空气污染物、重金属暴露与妊娠糖尿病发生风险的关系及机制研究

The relationship between air pollutants and heavy metal exposure and the risk of gestational diabetes mellitus, and the potential mechanisms

摘要:

目的 探讨空气污染物、重金属暴露与妊娠糖尿病（GDM）发生风险的关系，以及可能的作用机制。方法 本研究采用巢式病例对照研究设计，纳入2021年1月—2023年12月无锡市人民医院120例GDM孕妇为研究组，以年龄和口服糖耐量试验孕周为匹配条件1∶1匹配120例健康孕妇为对照组。通过收集研究对象的居住地址，结合无锡市环保局的空气质量监测数据，评估孕期暴露于PM2.5、NO₂、SO₂、CO等空气污染物的浓度。同时，采用原子吸收分光光度法测定孕妇血液中的铅、汞、镉等重金属水平。采用多因素逐步Logistic回归分析评估GDM发生的危险因素。结果 两组孕妇建册年龄、建册孕周、身高、产次构成、孕妇文化程度构成比较，差异均无统计学意义（P >0.05）。两组孕妇在建册时的体质量指数、收缩压、舒张压、葡萄糖激发试验、空腹血糖、1 h血糖、2 h血糖、糖尿病家族史率比较，差异均有统计学意义（P <0.05）。研究组PM2.5、PM10、SO₂、NO₂、CO、铅、镉、砷和汞水平均高于对照组（P <0.05）。多因素逐步Logistic回归分析结果表明，PM2.5水平高［O^R =1.148（95% CI：1.005，1.311）］、PM10水平高［O^R =1.081（95% CI：1.004，1.165）］、SO₂水平高［O^R =1.357（95% CI：1.049，1.756）］、NO₂水平高［O^R =1.107（95% CI：1.009，1.216）］、CO水平高［O^R =34.509（95% CI：2.207，539.556）］、铅水平高［O^R =1.083（95% CI：1.004，1.167）］、镉水平高［O^R =6.658（95% CI：2.195，20.192）］、砷水平高［O^R =1.878（95% CI：1.343，2.626）］、汞水平高［O^R =2.595（95% CI：1.389，4.848）］均是孕妇发生GDM的危险因素（P <0.05）。研究组的胰岛素抵抗的稳态模型评估指数、C反应蛋白、丙二醛水平均高于对照组（P <0.05），超氧化物歧化酶、谷胱甘肽过氧化物酶水平均低于对照组（P <0.05）。结论 空气污染物和重金属暴露显著增加妊娠糖尿病的发生风险，可能通过加重胰岛素抵抗、促进系统性炎症反应及增强氧化应激反应等机制发挥作用。

Abstract:

Objective To investigate the relationship between exposure to air pollutants and heavy metals and the risk of gestational diabetes mellitus (GDM), as well as the potential underlying mechanisms, in order to provide scientific evidence for the prevention and treatment of GDM.Methods A nested case-control study design was employed, including 120 pregnant women with GDM from Wuxi People's Hospital between January 2021 and December 2023. Each GDM case was matched 1:1 with a healthy pregnant woman based on age and gestational week at the time of the oral glucose tolerance test. The residential addresses of the participants were collected, and the concentrations of air pollutants (PM2.5, NO₂, SO₂, CO, etc.) during pregnancy were assessed using air quality monitoring data from the Wuxi Environmental Protection Bureau. Heavy metals such as lead, mercury, and cadmium in the blood of the pregnant women were measured using atomic absorption spectroscopy. Multivariate logistic regression analysis was performed to evaluate the association between exposure to air pollutants and heavy metals and the risk of GDM, and to further explore the potential biological mechanisms.Results No statistically significant differences were found between the study group and control group in terms of registration age, gestational week at registration, height, parity distribution, or maternal education level (P > 0.05). Statistically significant differences were observed between the two groups in BMI at registration, systolic blood pressure, diastolic blood pressure, GCT, fasting plasma glucose, 1-hour postprandial plasma glucose, 2-hour postprandial plasma glucose and family history of diabetes (P < 0.05). Comparisons of PM2.5, PM10, SO₂, NO₂, CO, lead, cadmium, arsenic and mercury levels between the study group and control group all showed statistically significant differences (P < 0.05), with the study group demonstrating higher levels of these pollutants than the control group. Multivariate logistic regression analysis indicated that elevated levels of PM2.5 [O^R = 1.148 (95% CI:1.005, 1.311) ], PM10 [O^R =1.081 (95% CI: 1.004, 1.165) ], SO₂ [O^R =1.357 (95% CI:1.049, 1.756) ], NO₂ [O^R =1.107 (95% CI:1.009, 1.216) ], CO [O^R =34.509 (95% CI: 2.207, 539.556) ], lead [O^R =1.083 (95% CI:1.004, 1.167) ], cadmium [O^R =6.658 (95% CI: 2.195, 20.192) ], arsenic [O^R =1.878 (95% CI: 1.343, 2.626) ], and mercury [O^R =2.595 (95% CI: 1.389, 4.848) ] were all risk factors for GDM (P < 0.05). Significant differences were also found between the two groups in HOMA-IR, CRP, MDA, SOD and GSH-Px levels (P < 0.05). The study group showed higher HOMA-IR, CRP and MDA levels, but lower SOD and GSH-Px levels compared to the control group.Conclusion Exposure to air pollutants and heavy metals significantly increases the risk of GDM, likely through mechanisms such as exacerbating insulin resistance, promoting systemic inflammation, and enhancing oxidative stress.