MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China.
Department of Gynecology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China.
Environ Int. 2017 May;102:207-212. doi: 10.1016/j.envint.2017.03.003. Epub 2017 Mar 7.
Endometriosis is one of the main causes for female infertility. Previous studies suggested that perfluoroalkyl substances (PFASs), a group of ubiquitous environmental chemicals with properties of endocrine disruption and reproductive toxicity, were risk factors for endometriosis but there lacks direct evidence on the possible role of PFASs in endometriosis-related infertility. To fill this gap, we examined the association between PFASs and endometriosis-related infertility among Chinese reproductive-age women in a case-control study, which comprised 157 surgically confirmed endometriosis cases and 178 controls seeking infertility treatment because of male reproductive dysfunction in 2014 and 2015. Blood specimens were collected at the enrollment and analyzed for ten PFASs. Logistic regression was utilized to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) for individual PFAS compound. Plasma concentrations of perfluorobutane sulfonic acid (PFBS) were associated with an increased risk of endometriosis-related infertility (second vs. lowest tertile: OR=3.74, 95% CI: 2.04, 6.84; highest vs. lowest tertile: OR=3.04, 95% CI: 1.65, 5.57). This association remained consistent when we restricted to subjects with no previous pregnancy (second vs. lowest tertile: OR=2.91, 95% CI: 1.28, 6.61; highest vs. lowest tertile: OR=3.41, 95% CI: 1.52, 7.65) or to subjects without other gynecologic pathology (second vs. lowest tertile: OR=4.65, 95% CI: 2.21, 9.82; highest vs. lowest tertile: OR=3.36, 95% CI: 1.58, 7.15). Plasma concentrations of perfluoroheptanoic acid (PFHpA), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) were inversely associated with endometriosis-related infertility, but the associations were attenuated in the sensitivity analyses. Our preliminary evidence suggests that exposure to PFBS may increase the risk of female infertility due to endometriosis. Future prospective studies are necessary to confirm these findings.
子宫内膜异位症是女性不孕的主要原因之一。先前的研究表明，全氟烷基物质（PFASs）是一组具有内分泌干扰和生殖毒性的普遍存在的环境化学物质，是子宫内膜异位症的危险因素，但缺乏 PFASs 与子宫内膜异位症相关不孕之间可能作用的直接证据。为了填补这一空白，我们在 2014 年至 2015 年期间进行了一项病例对照研究，对 157 名经手术证实的子宫内膜异位症病例和 178 名因男性生殖功能障碍寻求不孕治疗的对照者进行了研究，以检验 PFASs 与中国育龄妇女子宫内膜异位症相关不孕之间的关联。在入组时采集血样并分析十种 PFASs。利用 logistic 回归估计个体 PFAS 化合物的调整后比值比（OR）和 95%置信区间（CI）。发现全氟丁烷磺酸（PFBS）的血浆浓度与子宫内膜异位症相关不孕的风险增加相关（第二 vs. 最低三分位：OR=3.74，95%CI：2.04，6.84；最高 vs. 最低三分位：OR=3.04，95%CI：1.65，5.57）。当我们将研究对象限制为无既往妊娠史者（第二 vs. 最低三分位：OR=2.91，95%CI：1.28，6.61；最高 vs. 最低三分位：OR=3.41，95%CI：1.52，7.65）或无其他妇科疾病史者（第二 vs. 最低三分位：OR=4.65，95%CI：2.21，9.82；最高 vs. 最低三分位：OR=3.36，95%CI：1.58，7.15）时，这种关联仍然一致。全氟庚酸（PFHpA）、全氟己烷磺酸（PFHxS）和全氟壬酸（PFNA）的血浆浓度与子宫内膜异位症相关不孕呈负相关，但在敏感性分析中，这些关联减弱。我们的初步证据表明，PFBS 的暴露可能会增加因子宫内膜异位症导致的女性不孕的风险。需要进一步的前瞻性研究来证实这些发现。
