产前暴露于全氟烷基和多氟烷基物质与儿童特应性皮炎：一项前瞻性出生队列研究。
Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances and childhood atopic dermatitis: a prospective birth cohort study.
机构信息
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Department of Pediatric Pulmonology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
出版信息
Environ Health. 2018 Jan 17;17(1):8. doi: 10.1186/s12940-018-0352-7.
BACKGROUND
Perfluoroalkyl and polyfluoroalkyl substances (PFASs) have been reported to suppress immune function. However, previous studies on prenatal exposure to PFASs and allergic disorders in offspring provided inconsistent results. We aimed to examine the association between prenatal exposure to PFASs and childhood atopic dermatitis (AD) in offspring up to 24 months of age.
METHODS
A prospective birth cohort study involving 1056 pregnant women was conducted in two hospitals in Shanghai from 2012 to 2015. Prenatal information was collected by an interview with the women and from medical records. Fetal umbilical cord blood was collected at birth. Cord blood plasma PFASs were measured. Children were followed at 6, 12 and 24 months and information on the development of AD was recorded. AD was diagnosed by 2 dermatologists independently based on the questionnaires. Multiple logistic regression was used to compute odds ratio (OR) and corresponding 95% confidence interval (CI) for the association between AD and each PFASs, adjusting for potential confounders.
RESULTS
A total of 687 children completed a 2-year follow-up visit and had PFASs measurement. AD was diagnosed in 173 (25.2%) children during the first 24 months. In female children, a log-unit increase in perfluorooctanoic acid (PFOA) was associated with a 2.1-fold increase in AD risk (AOR 2.07, 95% CI 1.13-3.80) after adjusting for potential confounders. The corresponding risk was 2.22 (1.07-4.58) for perfluorononanoic acid (PFNA). The highest PFOA quartile was significantly associated with AD (2.52, 1.12-5.68) compared with the lowest quartile. The highest quartile of PFNA, perfluorodecanoic acid (PFDA) and perfluorohexane sulfonic acid (PFHxS) were associated with AD with AOR (95% CI) being 2.14 (0.97-4.74), 2.14 (1.00-4.57), and 2.30 (1.03-5.15), respectively. Additionally, the second quartile of perfluorododecanoic acid (PFDoA) was associated with a 3.2-fold increase in AD risk (3.24, 1.44-7.27). However, no significant associations were found in male children.
CONCLUSIONS
Prenatal exposure to PFOA, PFDA, PFDoA and PFHxS significantly increased the risk of childhood AD in female children during the first 24 months of life. In addition, the associations between AD with prenatal exposure to PFNA were close to statistical significance.
背景
全氟烷基和多氟烷基物质（PFAS）已被报道会抑制免疫功能。然而，先前关于产前接触 PFAS 与后代过敏疾病的研究结果并不一致。我们旨在研究产前接触 PFAS 与 24 个月龄以下儿童特应性皮炎（AD）之间的关联。
方法
2012 年至 2015 年，在上海的两家医院进行了一项前瞻性出生队列研究，共纳入 1056 名孕妇。通过对孕妇的访谈和病历收集产前信息。在出生时采集胎儿脐带血。检测脐带血浆 PFASs。在 6、12 和 24 个月时对儿童进行随访，并记录 AD 的发病情况。由 2 位皮肤科医生根据问卷独立诊断 AD。采用多因素 logistic 回归计算 AD 与各 PFASs 之间的比值比（OR）及其 95%置信区间（CI），调整潜在混杂因素。
结果
共有 687 名儿童完成了 2 年的随访，并进行了 PFASs 检测。在头 24 个月内，173 名（25.2%）儿童被诊断为 AD。在女性儿童中，在校正潜在混杂因素后，每增加一个对数单位的全氟辛酸（PFOA），AD 的风险增加 2.1 倍（OR 2.07，95%CI 1.13-3.80）。全氟壬酸（PFNA）的相应风险为 2.22（1.07-4.58）。与最低四分位数相比，最高四分位数的 PFOA 与 AD 显著相关（2.52，1.12-5.68）。PFNA、全氟癸酸（PFDA）和全氟己烷磺酸（PFHxS）的最高四分位数与 AD 相关，OR（95%CI）分别为 2.14（0.97-4.74）、2.14（1.00-4.57）和 2.30（1.03-5.15）。此外，全氟十二烷酸（PFDoA）的第二四分位数与 AD 风险增加 3.2 倍相关（3.24，1.44-7.27）。然而，在男性儿童中未发现显著相关性。
结论
产前暴露于 PFOA、PFDA、PFDoA 和 PFHxS 显著增加了女性儿童在生命头 24 个月内发生儿童特应性皮炎的风险。此外，产前接触 PFNA 与 AD 之间的关联接近统计学意义。
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