Cobellis L, Latini G, De Felice C, Razzi S, Paris I, Ruggieri F, Mazzeo P, Petraglia F
Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
Hum Reprod. 2003 Jul;18(7):1512-5. doi: 10.1093/humrep/deg254.
Emerging evidence suggests a potential role for ubiquitous environmental contaminants in the physiopathology of endometriosis. Di-(2-ethylhexyl)-phthalate (DEHP), the most commonly used plasticizer in flexible polyvinylchloride (PVC) formulations, is a widespread environmental contaminant with potentially adverse effects on fertility in animal models. In the present study, we tested the hypothesis that DEHP and/or and its main metabolite, mono-ethylhexyl phthalate (MEHP), play a role in the pathogenesis of endometriosis.
Specimens of blood and peritoneal fluid were collected in a group of women with endometriosis (n = 55), and in age-matched control women (n = 24). Concentrations of DEHP and MEHP were measured in plasma and peritoneal fluid by using high performance liquid chromatography (HPLC). Differences between groups were tested using the Fisher's exact test, Wilcoxon-test, and Kruskal-Wallis analysis of variance.
Endometriotic women showed significantly higher plasma DEHP concentrations than controls (median 0.57 micro g/ml, interquartile range: 0.06-1.23; values range: 0-3.24 versus median 0.18 micro g/ml, interquartile range: 0-0.44; values range: 0-1.03; P = 0.0047) and 92.6% of them had detectable DEHP and /or MEHP in the peritoneal fluid. No significant differences in either the DEHP/MEHP plasma concentrations (P >/= 0.31) or DEHP/MEHP peritoneal fluid concentrations (P >/= 0.66) were observed in the endometriotic patients as a function of the disease stage at the time of diagnosis.
The present findings showed for the first time an association between DEHP plasma concentrations and endometriosis, suggesting a possible role for phthalate esters in the pathogenesis.
新出现的证据表明，普遍存在的环境污染物在子宫内膜异位症的病理生理过程中可能发挥作用。邻苯二甲酸二（2-乙基己基）酯（DEHP）是软质聚氯乙烯（PVC）配方中最常用的增塑剂，是一种广泛存在的环境污染物，对动物模型的生育能力可能有不良影响。在本研究中，我们检验了DEHP和/或其主要代谢物单乙基己基邻苯二甲酸酯（MEHP）在子宫内膜异位症发病机制中起作用的假设。
收集一组子宫内膜异位症患者（n = 55）和年龄匹配的对照女性（n = 24）的血液和腹腔液样本。采用高效液相色谱法（HPLC）测定血浆和腹腔液中DEHP和MEHP的浓度。使用Fisher精确检验、Wilcoxon检验和Kruskal-Wallis方差分析来检验组间差异。
子宫内膜异位症女性的血浆DEHP浓度显著高于对照组（中位数0.57μg/ml，四分位间距：0.06 - 1.23；值范围：0 - 3.24，而对照组中位数为0.18μg/ml，四分位间距：0 - 0.44；值范围：0 - 1.03；P = 0.0047），其中92.6%的患者腹腔液中可检测到DEHP和/或MEHP。在子宫内膜异位症患者中，未观察到DEHP/MEHP血浆浓度（P≥0.31）或DEHP/MEHP腹腔液浓度（P≥0.66）随诊断时疾病分期的显著差异。
本研究结果首次表明血浆DEHP浓度与子宫内膜异位症之间存在关联，提示邻苯二甲酸酯在发病机制中可能发挥作用。
