Department of Environmental and Occupational Health, The George Washington University Milken Institute School of Public Health, Washington, DC.
Department of Environmental and Occupational Health, The George Washington University Milken Institute School of Public Health, Washington, DC.
Fertil Steril. 2019 Jan;111(1):112-121. doi: 10.1016/j.fertnstert.2018.09.009. Epub 2018 Nov 15.
To examine the association between phthalate exposure and two measures of uterine fibroid burden: diameter of largest fibroid and uterine volume.
Pilot, cross-sectional study.
Academic medical center.
PATIENT(S): Fifty-seven premenopausal women undergoing either hysterectomy or myomectomy for fibroids.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): The diameter of the largest fibroid and uterine dimensions were abstracted from medical records. Spot urine samples were analyzed for 14 phthalate biomarkers using mass spectrometry. We estimated associations between fibroid outcomes and individual phthalate metabolites, sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP), and a weighted sum of anti-androgenic phthalate metabolites (∑AA Phthalates) using linear regression, adjusting for age, race/ethnicity, and body mass index. Fibroid outcomes were also examined dichotomously (divided at the median) using logistic regression.
Most women were of black ethnicity, overweight or obese, and college educated. In multivariable models, higher levels of mono-hydroxyisobutyl phthalate, monocarboxyoctyl phthalate, monocarboxynonyl phthalate, mono(2-ethylhexyl) phthalate, mono(2-ethyl-5-hydroxyhexyl phthalate) (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), ∑DEHP, and ∑AA Phthalates were positively associated with uterine volume. Associations were most pronounced for individual DEHP metabolites (MEHHP, MEOHP, MECPP), ∑DEHP, and ∑AA Phthalates. For example, a doubling in ∑DEHP and ∑AA Phthalates was associated with 33.2% (95% confidence interval 6.6-66.5) and 26.8% (95% confidence interval 2.2-57.4) increase in uterine volume, respectively. There were few associations between phthalate biomarkers and fibroid size.
Exposure to some phthalate biomarkers was positively associated with uterine volume, which further supports the hypothesis that phthalate exposures may be associated with fibroid outcomes. Additional studies are needed to confirm these relationships.
研究邻苯二甲酸酯暴露与两种子宫肌瘤负担指标之间的关系：最大肌瘤直径和子宫体积。
试点，横断面研究。
学术医疗中心。
五十七例因子宫肌瘤接受子宫切除术或肌瘤切除术的绝经前妇女。
无。
从病历中提取最大肌瘤直径和子宫尺寸。使用质谱法分析 14 种邻苯二甲酸酯生物标志物的点尿样。我们使用线性回归估计了纤维瘤结果与个体邻苯二甲酸酯代谢物、邻苯二甲酸二（2-乙基己基）代谢物总和（∑DEHP）和抗雄激素邻苯二甲酸酯代谢物加权总和（∑AA Phthalates）之间的关系，调整了年龄、种族/民族和体重指数。还使用逻辑回归将纤维瘤结果进行了二分法（中位数划分）。
大多数女性为黑种人，超重或肥胖，大学学历。在多变量模型中，较高水平的单羟基异丁基邻苯二甲酸酯、单羧基辛基邻苯二甲酸酯、单羧基壬基邻苯二甲酸酯、单（2-乙基己基）邻苯二甲酸酯、单（2-乙基-5-羟基己基）邻苯二甲酸酯（MEHHP）、单（2-乙基-5-氧代己基）邻苯二甲酸酯（MEOHP）和单（2-乙基-5-羧基戊基）邻苯二甲酸酯（MECPP）、∑DEHP 和∑AA Phthalates 与子宫体积呈正相关。DEHP 代谢物（MEHHP、MEOHP、MECPP）、∑DEHP 和∑AA Phthalates 的个体关联最为明显。例如，∑DEHP 和∑AA Phthalates 增加一倍，与子宫体积分别增加 33.2%（95%置信区间 6.6-66.5）和 26.8%（95%置信区间 2.2-57.4）相关。邻苯二甲酸酯生物标志物与纤维瘤大小之间几乎没有关联。
一些邻苯二甲酸酯生物标志物的暴露与子宫体积呈正相关，这进一步支持了邻苯二甲酸酯暴露可能与纤维瘤结果相关的假设。需要进一步的研究来证实这些关系。
