| BackgroundGastric cancer is one of the leading causes of cancer deaths in China.Gastric precancerous lesions are an important stage in the transformation of normal gastric mucosa to gastric cancer,and studies have been conducted to prove the association between metal and metalloid elements and gastric cancer,but the evidence is too diverse to draw conclusions,and there is a lack of studies between gastric precancerous lesions and metal and metalloid elements.ObjectiveTo understand the lifestyle habits and plasma levels and distribution of arsenic and titanium concentrations in the population with gastric precancerous lesions and the local natural population in Lujiang County,Anhui Province,and to study the factors associated with the influence of gastric precancerous lesions and the relationship between internal exposure to arsenic and titanium with gastric precancerous lesions.MethodsIn this study,questionnaires and samples were collected from a total of 1769 residents,including 1007 patients with gastric precancerous lesions and 762 without disease,excluding 266 who did not complete the questionnaire,and random sampling was performed among the remaining 1503,matching the case and control groups according to age and sex,and finally a total of 316 people were included,158 each in the case and control groups.Relevant information about patients was collected by questionnaires from uniformly trained investigators,and fasting blood was collected from patients early in the morning,and the concentrations of elemental arsenic and titanium in plasma were detected by applying power-coupled plasma mass spectrometry.The detection of H.pylori was performed by latex method.A multivariate conditional logistic regression model was used to analyze the association between plasma metal elements and gastric precancerous lesions by including metal elements in the multi-element model.The dose-response relationship of the association between plasma arsenic concentration,titanium concentration and gastric precancerous lesions was analyzed using Restricted Cubic Spline(RCS)function.The multiplicative interaction between combined arsenictitanium exposure and gastric precancerous lesions was analyzed using a multifactorial logistic regression model;potential additive interactions between arsenic and titanium in gastric precancerous lesions were assessed using synergy index(S),interaction attribution score(AP),and relative excess risk of interaction(RERI).Relative excess risk of interaction(RERI)was used to assess the potential additive interaction of arsenic and titanium in gastric precancerous lesions.ResultsIn this study,158 pregastric cancer lesions and 158 matched normal people in Lujiang County,Hefei City,Anhui Province,and 316 were included.Among them,198people(62.66%)were male,mean age of 57 years,118(37.34%)were female,and mean age of 57 years.The detection rate of arsenic and titanium in plasma was 100%;the median concentration of arsenic in plasma species was 4.016 μg/L and the median concentration of titanium was 26.786 μg/L in the population with gastric precancerous lesions;the concentration of arsenic in plasma was 3.917 μg/L and the concentration of titanium was 21.335 μg/L in the normal population.Although the concentration of arsenic in plasma was higher in the population with gastric precancerous lesions than in the normal population,the difference was not statistically significant,whereas the concentration of titanium in plasma was higher in the population with precancerous gastric lesions than in the normal population,and the difference was statistically significant(P<0.05).Logistics Regression analysis showed that in multivariate regression model 3,the OR ratio of the risk of gastric cancer in the population of the reference group was2.90(95%CI: 1.22-6.94),there was a positive relationship between arsenic exposure in plasma and the risk of gastric cancer,and the difference was statistically significant(P<0.05).In the three models of regression analysis,plasma titanium concentrations were statistically different(P <0.05).In the one-factor crude model,the plasma concentration of titanium was significantly and positively associated with the anterior lesion of gastric cancer,and the OR ratio of the population risk of pregastric cancer in the reference group with the highest titanium exposure group(Q4)was 3.30(95%CI: 1.63-6.67).Considering the influence of confounding factors,after adjustment of BMI,education,occupation,family income,family history of chronic gastritis,Hp,the plasma titanium concentration and gastric cancer lesions,the risk of the risk and the reference group is 3.39(95%CI:1.65-6.95),the plasma titanium concentration is positively correlated with the gastric cancer lesions).On the basis of step 2 further adjust smoking,drinking,physical activity,sleep,defecation,emotional factors,diet,the regression analysis showed that the highest quantile of the risk of gastric cancer lesions and the reference group OR ratio is5.96(95%CI: 2.37-15.01),plasma metal concentration is significantly positive associated with gastric cancer lesions,indicating that titanium may be a risk factor for gastric cancer lesions.The correlation analysis of arsenic and titanium in plasma revealed a negative correlation between arsenic and titanium in plasma,with a correlation coefficient of-0.372 and P <0.01.The interaction between arsenic and titanium in plasma in gastric cancer,and the arsenic and titanium multiplication term was 0.213(95%CI: 0.081-0.556,P=0.002).There may be a multiplicative interaction between arsenic and titanium in plasma before gastric cancer lesions.The additive interaction results showed an additive interaction between arsenic and titanium.(RERI[95%CI]:-4.08[-10.59--1.30];AP[95%CI]:-2.21[-5.52--0.66];S[95%CI]: 0.17[0.06-0.53].The multiplicative interaction consistent with the additive interaction result is less than 1,and RERI,AP <0,S <1,therefore,there may be potential antagonism between arsenic and titanium.ConclusionThe results of our research indicated that the plasma of the study subjects had a higher concentration of arsenic than the blood of the general population surveyed in eight Chinese provinces,and the plasma of gastric precancerous lesions had a higher concentration of arsenic than the normal population;however,this difference was not statistically significant.Additionally,the plasma of gastric precancerous lesions had a higher concentration of titanium than the normal population,and this difference was statistically significant.There was a positive correlation between plasma arsenic and titanium and gastric precancerous lesions,and there was an interaction between arsenic and titanium in plasma.Arsenic and titanium may be risk factors for gastric precancerous lesions. |
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