Hepatology: the Official Clinical Practice Journal of the American Gastroenterological Association, refType=null, unstructuredReference=Wang X, Yu W, Jiang G, et al. 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Nutricion Hospitalaria, 2019, 36(Spec No3): 70-74., articleTitle=Nutritional intervention in the control of gallstones and renal lithiasis, refAbstract=null), Reference(id=1241771816742621676, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2024, volume=23, issue=1, pageStart=82, pageEnd=null, url=null, language=null, rfNumber=[10], rfOrder=9, authorNames=Du WY, Yan C, Wang YK, journalName=Lipids in Health and Disease, refType=null, unstructuredReference=Du WY, Yan C, Wang YK, et al. Association between dietary Magnesium intake and gallstones: the mediating role of atherogenic index of plasma[J]. 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Hepatology, 2020, 71(3): 917-928., articleTitle=A metallomic approach to assess associations of serum metal levels with gallstones and gallbladder cancer, refAbstract=null), Reference(id=1241771816994279935, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2021, volume=50, issue=3, pageStart=721, pageEnd=721l, url=null, language=null, rfNumber=[12], rfOrder=11, authorNames=Zhao X, Hong F, Yin JZ, journalName=International Journal of Epidemiology, refType=null, unstructuredReference=Zhao X, Hong F, Yin JZ, et al. Cohort profile: the China Multi-Ethnic cohort (CMEC) study[J]. International Journal of Epidemiology, 2021, 50(3): 721-721l., articleTitle=Cohort profile: the China Multi-Ethnic cohort (CMEC) study, refAbstract=null), Reference(id=1241771817115914765, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2023, volume=35, issue=3, pageStart=327, pageEnd=332, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=Su S, Trinh A, Metz AJ, journalName=European Journal of Gastroenterology & Hepatology, refType=null, unstructuredReference=Su S, Trinh A, Metz AJ, et al. Targeted liver ultrasound performed by an expert is the pivotal imaging examination for lowphospholipid-associated cholelithiasis[J]. European Journal of Gastroenterology & Hepatology, 2023, 35(3): 327-332., articleTitle=Targeted liver ultrasound performed by an expert is the pivotal imaging examination for lowphospholipid-associated cholelithiasis, refAbstract=null), Reference(id=1241771817224966681, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2020, volume=327, issue=null, pageStart=100, pageEnd=116, url=null, language=null, rfNumber=[14], rfOrder=13, authorNames=Deng FY, Bae YH, journalName=Journal of Controlled Release, refType=null, unstructuredReference=Deng FY, Bae YH. Bile acid transporter-mediated oral drug delivery[J]. Journal of Controlled Release, 2020, 327: 100-116., articleTitle=Bile acid transporter-mediated oral drug delivery, refAbstract=null), Reference(id=1241771817338212898, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2024, volume=40, issue=1, pageStart=199, pageEnd=203, url=null, language=null, rfNumber=[15], rfOrder=14, authorNames=谢晓暄, 杜丽娜, 郭紫云, journalName=临床肝胆病杂志, refType=null, unstructuredReference=谢晓暄，杜丽娜，郭紫云，等．顶端钠依赖性胆汁酸转运蛋白(ASBT)在肝胆疾病中的作用[J]．临床肝胆病杂志，2024，40（1）：199-203．, articleTitle=顶端钠依赖性胆汁酸转运蛋白(ASBT)在肝胆疾病中的作用, refAbstract=null), Reference(id=1241771817422098989, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2024, volume=40, issue=1, pageStart=199, pageEnd=203, url=null, language=null, rfNumber=[15], rfOrder=15, authorNames=Xie XX, Du LN, Guo ZY, journalName=Journal of Clinical Hepatology, refType=null, unstructuredReference=Xie XX, Du LN, Guo ZY, et al. Role of apical sodium-dependent bile acid transporter in hepatobiliary diseases[J]. Journal of Clinical Hepatology, 2024, 40(1): 199-203. (In Chinese), articleTitle=Role of apical sodium-dependent bile acid transporter in hepatobiliary diseases, refAbstract=null), Reference(id=1241771817531150903, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2023, volume=904, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[16], rfOrder=16, authorNames=Wang J, Sun YX, Xiang S, journalName=Science of the Total Environment, refType=null, unstructuredReference=Wang J, Sun YX, Xiang S, et al. The association between blood heavy metals and gallstones: A cross-sectional study[J]. Science of the Total Environment, 2023, 904: 166735., articleTitle=The association between blood heavy metals and gallstones: A cross-sectional study, refAbstract=null), Reference(id=1241771819104014910, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, doi=null, pmid=null, pmcid=null, year=2024, volume=103, issue=14, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[17], rfOrder=17, authorNames=Yan SM, Yu LH, Fang SL, journalName=Medicine, refType=null, unstructuredReference=Yan SM, Yu LH, Fang SL, et al. The association between intakes of dietary trace minerals and gallstone disease: A cross-sectional study from National Health and Nutrition Examination Survey 2017 to 2018[J]. Medicine, 2024, 103(14): e37741., articleTitle=The association between intakes of dietary trace minerals and gallstone disease: A cross-sectional study from National Health and Nutrition Examination Survey 2017 to 2018, refAbstract=null)], funds=[Fund(id=1241771814863573342, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, awardId=2017YFC0907301, language=CN, fundingSource=国家重点研发计划课题(2017YFC0907301), fundOrder=null, country=null), Fund(id=1241771815064899952, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, awardId=82173566, language=CN, fundingSource=国家自然科学基金(82173566), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241771806839869500, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, xref=null, ext=[AuthorCompanyExt(id=1241771806852452413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, companyId=1241771806839869500, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Key Laboratory of Environmental Pollution and Disease Control of Ministry of Education,School of Public Health and Health, Guizhou Medical University, Guiyang, Guizhou 561113, China), AuthorCompanyExt(id=1241771806860841022, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, companyId=1241771806839869500, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=贵州医科大学公共卫生与健康学院，环境污染与疾病监控教育部重点实验室，贵州 贵阳 550025)])], figs=[ArticleFig(id=1241771811172585701, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=EN, label=Fig.1, caption=Correlation analysis of metal elements in urine and gallstones in Bouyei meninqiannan region, figureFileSmall=v+TH/6NdwSi5v4YeBbmuqw==, figureFileBig=ZJS1hgpC8MWE0eLPRgIvEQ==, tableContent=null), ArticleFig(id=1241771811290026222, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=CN, label=图1, caption=黔南地区布依族男性尿中金属元素与胆结石的关联性分析

注：Ａ：布依族男性人群尿中金属元素浓度与胆结石的关联性分析（未调整协变量）；Ｂ：布依族男性人群尿中金属元素浓度与胆结石的关联性分析 （调整年龄、户口类型、全家收入、体重指数、高血压、油茶、喝茶习惯、胆固醇、低密度脂蛋白胆固醇、甘油三酯、高密度脂蛋白胆固醇）。

, figureFileSmall=v+TH/6NdwSi5v4YeBbmuqw==, figureFileBig=ZJS1hgpC8MWE0eLPRgIvEQ==, tableContent=null), ArticleFig(id=1241771811571044602, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=EN, label=Fig.2, caption=Correlation analysis of urinary metal elements and gallstones in Bouyeiwomeninqiannan region, figureFileSmall=gMfu90bOXWS8pXiyTHjpQg==, figureFileBig=Zg9jnlDTGvJaJXPPhdsWsA==, tableContent=null), ArticleFig(id=1241771811709456645, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=CN, label=图2, caption=黔南地区布依族女性尿中金属元素与胆结石的关联性分析

注：Ａ：布依族女性尿中金属元素与胆结石的关联性分析（未调整协变量）；Ｂ：苗布依族女性尿中金属元素与胆结石的关联性分析（调整年龄、户口类型、全家收入、体重指数、高血压、油茶、喝茶习惯、胆固醇、低密度脂蛋白胆固醇、甘油三酯、高密度脂蛋白胆固醇）。

, figureFileSmall=gMfu90bOXWS8pXiyTHjpQg==, figureFileBig=Zg9jnlDTGvJaJXPPhdsWsA==, tableContent=null), ArticleFig(id=1241771811847868688, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=EN, label=Fig.3, caption=Dose-response relationship between urinary selenium, urinary iron and gallstone risk in male of Bouyei populationinqiannan region, figureFileSmall=RXAEHFA3ZhhT3WxzMZHpXQ==, figureFileBig=qxaEhKhY9jgl7Pi+7fEymg==, tableContent=null), ArticleFig(id=1241771811940143384, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=CN, label=图3, caption=黔南地区布依族男性尿硒、尿铁与胆结石患病风险的剂量反应关系图

注：Ａ：对数转换后的尿硒浓度和胆结石患病风险的剂量反应关系图；Ｂ：对数转换后的尿铁浓度和胆结石患病风险的剂量反应关系图。两个模型都调整了年龄、户口类型、全家收入、体重指数、高血压、油茶、喝茶习惯、胆固醇、低密度脂蛋白胆固醇、甘油三酯、高密度脂蛋白胆固醇。

, figureFileSmall=RXAEHFA3ZhhT3WxzMZHpXQ==, figureFileBig=qxaEhKhY9jgl7Pi+7fEymg==, tableContent=null), ArticleFig(id=1241771812212773154, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=EN, label=Fig.4, caption=Dose-response relationship between urinary selenium, urinary iron and gallstone risk in female of Bouyei populationinqiannan region, figureFileSmall=TpkQhPYoY7TQCB9zC/FgVA==, figureFileBig=fAInzoTD658+JvdwfyFAYA==, tableContent=null), ArticleFig(id=1241771812447654187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=CN, label=图4, caption=布依族女性尿铝、尿钠与胆结石患病风险的剂量反应关系图

注：Ａ：对数转换后的尿铝浓度和胆结石患病风险的剂量反应关系图；Ｂ：对数转换后的尿钠浓度和胆结石患病风险的剂量反应关系图。两个模型都调整了年龄、户口类型、全家收入、体重指数、高血压、油茶、喝茶习惯、胆固醇、低密度脂蛋白胆固醇、甘油三酯、高密度脂蛋白胆固醇。

, figureFileSmall=TpkQhPYoY7TQCB9zC/FgVA==, figureFileBig=fAInzoTD658+JvdwfyFAYA==, tableContent=null), ArticleFig(id=1241771812674146612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=EN, label=Table 1, caption=

The description of basic characteristics in Bouyei populationinqiannan region

, figureFileSmall=null, figureFileBig=null, tableContent=
特征男性女性
非胆结石胆结石Z/χ2值P值非胆结石胆结石Z/χ2值P值
年龄(岁)1.7570.41514.2540.001
>30～45386(26.259)27(23.478)952(29.657)59(19.799)
>45～60658(44.762)48(41.739)1 552(48.349)156(52.349)
>60426(28.980)40(34.783)706(21.994)83(27.852)
户口类型0.8980.3435.6840.017
农村1 285(87.415)97(84.348)2 861(89.128)252(84.564)
城市1 85(12.585)18(15.652)349(10.872)46(15.436)
婚姻状态5.7510.0562.2920.318
已婚/同居1 308(88.980)103(89.565)2 766(86.168)248(83.221)
分居/离异/丧偶130(8.844)6(5.217)439(13.676)49(16.443)
从未结婚32(2.177)6(5.217)5(0.156)1(0.336)
教育程度1.1310.5682.9310.231
初中及以下1 211(82.381)91(79.130)2 861(89.128)257(86.242)
高中（包括中专、技校）166(11.293)14(12.174)191(5.950)20(6.711)
大专，大学（包括研究生）93(6.327)10(8.696)158(4.922)21(7.047)
职业类型0.8660.8345.8290.120
从事第一产业657(44.694)52(45.217)1 313(40.903)116(38.926)
从事第二产业219(14.898)18(15.652)363(11.308)23(7.718)
从事第三产业305(20.748)20(17.391)1 142(35.576)114(38.255)
待业或其他289(19.660)25(21.739)392(12.212)45(15.101)
家庭年总收入（元）3.3930.63912.5280.028
<12 000506(34.422)42(36.522)1 025(31.931)107(35.906)
12 000～19 999316(21.497)26(22.609)783(24.393)63(21.141)
20 000～59 999425(28.912)25(21.739)989(30.810)76(25.503)
6 0000~99 999130(8.844)13(11.304)264(8.224)28(9.396)
100 000～199 99986(5.850)8(6.957)130(4.050)22(7.382)
≥200 0007(0.476)1(0.870)19(0.592)2(0.671)
吸烟3.5300.1711.2190.544
从不648(44.082)55(47.826)3 198(99.626)296(99.329)
在吸666(45.306)43(37.391)10(0.312)2(0.671)
已戒156(10.612)17(14.782)2(0.062)0(0.0)
喝酒1.0340.5961.3980.497
从不354(24.082)32(27.826)1 917(59.720)176(59.060)
偶尔662(45.034)47(40.870)1 166(36.323)106(35.570)
经常454(30.884)36(31.304)127(3.956)16(5.369)
BMI（kg/m2）1.8770.39133.818<0.001
偏轻(0～18.50)39(2.653)2(1.739)148(4.611)7(2.349)
正常(>18.50～24)681(46.326)47(40.870)1 608(50.093)104(34.899)
超重(>24.00)750(51.020)66(57.391)1 454(45.296)187(62.752)
高血压0.8020.3716.9220.009
否1 152(78.367)86(74.782)2 783(86.698)242(81.208)
是318(21.633)29(25.217)427(13.302)56(18.792)
糖尿病2.1470.1432.6140.106
否1410(95.918)107(93.043)3 139(97.788)287(96.309)
是60(4.082)8(6.957)71(2.212)11(3.691)
高脂血症2.5710.1092.1430.143
否1 413(96.122)107(93.043)3 152(98.193)289(96.980)
是57(3.878)8(7.957)58(1.807)9(3.020)
是否食用腌制蔬菜0.0990.7530.4140.520
否687(46.735)52(45.217)1 521(47.383)147(49.329)
是783(53.265)63(54.783)1 689(52.617)151(50.671)
是否食用糯米及其制品2.8290.0930.2590.611
否392(26.667)39(33.913)534(16.636)53(17.785)
是1 078(73.333)76(66.087)2 676(83.364)245(82.215)
是否食用腌制鱼/肉类0.0760.7830.0530.818
否1 108(75.374)88(76.522)2502(77.944)234(78.523)
是362(24.626)27(23.478)708(22.056)64(21.477)
是否食用腊/熏肉0.1240.7250.1390.709
否156(10.612)11(9.565)290(9.034)25(8.389)
是1314(89.388)104(90.434)2920(90.966)273(91.611)
是否食用酸汤（白酸）0.0620.8030.0890.765
否1 019(69.320)81(70.435)2 268(70.654)213(71.477)
是451(30.680)34(29.565)942(29.346)85(28.523)
是否食用酸汤（红酸）3.3430.0672.5020.114
否588(40.000)56(48.696)1171(36.480)95(31.879)
是882(60.000)59(51.304)2039(63.520)203(68.121)
是否食用牛/羊瘪菜0.4450.5051.2210.269
否1 327(90.272)106(92.173)2 971(92.555)281(94.295)
是143(9.728)9(7.826)239(7.445)17(5.705)
是否食用紫血肉0.2920.5901.0890.297
否1 107(75.306)84(73.043)2 660(82.866)254(85.235)
是363(24.694)31(26.957)550(17.134)44(14.765)
是否食用鱼腥草0.3430.5580.0630.802
否311(21.156)27(23.478)677(21.090)61(20.470)
是1 159(78.844)88(76.521)2 533(78.910)237(79.530)
是否食用蕨菜0.0880.7672.0440.153
否240(16.327)20(17.391)622(19.377)68(22.819)
是1 230(83.673)95(82.609)2 588(80.623)230(77.181)
是否食用油茶5.0070.2531.4420.230
否1 425(96.939)107(93.043)3 111(96.916)285(95.638)
是45(3.061)8(6.957)99(3.0084)13(4.362)
是否有喝茶习惯0.3020.58312.2380.001
否1157(78.707)88(76.522)2981(92.866)260(87.248)
是313(21.293)27(23.478)229(7.134)38(12.752)
胆固醇(mmol/L)4.900(4.310, 5.550)4.735(4.203, 5.345)-1.8280.0684.880(4.320, 5.520)5.060(4.420, 5.600)-2.1540.031
低密度脂蛋白胆固醇(mmol/L)2.500(2.030, 3.000)2.500(2.100, 2.855)-0.7550.4502.420(2.030, 2.900)2.580(2.110, 3.030)-2.9030.004
甘油三酯(mmol/L)1.580(1.080, 2.460)1.395(0.992, 2.090)-1.7360.0831.310(0.960, 1.860)1.460(1.080, 2.040)-3.547<0.001
高密度脂蛋白胆固醇（mmol/L)1.450(1.280, 1.660)1.405(1.240, 1.555)-2.1830.0291.520(1.350, 1.700)1.520(1.340, 1.680)-0.8580.391
), ArticleFig(id=1241771813009690939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=CN, label=表1, caption=

黔南地区布依族人群基本特征描述

, figureFileSmall=null, figureFileBig=null, tableContent=
特征男性女性
非胆结石胆结石Z/χ2值P值非胆结石胆结石Z/χ2值P值
年龄(岁)1.7570.41514.2540.001
>30～45386(26.259)27(23.478)952(29.657)59(19.799)
>45～60658(44.762)48(41.739)1 552(48.349)156(52.349)
>60426(28.980)40(34.783)706(21.994)83(27.852)
户口类型0.8980.3435.6840.017
农村1 285(87.415)97(84.348)2 861(89.128)252(84.564)
城市1 85(12.585)18(15.652)349(10.872)46(15.436)
婚姻状态5.7510.0562.2920.318
已婚/同居1 308(88.980)103(89.565)2 766(86.168)248(83.221)
分居/离异/丧偶130(8.844)6(5.217)439(13.676)49(16.443)
从未结婚32(2.177)6(5.217)5(0.156)1(0.336)
教育程度1.1310.5682.9310.231
初中及以下1 211(82.381)91(79.130)2 861(89.128)257(86.242)
高中（包括中专、技校）166(11.293)14(12.174)191(5.950)20(6.711)
大专，大学（包括研究生）93(6.327)10(8.696)158(4.922)21(7.047)
职业类型0.8660.8345.8290.120
从事第一产业657(44.694)52(45.217)1 313(40.903)116(38.926)
从事第二产业219(14.898)18(15.652)363(11.308)23(7.718)
从事第三产业305(20.748)20(17.391)1 142(35.576)114(38.255)
待业或其他289(19.660)25(21.739)392(12.212)45(15.101)
家庭年总收入（元）3.3930.63912.5280.028
<12 000506(34.422)42(36.522)1 025(31.931)107(35.906)
12 000～19 999316(21.497)26(22.609)783(24.393)63(21.141)
20 000～59 999425(28.912)25(21.739)989(30.810)76(25.503)
6 0000~99 999130(8.844)13(11.304)264(8.224)28(9.396)
100 000～199 99986(5.850)8(6.957)130(4.050)22(7.382)
≥200 0007(0.476)1(0.870)19(0.592)2(0.671)
吸烟3.5300.1711.2190.544
从不648(44.082)55(47.826)3 198(99.626)296(99.329)
在吸666(45.306)43(37.391)10(0.312)2(0.671)
已戒156(10.612)17(14.782)2(0.062)0(0.0)
喝酒1.0340.5961.3980.497
从不354(24.082)32(27.826)1 917(59.720)176(59.060)
偶尔662(45.034)47(40.870)1 166(36.323)106(35.570)
经常454(30.884)36(31.304)127(3.956)16(5.369)
BMI（kg/m2）1.8770.39133.818<0.001
偏轻(0～18.50)39(2.653)2(1.739)148(4.611)7(2.349)
正常(>18.50～24)681(46.326)47(40.870)1 608(50.093)104(34.899)
超重(>24.00)750(51.020)66(57.391)1 454(45.296)187(62.752)
高血压0.8020.3716.9220.009
否1 152(78.367)86(74.782)2 783(86.698)242(81.208)
是318(21.633)29(25.217)427(13.302)56(18.792)
糖尿病2.1470.1432.6140.106
否1410(95.918)107(93.043)3 139(97.788)287(96.309)
是60(4.082)8(6.957)71(2.212)11(3.691)
高脂血症2.5710.1092.1430.143
否1 413(96.122)107(93.043)3 152(98.193)289(96.980)
是57(3.878)8(7.957)58(1.807)9(3.020)
是否食用腌制蔬菜0.0990.7530.4140.520
否687(46.735)52(45.217)1 521(47.383)147(49.329)
是783(53.265)63(54.783)1 689(52.617)151(50.671)
是否食用糯米及其制品2.8290.0930.2590.611
否392(26.667)39(33.913)534(16.636)53(17.785)
是1 078(73.333)76(66.087)2 676(83.364)245(82.215)
是否食用腌制鱼/肉类0.0760.7830.0530.818
否1 108(75.374)88(76.522)2502(77.944)234(78.523)
是362(24.626)27(23.478)708(22.056)64(21.477)
是否食用腊/熏肉0.1240.7250.1390.709
否156(10.612)11(9.565)290(9.034)25(8.389)
是1314(89.388)104(90.434)2920(90.966)273(91.611)
是否食用酸汤（白酸）0.0620.8030.0890.765
否1 019(69.320)81(70.435)2 268(70.654)213(71.477)
是451(30.680)34(29.565)942(29.346)85(28.523)
是否食用酸汤（红酸）3.3430.0672.5020.114
否588(40.000)56(48.696)1171(36.480)95(31.879)
是882(60.000)59(51.304)2039(63.520)203(68.121)
是否食用牛/羊瘪菜0.4450.5051.2210.269
否1 327(90.272)106(92.173)2 971(92.555)281(94.295)
是143(9.728)9(7.826)239(7.445)17(5.705)
是否食用紫血肉0.2920.5901.0890.297
否1 107(75.306)84(73.043)2 660(82.866)254(85.235)
是363(24.694)31(26.957)550(17.134)44(14.765)
是否食用鱼腥草0.3430.5580.0630.802
否311(21.156)27(23.478)677(21.090)61(20.470)
是1 159(78.844)88(76.521)2 533(78.910)237(79.530)
是否食用蕨菜0.0880.7672.0440.153
否240(16.327)20(17.391)622(19.377)68(22.819)
是1 230(83.673)95(82.609)2 588(80.623)230(77.181)
是否食用油茶5.0070.2531.4420.230
否1 425(96.939)107(93.043)3 111(96.916)285(95.638)
是45(3.061)8(6.957)99(3.0084)13(4.362)
是否有喝茶习惯0.3020.58312.2380.001
否1157(78.707)88(76.522)2981(92.866)260(87.248)
是313(21.293)27(23.478)229(7.134)38(12.752)
胆固醇(mmol/L)4.900(4.310, 5.550)4.735(4.203, 5.345)-1.8280.0684.880(4.320, 5.520)5.060(4.420, 5.600)-2.1540.031
低密度脂蛋白胆固醇(mmol/L)2.500(2.030, 3.000)2.500(2.100, 2.855)-0.7550.4502.420(2.030, 2.900)2.580(2.110, 3.030)-2.9030.004
甘油三酯(mmol/L)1.580(1.080, 2.460)1.395(0.992, 2.090)-1.7360.0831.310(0.960, 1.860)1.460(1.080, 2.040)-3.547<0.001
高密度脂蛋白胆固醇（mmol/L)1.450(1.280, 1.660)1.405(1.240, 1.555)-2.1830.0291.520(1.350, 1.700)1.520(1.340, 1.680)-0.8580.391
), ArticleFig(id=1241771814523834697, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=EN, label=Table 2, caption=

The urinary metal distribution for the Bouyei populationinqiannan region (ug/L）

, figureFileSmall=null, figureFileBig=null, tableContent=
金属元素男性
非胆结石胆结石Z/χ2值P值
Al5.98(0.01,33.40)10.75(0.01,63.41)-1.4610.144
As53.78(37.35,75.51)51.55(35.63,71.19)-0.8830.377
B922.20(629.73,1 408.57)1 007.47(652.97,1 436.46)-1.1030.270
Cd1.76(0.37,3.94)1.70(0.54,3.35)-0.1890.851
Co0.00(0.00,0.06)0.00(0.00,0.00)-0.1030.918
Cr16.35(0.92,47.02)8.59(1.14,50.12)-0.3280.743
Cu58.66(12.69,270.98)27.32(12.72,224.39)-1.0190.308
Fe252.06(115.05,699.63)265.92(128.48,571.08)-0.2560.798
Hg0.28(0.22,0.37)0.25(0.22,0.37)-0.2060.837
Li13.75(8.81,21.92)13.97(9.03,23.82)-0.1960.845
Mn0.00(0.00,1.47)0.00(0.00,1.16)-0.4300.667
Mo88.86(54.06,152.34)101.90(50.72,173.02)-1.1550.248
Ni1.09(0.00,8.38)1.09(0.00,6.57)-0.2130.831
Pb0.97(0.00,2.73)0.96(0.00,2.51)-0.4140.679
Sr84.34(54.12,124.25)88.81(57.65,128.03)-0.5840.559
Se27.32 (11.10, 42.79)31.43 (19.17, 42.77)-1.8960.058
V14.48(2.33,38.20)8.20(1.54,35.15)-1.4870.137
Zn720.24(498.59,1 044.31)749.66(540.84,1 225.27)-1.4570.145
Ca10 118.69(4 019.23,27 976.14)9 206.54(3 764.44,41 714.49)-0.5270.598
Na230 556.66(114 075.50,364 338.97)246 638.01(123 464.58,357 651.23)-0.1730.863
Mg7 200.10(4 357.80,13 682.1)7 144.18(3 718.00,15 742.34)-0.0090.993
P83 493.03(37 561.38,204 468.06)88 410.21(37 563.45,251 452.88)-0.8240.410
金属元素女性
非胆结石胆结石Z/χ2值P值
Al0.10(0.01,32.67)6.10(0.01,37.58)-2.4570.014
As53.12(34.88,75.24)49.82(32.22,70.93)-1.5420.123
B1 061.80(706.73,1 607.5)1 088.05(763.61,1 807.22)-1.7110.087
Cd2.45(0.55,5.34)2.81(0.85,5.29)-1.1770.239
Co0.00(0.00,0.24)0.00(0.00,0.08)-1.8180.069
Cr20.09(1.16,44.09)9.77(0.96,40.35)-1.9110.056
Cu99.28(12.01,266.15)49.45(12.34,231.12)-1.0390.299
Fe291.44(121.44,719.47)246.15(119.49,619.54)-1.2700.204
Hg0.28(0.22,0.37)0.22(0.22,0.37)-1.5100.131
Li11.85(7.02,19.73)12.34(7.60,20.63)-1.6250.104
Mn0.00(0.00,1.43)0.00(0.00,1.49)-0.8060.420
Mo79.32(49.90,130.77)79.50(50.96,118.90)-0.5270.598
Ni1.67(0.00,9.28)1.21(0.00,6.94)-1.7510.080
Pb0.62(0.00,2.18)0.89(0.00,2.35)-1.5980.110
Sr79.01(49.20,117.02)76.28(49.41,114.75)-0.2480.804
Se23.57 (8.33, 40.81)23.45 (7.31, 40.73)-0.1790.858
V17.28(2.47,39.60)11.36(2.17,37.74)-1.3850.166
Zn490.42(322.98,747.30)535.23(353.12,797.22)-1.5980.110
Ca9 337.68(4 059.28,24 030.52)9 891.84(3 704.80,29 422.44)-0.1310.896
Na246 838.29(129 547.09,381 899.18)219 950.16(122 691.52,335 342.06)-2.1970.028
Mg7 197.56(4 282.80,12 814.78)6 699.65(3 826.66,12 568.62)-1.1770.239
P76 724.15(38 253.93,216 026.04)82 426.61(39 601.31,223 105.58)-0.7450.456
), ArticleFig(id=1241771814679023953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803585089562, language=CN, label=表2, caption=

黔南地区布依族男女性尿液中的金属元素分布(ug/L）

, figureFileSmall=null, figureFileBig=null, tableContent=
金属元素男性
非胆结石胆结石Z/χ2值P值
Al5.98(0.01,33.40)10.75(0.01,63.41)-1.4610.144
As53.78(37.35,75.51)51.55(35.63,71.19)-0.8830.377
B922.20(629.73,1 408.57)1 007.47(652.97,1 436.46)-1.1030.270
Cd1.76(0.37,3.94)1.70(0.54,3.35)-0.1890.851
Co0.00(0.00,0.06)0.00(0.00,0.00)-0.1030.918
Cr16.35(0.92,47.02)8.59(1.14,50.12)-0.3280.743
Cu58.66(12.69,270.98)27.32(12.72,224.39)-1.0190.308
Fe252.06(115.05,699.63)265.92(128.48,571.08)-0.2560.798
Hg0.28(0.22,0.37)0.25(0.22,0.37)-0.2060.837
Li13.75(8.81,21.92)13.97(9.03,23.82)-0.1960.845
Mn0.00(0.00,1.47)0.00(0.00,1.16)-0.4300.667
Mo88.86(54.06,152.34)101.90(50.72,173.02)-1.1550.248
Ni1.09(0.00,8.38)1.09(0.00,6.57)-0.2130.831
Pb0.97(0.00,2.73)0.96(0.00,2.51)-0.4140.679
Sr84.34(54.12,124.25)88.81(57.65,128.03)-0.5840.559
Se27.32 (11.10, 42.79)31.43 (19.17, 42.77)-1.8960.058
V14.48(2.33,38.20)8.20(1.54,35.15)-1.4870.137
Zn720.24(498.59,1 044.31)749.66(540.84,1 225.27)-1.4570.145
Ca10 118.69(4 019.23,27 976.14)9 206.54(3 764.44,41 714.49)-0.5270.598
Na230 556.66(114 075.50,364 338.97)246 638.01(123 464.58,357 651.23)-0.1730.863
Mg7 200.10(4 357.80,13 682.1)7 144.18(3 718.00,15 742.34)-0.0090.993
P83 493.03(37 561.38,204 468.06)88 410.21(37 563.45,251 452.88)-0.8240.410
金属元素女性
非胆结石胆结石Z/χ2值P值
Al0.10(0.01,32.67)6.10(0.01,37.58)-2.4570.014
As53.12(34.88,75.24)49.82(32.22,70.93)-1.5420.123
B1 061.80(706.73,1 607.5)1 088.05(763.61,1 807.22)-1.7110.087
Cd2.45(0.55,5.34)2.81(0.85,5.29)-1.1770.239
Co0.00(0.00,0.24)0.00(0.00,0.08)-1.8180.069
Cr20.09(1.16,44.09)9.77(0.96,40.35)-1.9110.056
Cu99.28(12.01,266.15)49.45(12.34,231.12)-1.0390.299
Fe291.44(121.44,719.47)246.15(119.49,619.54)-1.2700.204
Hg0.28(0.22,0.37)0.22(0.22,0.37)-1.5100.131
Li11.85(7.02,19.73)12.34(7.60,20.63)-1.6250.104
Mn0.00(0.00,1.43)0.00(0.00,1.49)-0.8060.420
Mo79.32(49.90,130.77)79.50(50.96,118.90)-0.5270.598
Ni1.67(0.00,9.28)1.21(0.00,6.94)-1.7510.080
Pb0.62(0.00,2.18)0.89(0.00,2.35)-1.5980.110
Sr79.01(49.20,117.02)76.28(49.41,114.75)-0.2480.804
Se23.57 (8.33, 40.81)23.45 (7.31, 40.73)-0.1790.858
V17.28(2.47,39.60)11.36(2.17,37.74)-1.3850.166
Zn490.42(322.98,747.30)535.23(353.12,797.22)-1.5980.110
Ca9 337.68(4 059.28,24 030.52)9 891.84(3 704.80,29 422.44)-0.1310.896
Na246 838.29(129 547.09,381 899.18)219 950.16(122 691.52,335 342.06)-2.1970.028
Mg7 197.56(4 282.80,12 814.78)6 699.65(3 826.66,12 568.62)-1.1770.239
P76 724.15(38 253.93,216 026.04)82 426.61(39 601.31,223 105.58)-0.7450.456
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黔南地区不同性别的布依族尿液金属浓度与胆结石患病风险的关联研究
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周恩慧 , 吴申燕 , 胡宇欣 , 肖斐 , 王媛 , 洪峰
现代预防医学 | 流行病与统计方法 2024,51(20): 3649-3656
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现代预防医学 | 流行病与统计方法 2024, 51(20): 3649-3656
黔南地区不同性别的布依族尿液金属浓度与胆结石患病风险的关联研究
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周恩慧, 吴申燕, 胡宇欣, 肖斐, 王媛, 洪峰
作者信息
  • 贵州医科大学公共卫生与健康学院，环境污染与疾病监控教育部重点实验室，贵州 贵阳 550025

    • 周恩慧（1999—），女，硕士在读，研究方向：环境与遗传流行病学

通讯作者:

洪峰, E-mail :
Gender-specific association between urinary metal and urinary metal in Bouyei population in Qiannan region
En-hui ZHOU, Shen-yan WU, Yu-xin HU, Fei XIAO, Yuan WANG, Feng HONG
Affiliations
  • Key Laboratory of Environmental Pollution and Disease Control of Ministry of Education,School of Public Health and Health, Guizhou Medical University, Guiyang, Guizhou 561113, China
出版时间: 2024-10-25 doi: 10.20043/j.cnki.MPM.202405471
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摘要
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目的

本研究旨在探究黔南布依族人群尿液中22种金属元素与胆结石风险的关联，提供科学依据以促进早期的预防和干预措施。

方法

2018年7月至2019年8月，在黔南布依族苗族自治州，采用多阶段分层整群抽样对30至79岁居民进行基线调查，其中包括了问卷、体检和ICP-MS检测尿液金属元素浓度。将尿金属浓度分为四组(Q1、Q2、Q3、Q4)，并运用二元logistic回归模型分析单个金属元素与胆结石风险的关系。同时，通过应用限制性立方样条分析，进一步深入分析了金属元素浓度与胆结石风险之间的剂量-反应关系。

结果

布依族总人群的胆结石检出率为8.825%。二元logistic回归模型结果显示，调整协变量后，在男性群体中，以Q1组为参考组，硒Q2组(OR=1.894，95%CI: 1.046～3.431)；硒Q3组(OR=1.912，95%CI: 1.053～3.472)；铁Q3组(OR=1.827，95%CI: 1.040～3.210)与胆结石患病风险呈正相关。在女性群体中，以Q1组为参考组，铝Q3组(OR=1.460，95%CI: 1.050～2.028)与胆结石患病风险呈正相关；钠Q4组(OR=0.654，95%CI: 0.452～0.948)与胆结石患病风险呈负相关，且存在剂量反应关系。

结论

尿液中特定金属元素的浓度与胆结石风险存在显著的相关性。特别是在布依族女性群体中，尿铝和尿钠的浓度对胆结石的形成具有显著的影响，为未来的预防和治疗策略提供了可能的方向。

胆结石  /  重金属  /  布依族
Objective

The primary objective of this study was to investigate the potential correlation between the presence of 22 metals in urine and the risk of developing gallstones in Bouyei population in qiannan region, ultimately aiming to furnish a scientific foundation for early preventative measures and targeted interventions.

Methods

From July 2018 to August 2019, a baseline survey was conducted among residents aged 30 to 79 years in Qiannan Bouyei and Miao Autonomous Prefecture using multistage stratified cluster sampling, including questionnaires, physical examination and ICP-MS to detect urine metal concentration. Urinary metal concentrations were divided into four groups (Q1, Q2, Q3, Q4), and binary logistic regression model was used to analyze the relationship between single metal and gallstone risk. At the same time, the dose-response relationship between metal concentration and gallstone risk was investigated by using restricted cubic splines.

Results

The gallstone detection rate of Bouyei population was 8.825%. After adjusting for covariates, binary logistic regression analysis revealed that in the male group, compared to the Q1 group, there was a positive association between gallstone risk and selenium in the Q2 group (OR=1.894, 95%CI: 1.046-3.431), Se in the Q3 group (OR=1.912, 95%CI: 1.053-3.472), and Fe in the Q3 group (OR=1.827, 95%CI: 1.040-3.210). In the female group, Al in the Q3 group (OR=1.460, 95%CI: 1.050-2.028) was positively associated with gallstone risk, while Na in the Q4 group (OR=0.654, 95%CI: 0.452-0.948) was negatively associated with gallstone risk, with a dose-response relationship observed.

Conclusion

There is a significant correlation between the concentration of certain metals in urine and the risk of gallstones. In the Bouyei female population in particular, urinary aluminum and urinary sodium concentrations have a significant impact on gallstone formation, providing possible directions for future prevention and treatment strategies.

Gallstone  /  Heavy metal  /  Bouyei population
周恩慧, 吴申燕, 胡宇欣, 肖斐, 王媛, 洪峰. 黔南地区不同性别的布依族尿液金属浓度与胆结石患病风险的关联研究. 现代预防医学, 2024 , 51 (20) : 3649 -3656 . DOI: 10.20043/j.cnki.MPM.202405471
En-hui ZHOU, Shen-yan WU, Yu-xin HU, Fei XIAO, Yuan WANG, Feng HONG. Gender-specific association between urinary metal and urinary metal in Bouyei population in Qiannan region[J]. Modern Preventive Medicine, 2024 , 51 (20) : 3649 -3656 . DOI: 10.20043/j.cnki.MPM.202405471
正文
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胆结石是一种常见的泌尿系统疾病，通常10%～20%成年的胆结石患者会出现症状或并发症，比如胆道绞痛或感染[1]。在过去的十年中，东亚地区胆结石疾病的发病率一直在增加[2]。环境污染物中，重金属是一个广受关注的类别，其对人类健康的潜在危害尤为严峻。随着工业化进程的加快与城市规模的扩张，多种渠道使得这些污染物得以渗透至自然环境之中[3]。因此，人们通过各种途径接触到重金属，包括水、空气、饮食和皮肤接触[4]。随着时间的推移，重金属极有可能在组织和器官中积累[5]。这种积累可导致多种健康问题，如胆脏损伤、心血管疾病和神经毒性[6-7]。并且在结石的组成中发现了不同种类的重金属和微量元素[8]。目前有研究表明，通过食物摄入的钙，镁元素是胆结石的保护因素[9]，并且也有其他研究发现增加食物中镁的摄入量来降低出现胆结石症状的风险[10]。一项横断面研究表明于胆结石组相比与正常对照组，体内的硼，钼和钒明显增多，并且有剂量-反应趋势[11]。当前，多数研究主要聚焦于汉族群体，而对于少数民族，特别是关于多金属元素暴露与胆结石之间关联的流行病学数据显得尤为稀缺。鉴于此，本研究计划以黔南地区的布依族人群为基础，深入探究其尿液中22种金属元素的内暴露水平与胆结石之间的关系，这一举措旨在为少数民族群体提供一个强有力的科学依据，以便更早地识别和防范相关风险，并科学指导相关干预措施的制定。
1　资料与方法
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1.1　研究对象
本研究基于“西南区域少数民族聚集地世居自然人群队列研究”数据库。该项目于2018年7月至2019年8月在贵州黔南布依族苗族自治州开展，采用多阶段分层整群抽样，对当地30～79岁布依族居民进行基线调查，包括电子问卷、体检和实验室分析。纳入标准为年龄30～79岁，三代以上居住当地，自愿参与并同意提供生物样本，且无精神或严重疾病，具正常沟通能力的布依族居民。排除标准为恶性肿瘤、有相关疾病史、未提供尿样、有胆囊切除史及未进行腹部超声者。筛选后，共纳入5 093名参与者。本研究获四川大学华西医院（K2016038）和贵州医科大学附属医院（2018（094））医学伦理委员会批准，所有参与者均签署知情同意书。
1.2　研究内容
本研究采用中国多民族队列研究项目组开发的电子问卷[12]，内容涵盖人口统计、生活方式及病史，由专业调查员与参与者共同完成。胆结石的诊断基于腹部B超检查（SIUI Apogee1200），通过识别胆囊内的声影来确定[13]。胆道沉淀物归类为胆结石，胆囊切除则通过通过病历记录或手术记录来确认。所有调查员及专科医生在研究前均接受标准化培训。变量定义如下：年龄分为30～45岁、45～60岁、≥60岁；户口类型为农业和城市；婚姻状态为已婚或同居、分居、离异或丧偶、从未结婚；教育程度为高中及以下、大专及以上；职业为第一、第二、第三产业或待业/其他；全家年收入分为<12 000元、12 000～19 999元、20 000～59 999元、60 000～99 999元、100 000～199 999元、≥200 000元；吸烟状况为从不、吸烟中、已戒烟；饮酒频率为从不、偶尔、经常；BMI分为偏轻、正常、超重；高血压、糖尿病、高脂血症患病状况；饮食习性如腌制蔬菜、糯米及制品摄入频率；以及是否有喝茶习惯。记录了胆固醇、低密度脂蛋白、甘油三酯、高密度脂蛋白（mmol/L）等血液指标。参与者均接受了全面体检，体质指数（BMI）通过体重（kg）除以身高平方（m2）计算。此外，采用电感耦合等离子体质谱法（ICP-MS）检测晨尿中22种元素的浓度。
1.3　尿液中金属元素的测定及质量控制
本研究从禁食超过8 h的志愿者中收集5 ml中游尿液。为确保一致性，将原尿上清液充分混合，用5%硝酸（分析纯，国药化学试剂有限公司，上海）稀释并过滤。实验中，采用超纯水作为试剂空白，并制备了一系列元素标准溶液，用5%硝酸稀释构建标准曲线。使用PerkinElmer的内标溶液（10 μg/L）进行在线定标，确保标准曲线回归系数>0.999，保证分析准确性与重复性。实验用SeronormTM微量元素尿液L-2 RUO（Sero，挪威）作为质控样本，元素回收率在80%至120%之间，符合要求。采用电感耦合等离子体质谱法（ICP-MS）（NexION 2000，PerkinElmer，美国）对22种尿液金属元素进行定量分析。对于浓度低于检测限的元素，采用定量限的一半表示，并结合尿液比重评估，确保数据可靠性。
1.4　统计学分析
人口统计学特征中，连续变量用M（P25，P75）表示，分类变量用频数和百分比表示。组间比较采用Mann-Whitney U检验或卡方检验。尿液金属元素浓度按尿比重校正，低于检测限的值按LOD一半计算。基于性别分层，将金属元素浓度分为四分位数（Q1至Q4），以Q1为参照，运用多因素logistic回归分析金属元素浓度与布依族胆结石的关系，结果用比值比（OR）和95%置信区间（95% CI）表示。模型1为未调整，模型2校正了年龄、户籍、收入、BMI、高血压、油茶消费、饮茶习惯及血脂等变量。统计分析与图表制作采用SPSS 25.0和R 4.0.3，双尾检验，显著性水平设为α=0.05。
2　结果
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2.1　人口学特征
本研究共纳入5 093人，基本信息如表1所示。其中总布依族人群的胆结石检出率为8.825%，男性检出率7.823％，女性检出率为9.283％。在男性布依族群体中，是否食用油茶、高密度脂蛋白胆固醇在胆结石组和非胆结石组中差异有统计学意义（P<0.05）。在女性布依族群体中，年龄 （岁）、户口类型、全家过去一年的总收入、BMI、高血压、是否有喝茶习惯、胆固醇、低密度脂蛋白胆固醇、甘油三酯在胆结石组和非胆结石组中差异有统计学意义（P<0.05）。
2.2　尿液金属元素分布情况
在女性布依族群体中,胆结石组尿铝浓度高于非胆结石组（分别为6.10、0.10ug/L，P=0.014），胆结石组尿钠浓度低于非胆结石组（分别为7 197.56 ug/L、6 699.65 ug/L，P=0.025），其他尿金属元素浓度水平均差异无统计学意义（P> 0.05）。在男性布依族群体中，所有尿金属元素浓度差异均无统计学意义（P>0.05）。
2.3　尿液金属元素与胆结石患病风险的关联分析
在布依族男性群体中（图1），模型1显示，以硒Q1为参考，尿硒水平四分位数与胆结石的OR值分别为1.967 （1.091～3.545） 、1.972 （1.094～3.555） 、1.659 （0.906～3.04）。在调整混杂因素的模型2中，尿硒水平四分位数的胆结石的OR值关系无显著变化，但发现尿铁的Q3与胆结石患病风险有关（P<0.05），在布依族女性群体中（图2），模型1显示，AlQ3、PbQ4、CaQ2、NaQ4与胆结石的OR值分别为1.542 （1.116～2.13）、1.389 （1.004～1.922） 、0.706 （0.5～0.995）、0.619 （0.431～0.889）。在调整混杂因素的模型2中，AlQ3、NaQ4与胆结石的OR值仍然保持显著（P<0.05）。
由图3可知，在布依族男性中，尿硒和尿铁与胆结石患病风险不存在剂量反应关系（P-overall>0.05）；由图4可知，在布依族女性中，尿铝与胆结石患病风险不存在剂量反应关系（P-overall>0.05）。尿钠与胆结石患病风险存在剂量反应关系（P-overall<0.05），但不具有线性关系（P-nonlinearity <0.05）。
3　讨论
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本研究发现，在未调整任何协变量的模型1中，布依族男性群体的尿硒水平与胆结石风险呈正相关，而在调整了混杂因素后，尿铁的浓度与胆结石风险显著相关。对于布依族女性群体，尿铝和尿钠的浓度与胆结石风险显著相关，即使在调整了相应协变量后，这种关联仍然存在。此外，本研究的研究还发现，尿液中的镁和钠是胆结石风险的关键预测指标，这为胆结石的风险评估提供了新的生物标志物。
目前关于钠与胆结石风险的研究有限，但有证据表明，钠可能通过影响顶端钠依赖性胆汁酸转运蛋白（ASBT）来影响胆结石风险。ASBT位于小肠末端上皮细胞顶端，负责胆汁酸重吸收，维持胆汁酸和胆固醇稳态，钠在这一过程中的作用关键[14]。ASBT功能异常可能通过影响胆汁酸代谢，间接导致胆结石形成[15]。本研究发现，在布依族女性中，高钠暴露可能降低胆结石风险，这一结果需进一步研究验证。
硒是人体必需的微量元素，尽管本研究未发现尿液硒与胆结石患病率的剂量反应关系，但其他研究显示血液硒与胆结石正相关[16]，与本研究结果一致，进一步证实了以往研究的结论。
铁的过量储存可能影响肝脏代谢，间接改变胆汁组成与胆囊功能。尽管现有研究表明铁与胆结石关联有限，但Yan的研究表明食物铁摄入与胆结石无显著联系[17]。本研究在布依族男性中发现尿铁水平与胆结石风险正相关，可能与测量对象中的铁含量差异有关，仍需更多研究补充现有空白。
本研究存在一些限制。首先，横截面设计无法确定尿液金属元素与胆结石的因果关系，仅能观察其关联。其次，尽管调整了混杂因素，仍可能存在未量化的混杂因素，如饮食习惯、职业暴露等。此外，尿液金属元素浓度可能受肾功能、历史暴露和尿液稀释程度影响。
综上，尿液中特定金属元素与胆结石风险存在显著相关性，特别是在布依族女性中，尿铝和尿钠对胆结石的形成有显著影响。未来研究需验证这些金属元素与胆结石的因果关系，并探索预防措施和生物标志物的应用。
基金
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  • 国家重点研发计划课题(2017YFC0907301)
  • 国家自然科学基金(82173566)
文献
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2024年第51卷第20期
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doi: 10.20043/j.cnki.MPM.202405471
  • 接收时间：2024-05-30
  • 首发时间：2026-03-20
  • 出版时间：2024-10-25
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  • 收稿日期：2024-05-30
基金
国家重点研发计划课题(2017YFC0907301)
国家自然科学基金(82173566)
作者信息
    贵州医科大学公共卫生与健康学院，环境污染与疾病监控教育部重点实验室，贵州 贵阳 550025

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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