【作者】 王艳芳；

【导师】 金丽娜；

【作者基本信息】 吉林大学 ， 流行病与卫生统计学， 2024， 硕士

【摘要】 目的:抑郁是一种高度流行的心理健康疾病,常与糖尿病、高血压、高脂血症等代谢性疾病共存,导致发病率增加且预后不佳。同时,随着社会经济的发展,重金属污染日益严重,通过受污染的食物、饮用水或空气等多种方式进入人体后破坏主要代谢过程,最终可能导致代谢性疾病。抑郁也可能会通过不良生活方式、干扰免疫炎症反应、内分泌和代谢功能等途径影响重金属的吸收、代谢和排泄,加剧毒物的危害。因此,本研究旨在探索与非抑郁人群相比,抑郁人群的重金属暴露与代谢性疾病之间是否会有更强的关联,进而揭示心理健康对环境和代谢性疾病的修饰作用,为更好地理解和干预疾病提供新视角。方法:本研究选取2007-2018年美国健康与营养调查（NHANES）≥20岁的成年人为研究对象。以PHQ-9抑郁量表得分对抑郁状态进行分类:<5分为无抑郁,≥5分为抑郁。血液和尿液重金属（镉、铅、汞）指标反映了短期和长期暴露时间。本研究描述不同抑郁状态下代谢性疾病（糖尿病、高血压、高脂血症、代谢综合征）的分布情况和血液、尿液重金属的内暴露水平。采用多因素Logistic回归模型分析不同抑郁状态下血液和尿液重金属与代谢性疾病的关联,并探讨重金属与抑郁状态之间的相乘交互作用,探索抑郁是否在重金属和代谢性疾病之间存在修饰作用。所有分析均基于复杂加权,使用IBM SPSS 24.0和R 4.1.2进行统计分析,以双侧检验P<0.05为差异具有统计学意义。结果:1.不同抑郁状态下尿液重金属与代谢性疾病的关联分析:非抑郁人群中,Ln-尿镉与糖尿病、高血压、高脂血症和代谢综合征患病风险均呈正相关,OR（95%CI）值分别为2.30（1.57-3.38）、2.41（1.92-3.04）、2.47（1.91-3.21）、2.83（1.90-4.23）。Ln-尿铅与高血压和高脂血症患病风险呈正相关,OR（95%CI）值分别为1.51（1.12-2.05）,1.65（1.24-2.19）,未发现尿铅与糖尿病、代谢综合征之间的关联。Ln-尿汞与高脂血症、代谢综合征患病风险呈正相关,OR（95%CI）值分别为1.29（1.05-1.58）、1.45（1.08-1.93）,未发现尿汞与糖尿病、高血压之间的关联。抑郁人群中,Ln-尿镉与糖尿病、高血压、高脂血症和代谢综合征患病风险均呈正相关,OR（95%CI）值分别为3.02（1.75-5.22）、3.20（2.11-4.83）、2.74（1.70-4.43）、2.42（1.35-4.35）。Ln-尿铅与糖尿病患病风险呈正相关OR（95%CI）值为2.33（1.23-4.41）,未发现尿铅与高血压、高脂血症、代谢综合征之间有关联。Ln-尿汞与高脂血症患病风险呈正相关,OR（95%CI）值为1.56（1.12-2.17）,未发现尿汞与糖尿病、高血压和代谢综合征之间有关联。抑郁状态和尿铅对糖尿病患病风险的相乘交互项OR（95%CI）值为1.82（1.01-3.34）,P_交互=0.033。2.不同抑郁状态下血液重金属与代谢性疾病的关联分析:非抑郁人群中,未发现血镉与糖尿病、高脂血症、代谢综合征之间有关联,Ln-血镉与高血压患病风险呈正相关,OR（95%CI）值为1.78（1.37-2.36）。Ln-血铅与糖尿病患病风险呈负相关,OR（95%CI）值为0.55（0.41-0.75）,Ln-血铅与高血压、高脂血症患病风险呈正相关,OR（95%CI）值分别为3.03（2.49-3.70）,1.69（1.38-2.06）,未发现Ln-血铅与代谢综合征之间有关联。Ln-血汞与糖尿病患病风险呈负相关,OR（95%CI）值为0.75（0.61-0.92）,Ln-血汞与高脂血症患病风险呈正相关,OR（95%CI）值为1.22（1.05-1.41）,未发现血汞与高血压、代谢综合征之间有关联。抑郁人群中,未发现血镉与糖尿病、高脂血症、代谢综合征之间有关联,Ln-血镉与患高血压风险呈正相关,OR（95%CI）值为2.41（1.70-3.43）。未发现血铅与糖尿病、代谢综合征之间有关联,Ln-血铅与高血压、高脂血症患病风险呈正相关,OR（95%CI）值分别为2.56（1.88-3.48）,1.89（1.35-2.65）。Ln-血汞与患糖尿病风险呈负相关,OR（95%CI）值为0.69（0.49-0.97）,Ln-血汞与患高脂血症风险呈正相关,OR（95%CI）值为1.26（1.03-1.55）,未发现血汞与高血压、代谢综合征之间有关联。未发现抑郁状态和血液重金属（镉、铅、汞）对代谢性疾病患病风险的相乘交互作用有统计学意义。结论:1.抑郁状态和尿铅对糖尿病患病风险存在相乘交互作用。非抑郁人群中,尿镉水平的增加可能与糖尿病的患病风险增加有关;抑郁人群中,尿镉和尿铅水平的增加可能与糖尿病的患病风险增加有关。本研究强调了抑郁可能会对尿铅和糖尿病之间的关联存在正向修饰作用。2.未发现抑郁状态与血液和尿液重金属对高血压患病风险存在相乘交互作用。3.未发现抑郁状态与血液和尿液重金属对高脂血症患病风险存在相乘交互作用。4.未发现抑郁状态与血液和尿液重金属对代谢综合征患病风险存在相乘交互作用。更多还原

【Abstract】 Objective:Depression is a highly prevalent mental health disorder that often coexists with metabolic diseases like diabetes,hypertension,and hyperlipidemia,leading to increased morbidity and poor prognosis.With the development of the social economy,heavy metal pollution has become increasingly serious.These pollutants enter the human body through contaminated food,drinking water,air,and other means,disrupting the main metabolic processes and potentially leading to metabolic diseases.Depression may affect the absorption,metabolism,and excretion of heavy metals through adverse lifestyle choices.It can also interfere with immune inflammatory response,endocrine,and metabolic functions,exacerbating the harm caused by toxicants.The study aims to investigate whether depressed individuals exhibit a stronger association between heavy metal exposure and metabolic diseases compared to non-depressed individuals.Additionally,we aim to elucidate the role of mental health in modifying environmental and metabolic diseases,providing new perspectives for better disease understanding and intervention.Methods:This study involved adults aged ≥ 20 years from the National Health and Nutrition Examination Survey(NHANES)conducted in the United States in2007-2018.Depression status was defined as using the PHQ-9 health questionnaire,with scores < 5 indicating non-depression and scores ≥ 5 indicating depression.The indicators of heavy metals in blood and urine(cadmium,lead,mercury)reflect both short-term and long-term exposure durations.This study describes the distribution of metabolic diseases(diabetes,hypertension,hyperlipidemia,metabolic syndrome)and the internal exposure levels of blood and urine heavy metals under different depression statuses.Multiple logistic regression models were used to analyze the association between blood and urine heavy metals and metabolic diseases under different depression statuses.Additionally,the study explored the multiplicative interaction between heavy metals and depression status to investigate whether depression had a modifying effect on the association between heavy metals and metabolic diseases.All analyses were based on complex weighting and conducted using IBM SPSS 24.0 and R 4.1.2.Statistical significance was set at P < 0.05 for two-tailed tests.Results:1.The association analysis between urine heavy metals and metabolic diseases under different depression statuses:In the non-depressed population,Ln-urine cadmium showed a positive correlation with the risk of diabetes,hypertension,hyperlipidemia,and metabolic syndrome,with OR(95% CI)of 2.30(1.57-3.38),2.41(1.92-3.04),2.47(1.91-3.21),and 2.83(1.90-4.23).Ln-urine lead was positively associated with hypertension and hyperlipidemia,with OR(95% CI)of 1.51(1.12-2.05)and 1.65(1.24-2.19),while no association was found between urine lead and diabetes or metabolic syndrome.Ln-urine mercury showed a positive correlation with hyperlipidemia and metabolic syndrome,with OR(95% CI)of 1.29(1.05-1.58)and 1.45(1.08-1.93),but no association was found between urine mercury and diabetes or hypertension.In the depressed population,Ln-urine cadmium exhibited a positive correlation with the risk of diabetes,hypertension,hyperlipidemia,and metabolic syndrome,with OR(95% CI)of 3.02(1.75-5.22),3.20(2.11-4.83),2.74(1.70-4.43),and 2.42(1.35-4.35).Ln-urine lead was positively associated with the risk of diabetes,with an OR(95% CI)of 2.33(1.23-4.41),while no association was found between urine lead and hypertension,hyperlipidemia,or metabolic syndrome.Ln-urine mercury was positively associated with the risk of hyperlipidemia,with an OR(95% CI)of 1.56(1.12-2.17),while no association was found between urine mercury and diabetes,hypertension,and metabolic syndrome.The multiplicative interaction term OR(95% CI)of depression status and urine lead on diabetes risk was 1.82(1.01-3.34).P-interaction = 0.033.2.The association analysis between blood heavy metals and metabolic diseases under different depression statuses:In the non-depressed population,no association was found between blood cadmium and diabetes,hyperlipidemia,or metabolic syndrome,while Ln-blood cadmium was positively associated with hypertension,with OR(95% CI)of 1.78(1.37-2.36).Ln-blood lead was negatively associated with diabetes,with OR(95% CI)of 0.55(0.41-0.75),but positively associated with hypertension and hyperlipidemia,with OR(95% CI)of 3.03(2.49-3.70)and 1.69(1.38-2.06),and no association was found with metabolic syndrome.Ln-blood mercury was negatively associated with diabetes,with OR(95% CI)of 0.75(0.61-0.92),but positively associated with hyperlipidemia,with OR(95% CI)of 1.22(1.05-1.41),and no association was found with hypertension or metabolic syndrome.In the depressed population,no association was found between blood cadmium and diabetes,hyperlipidemia,or metabolic syndrome,while Ln-blood cadmium was positively associated with hypertension,with OR(95% CI)of 2.41(1.70-3.43).No association was found between blood lead and diabetes or metabolic syndrome,but Ln-blood lead was positively associated with hypertension and hyperlipidemia,with OR(95% CI)of 2.56(1.88-3.48)and 1.89(1.35-2.65).Ln-blood mercury was negatively associated with diabetes,with OR(95% CI)of 0.69(0.49-0.97),but positively associated with hyperlipidemia,with OR(95% CI)of 1.26(1.03-1.55),and no association was found with hypertension or metabolic syndrome.There was no statistically significant multiplicative interaction between blood heavy metals(cadmium,lead,mercury)and depression status regarding the risk of metabolic diseases.Conclusion:1.Depression status and urine lead have a multiplicative interaction on the risk of diabetes.In the non-depressed population,an increase in urine cadmium levels may be associated with an increased risk of diabetes.In the depressed population,increases in urine cadmium and lead levels may be associated with an increased risk of diabetes.This study highlights that depression may positively modify the association between urine lead and diabetes.2.No multiplicative interaction was found between depression status and heavy metals in blood and urine on the risk of hypertension.3.No multiplicative interaction was found between depression status and heavy metals in blood and urine on the risk of hyperlipidemia.4.No multiplicative interaction was found between depression status and heavy metals in blood and urine on the risk of metabolic syndrome.更多还原