Master of Environmental Studies Program, College of Charleston, Charleston, SC, USA.
Public Health Program, Department of Health and Human Performance, School of Education, Health and Human Performance, College of Charleston, Charleston, SC, USA.
Environ Res. 2014 Jul;132:126-31. doi: 10.1016/j.envres.2014.03.043. Epub 2014 Apr 25.
Nephropathy, or kidney disease, is a major, potential complication of diabetes. We assessed the association of 6 chlorinated dibenzo-p-dioxins, 9 chlorinated dibenzofurans and 8 polychlorinated biphenyls (PCBs) in blood with diabetic nephropathy in the 1999-2004 National Health and Nutrition Examination Survey (unweighted N=2588, population estimate=117,658,357). Diabetes was defined as diagnosed or undiagnosed (glycohemoglobin ≥ 6.5%) and nephropathy defined as urinary albumin to creatinine ratio >30 mg/g, representing microalbuminuria or macroalbuminuria. For the 8 chemicals analyzed separately, values above the 75th percentile were considered elevated, whereas for the other 15 compounds values above the maximum limit of detection were considered elevated. Seven of 8 dioxins and dioxin-like compounds, analyzed separately, were found to be associated with diabetic nephropathy. The chemicals associated with diabetic nephropathy were: 1,2,3,6,7,8-Hexachlorodibenzo-p-dioxin; 1,2,3,4,6,7,8,9-Octachlorodibenzo-p-dioxin; 2,3,4,7,8-Pentachlorodibenzofuran; PCB 126; PCB 169; PCB 118; and PCB 156. Three of the 8 dioxins and dioxin-like compounds; 1,2,3,4,6,7,8,9-Octachlorodibenzo-p-dioxin; 2,3,4,7,8-Pentachlorodibenzofuran and PCB 118; expressed as log-transformed continuous variables; were associated with diabetes without nephropathy. When 4 or more of the 23 chemicals were elevated the odds ratios were 7.00 (95% CI=1.80-27.20) for diabetic nephropathy and 2.13 (95% CI=0.95-4.78) for diabetes without nephropathy. Log-transformed toxic equivalency (TEQ) was associated with both diabetic nephropathy, and diabetes without nephropathy, the odds ratios were 2.35 (95% CI=1.57-3.52) for diabetic nephropathy, and 1.44 (95% CI=1.11-1.87) for diabetes without nephropathy. As the kidneys function to remove waste products from the blood, diabetic nephropathy could be either the cause or the consequence (or both) of exposure to dioxins, furans and dioxin-like PCBs.
肾病，或肾脏疾病，是糖尿病的一个主要的、潜在的并发症。我们评估了血液中 6 种氯代二苯并对二恶英、9 种氯代二苯并呋喃和 8 种多氯联苯（PCBs）与 1999-2004 年全国健康和营养检查调查（未经加权的 N=2588，人口估计=117658357）中糖尿病肾病之间的关联。糖尿病的定义为已确诊或未确诊（糖化血红蛋白≥6.5%），肾病的定义为尿白蛋白与肌酐比值>30mg/g，代表微量白蛋白尿或大量白蛋白尿。对于单独分析的 8 种化学物质，高于第 75 百分位数的值被认为是升高的，而对于其他 15 种化合物，高于最大检测限的值被认为是升高的。单独分析的 8 种二恶英和类二恶英化合物中的 7 种与糖尿病肾病有关。与糖尿病肾病相关的化学物质包括：1,2,3,6,7,8-六氯二苯并对二恶英；1,2,3,4,6,7,8,9-八氯二苯并对二恶英；2,3,4,7,8-五氯二苯并呋喃；PCB126；PCB169；PCB118；和 PCB156。在 8 种二恶英和类二恶英化合物中，有 3 种；1,2,3,4,6,7,8,9-八氯二苯并对二恶英；2,3,4,7,8-五氯二苯并呋喃和 PCB118；表示为对数转换的连续变量；与无肾病的糖尿病有关。当 23 种化学物质中有 4 种或更多种升高时，糖尿病肾病的比值比为 7.00（95%置信区间=1.80-27.20），无肾病的糖尿病比值比为 2.13（95%置信区间=0.95-4.78）。对数转换的毒性等效（TEQ）与糖尿病肾病和无肾病的糖尿病均有关，糖尿病肾病的比值比为 2.35（95%置信区间=1.57-3.52），无肾病的糖尿病比值比为 1.44（95%置信区间=1.11-1.87）。由于肾脏的功能是从血液中清除废物，因此糖尿病肾病可能是接触二恶英、呋喃和类二恶英 PCBs 的原因或后果（或两者兼有）。
