使用核磁共振儀探討健康照護人員在熱暴露下的尿液代謝體反應

Abstract

熱應力對於在職場工作人員身體健康有顯著負面影響。最近的研究顯示，職場中的熱暴露與腎臟疾病之間具有關聯性，其中包括急性腎損傷。在COVID-19疫情爆發期間，由於健康照護人員需要在工作時穿戴個人防護具，此行為可能會影響其體內的熱交換，進而增加健康照護人員面臨熱應力的風險。然而，目前對於熱應力所引起之急性腎損傷的分子效應仍尚未明確。 因此，為了解健康照護人員在熱暴露後的代謝效應，我們利用核磁共振儀進行尿液的代謝體學研究。在這項研究中，收集了在COVID-19篩檢巴士站工作的健康照護人員工作前與工作後的尿液樣本，並藉由核磁共振儀測量了他們的尿液代謝體，測量之圖譜數據經過處理，接著進行多變量和單變量分析，以評估代謝物改變和熱應力之間的關係。 利用核磁共振儀進行的代謝體學研究方法能夠有效地揭示受熱應力影響後的代謝效應。多變量分析之結果顯示，健康照護人員工作前與工作後的尿液樣本之代謝體存在顯著差異；除此之外，單變量分析結果顯示，健康照護人員在工作後，其尿液中有些代謝物的含量產生了顯著變化，包括3-hydroxyisovalerate、creatine、methylguanidine、taurine、trimethylamine N-oxide和valine的增加；4-hydroxybenzoate、adenine、formate、hippurate、methylmalonate和 tryptophan的降低。透過使用不同的分組比較方法，我們發現taurine和trimethylamine N-oxide是與健康照護人員在受熱暴露後發生急性腎損傷相關的重要代謝物。taurine的增加可能與保護腎臟有關連性；而trimethylamine N-oxide的上升則可能反映了腸腎軸內的異常交互作用，進而影響腎臟健康。 綜上所述，這項研究發現了受熱暴露後健康照護人員尿樣中的代謝物變化，此研究發現熱暴露引起的代謝反應，可提供之後開發潛在的生物標記及闡述其可能涉及的機制。

Heat stress has significant negative impacts on human health in the occupational environment. Recent studies suggested a link between occupational heat exposure and kidney disease, including acute kidney injury (AKI). Health care workers (HCWs) were at an increased risk of heat stress during the COVID-19 pandemic due to the need to wear personal protective equipment, which can interfere with heat exchange in the body. However, the molecular events of heat stress-induced AKI are still unclear. A nuclear magnetic resonance (NMR)-based metabolomics study was conducted to understand the metabolic effects of heat exposure in the urine of HCWs. In this study, pre-work and post-work urine samples were collected among HCWs who worked at the COVID-19 screening bus station. The urinary metabolic profiles were measured by NMR. The spectral data were processed and analyzed by multivariate analysis and univariate analysis to assess the relationship between metabolites and heat stress. This NMR-based metabolomic approach revealed the global metabolic effects of exposure to heat stress. The results of the study showed that there was a significant difference between the metabolomics of pre-work and post-work urine samples, as evidenced by partial least squares discriminant analysis. Moreover, t-tests indicated levels of some metabolites had changed significantly in the urine of workers after eight-hour working. Those changed metabolites include increased levels of 3-hydroxyisovalerate, creatine, methylguanidine, taurine, trimethylamine N-oxide, valine and decreased levels of 4-hydroxybenzoate, adenine, formate, hippurate, methylmalonate and tryptophan. We found taurine and trimethylamine N-oxide were the important metabolites related to AKI in HCWs after heat exposure by using different grouping methods. Increased levels of taurine played a role in protecting the kidneys. While the elevation in trimethylamine N-oxide levels may reflected abnormal interactions within the gut-kidney axis which affected kidney health. To sum up, this study highlighted changed metabolites in the urine samples of workers after heat exposure. The results of this study provided valuable information to understand heat-induced biological responses with the expectation of developing potential biomarkers and elucidating the possible mechanisms involved.