Diabetes Care:有机污染物(POP)增加老年糖尿病危险

　瑞典乌普萨拉的年长者脉管系统的前瞻性研究（PIVUS研究）表明，接触某些持久性有机污染物（POP）可显著增加老年人群未来患2型糖尿病的危险，尽管其发病病例数较少。该研究2011年6月23日在线发表于《糖尿病护理》（Diabetes care）杂志。

　　近期研究证实，主要蓄积于脂肪组织的POP和亲脂性化学物质，与2型糖尿病相关。不过，来自前瞻性研究的证据较为匮乏。该研究评价了特定POP与老年人2型糖尿病的潜在相关性。

　　研究共纳入来自PIVUS研究的725例、年龄为70岁的受试者。通过血浆检测共分析了受试者体内19种POP[包括14种多氯联苯（PCB）同源物，3种有机氯杀虫剂，溴化二苯醚和二恶英]的基线值。

　　结果显示，随访5年后，共有36例受试者发生2型糖尿病。校正包括肥胖在内的已知2型糖尿病危险因素后，依据PCB浓度简易测量值的五分位数（与最低五分位数比较），得出75岁2型糖尿病患者的比值比（OR）（95%置信区间）分别为4.5，5.1，8.8（1.8~42.7）和 7.5（1.4~38.8）（P_trend<0.01）。在有机氯杀虫剂中，反式-九氯的不同浓度值校正OR的P_trend为0.03。总计3种有机氯杀虫剂的五分位数值，得出其校正的OR值（95%置信区间）为1.1，1.6，1.5和3.4（1.0~11.7）（P_trend = 0.03）。溴化二苯醚47和二恶英与伴随的2型糖尿病事件均无显著相关性。将PCBs的总计值加入到传统的糖尿病危险因素中，能显著促进重新分级。

　　链接：Polychlorinated Biphenyls and Organochlorine Pesticides in Plasma Predict Development of Type 2 Diabetes in the Elderly

英文摘要

OBJECTIVE Persistent organic pollutants (POPs), lipophilic chemicals that accumulate mainly in adipose tissue, have recently been linked to type 2 diabetes. However, evidence from prospective studies is sparse. This study was performed to evaluate prospective associations of type 2 diabetes with selected POPs among the elderly. RESEARCH DESIGN AND METHODS Nineteen POPs (14 polychlorinated biphenyl [PCB] congeners, 3 organochlorine pesticides, 1 brominated diphenyl ether, and 1 dioxin) were measured in plasma collected at baseline in 725 participants, aged 70 years, of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). RESULTS After adjusting for known type 2 diabetes risk factors, including obesity, odds ratios (ORs) (95% CIs) for type 2 diabetes at age 75 years (n = 36) according to the quintiles of a summary measure of concentrations of PCBs (vs. the lowest quintile) were 4.5, 5.1, 8.8 (1.8-42.7), and 7.5 (1.4-38.8) (P(trend) <0.01). Among organochlorine pesticides, adjusted ORs across concentrations of trans-nonachlor showed that P(trend) = 0.03. Adjusted ORs (95% CIs) across quintiles of the sum of three organochlorine pesticides were 1.1, 1.6, 1.5, and 3.4 (1.0-11.7) (P(trend) = 0.03). Neither brominated diphenyl ether 47 nor dioxin was significantly associated with incident diabetes. The sum of PCBs improved reclassification significantly when added to traditional risk factors for diabetes. CONCLUSIONS Despite the small number of incident cases, this study found that environmental exposure to some POPs substantially increased risk of future type 2 diabetes in an elderly population.