肝脏疾病,包括非酒精性脂肪性肝病(NAFLD),是一个日益严重的全球健康问题。环境暴露于有毒金属会伤害肝脏,增加NAFLD的风险。基本要素对肝脏健康至关重要,但失衡或缺陷可能导致NAFLD的发展。因此,了解肝脏疾病中有毒金属和必需元素之间的相互作用非常重要。本研究旨在评估有毒金属(铅(Pb)、镉(Cd),汞(Hg)),和必需元素(锰和硒)对肝脏疾病的风险。方法:我们评估了铅的个体和综合效应,Cd,Hg,锰(Mn),使用2017年至2018年国家健康和营养检查调查的数据,硒(Se)对肝病风险的影响。我们进行了描述性统计和线性回归分析,然后利用贝叶斯内核机器回归(BKMR)技术,如单变量、双变量,和总体效果分析。BKMR能够评估非线性暴露响应函数以及金属与基本要素之间的相互作用。计算后包含概率(PIP)以确定每种金属和必需元素在肝脏疾病中的重要性。关于我们的研究结果,肝损伤生物标志物ALT的回归分析,AST,ALP,GGT,总胆红素,和FLI-NAFLD的指标-具有有毒金属和必需元素,调整协变量,如年龄,性别,BMI,酒精消费,种族,收入,和吸烟状况,证明了这些污染物对目标标志物的不同影响。我们的BKMR分析提供了进一步的见解。例如,PIP结果强调了铅在肝病中的一贯重要性(PIP=1.000),其次是汞(PIP=0.9512),Cd(PIP=0.5796),Se(PIP=0.5572),和Mn(PIP=0.4248)。我们的单因素分析显示,铅呈正趋势,而其他暴露相对平稳。我们对有毒金属和必需元素对NAFLD的单变量影响的分析还表明,Pb显着影响NAFLD的风险。我们的双变量分析发现,当Pb与其他金属和必需元素结合时,呈正(有毒)趋势。对于所有污染物一起暴露的整体暴露效果,NAFLD的估计风险从第60百分位数稳步上升至第75百分位数.总之,我们的研究表明铅暴露,当与其他有毒金属和必需元素结合时,在导致不良肝病结局方面发挥着重要作用.
Liver diseases, including non-alcoholic fatty liver disease (NAFLD), are a growing global health issue. Environmental exposure to toxic metals can harm the liver, increasing the risk of NAFLD. Essential elements are vital for liver health, but imbalances or deficiencies can contribute to the development of NAFLD. Therefore, understanding the interplay between toxic metals and essential elements in liver disease is important. This study aims to assess the individual and combined effects of toxic metals (lead(Pb), cadmium (Cd), mercury (Hg)), and essential elements (manganese and selenium) on the risk of liver disease. Methods: We assessed the individual and combined effects of Pb, Cd, Hg, manganese (Mn), and selenium (Se) on liver disease risk using data from the National Health and Nutrition Examination Survey between 2017 and 2018. We performed descriptive statistics and linear regression analysis and then utilized Bayesian Kernel Machine Regression (BKMR) techniques such as univariate, bivariate, and overall effect analysis. BKMR enabled the assessment of non-linear exposure-response functions and interactions between metals and essential elements. Posterior Inclusion Probabilities (PIPs) were calculated to determine the importance of each metal and essential element in contributing to liver disease. Regarding our study results, the regression analysis of liver injury biomarkers ALT, AST, ALP, GGT, total bilirubin, and the FLI-an indicator of NAFLD-with toxic metals and essential elements, adjusting for covariates such as age, sex, BMI, alcohol consumption, ethnicity, income, and smoking status, demonstrated the differential effects of these contaminants on the markers of interest. Our BKMR analysis provided further insights. For instance, the PIP results underscored Pb\'s consistent importance in contributing to liver disease (PIP = 1.000), followed by Hg (PIP = 0.9512), Cd (PIP = 0.5796), Se (PIP = 0.5572), and Mn (PIP = 0.4248). Our univariate analysis showed a positive trend with Pb, while other exposures were relatively flat. Our analysis of the single-variable effects of toxic metals and essential elements on NAFLD also revealed that Pb significantly affected the risk of NAFLD. Our bivariate analysis found a positive (toxic) trend when Pb was combined with other metals and essential elements. For the overall exposure effect of exposure to all the contaminants together, the estimated risk of NAFLD showed a steady increase from the 60th to the 75th percentile. In conclusion, our study indicates that Pb exposure, when combined with other toxic metals and essential elements, plays a significant role in bringing about adverse liver disease outcomes.