Eckert Elisabeth, Müller Johannes, Höllerer Christine, Purbojo Ariawan, Cesnjevar Robert, Göen Thomas, Münch Frank
Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 9-11, 91054 Erlangen, Germany.
Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 9-11, 91054 Erlangen, Germany.
Toxicol Lett. 2020 May 6;330:7-13. doi: 10.1016/j.toxlet.2020.04.004.
In the present study we investigated the internal exposure situation of infant patients to the plasticizers TEHTM (tri-2-ethylhexyl trimellitate) and DEHP (di-2-ethylhexyl phthalate). The study collective included 21 infant patients aged 2-22 months that had to undergo cardiac surgery using cardio pulmonary bypass (CPB). Each patient, but one, received blood products during surgery. A special feature was that the used CPB tubings were exclusively plasticized with the alternative plasticizer TEHTM and were free of the standard plasticizer DEHP, that raises increasing toxicological concern. The blood products were stored in DEHP plasticized blood bags. Blood and urine samples of each infant patient were analysed before and after the surgery for the levels of the plasticizers DEHP and TEHTM and their metabolites. In general, the plasticizers were detected in the post-surgery blood samples only, with TEHTM in low levels (median 18.4 μg/L) and DEHP in rather elevated levels (median 1046 μg/L). With respect to the urine samples, TEHTM metabolites were not detected in any of the samples. DEHP metabolites were found in all urine samples, however, in significantly increased median levels in the post-surgery urine samples of the infants (increase factor 5-26). Thus, the present study clearly demonstrates the strong contribution of standard medical procedures to the internal plasticizer burden of patients. Particularly with regard to the suspected endocrine disrupting activities of the phthalate plasticizer DEHP, the elevated internal levels of this plasticizer and its metabolites in infants following cardiac surgery are alarming.
在本研究中，我们调查了婴儿患者对增塑剂偏苯三酸三（2-乙基己基）酯（TEHTM）和邻苯二甲酸二（2-乙基己基）酯（DEHP）的体内暴露情况。研究对象包括21名年龄在2至22个月之间、必须接受体外循环心脏手术（CPB）的婴儿患者。除一名患者外，每位患者在手术期间均接受了血液制品。一个特别之处在于，所使用的CPB管道仅用替代增塑剂TEHTM进行了增塑，且不含引发越来越多毒理学关注的标准增塑剂DEHP。血液制品储存在DEHP增塑的血袋中。对每位婴儿患者手术前后的血液和尿液样本进行分析，以检测增塑剂DEHP和TEHTM及其代谢物的水平。一般来说，仅在术后血液样本中检测到了增塑剂，其中TEHTM水平较低（中位数为18.4μg/L），而DEHP水平较高（中位数为1046μg/L）。关于尿液样本，在任何样本中均未检测到TEHTM代谢物。然而，在所有尿液样本中均发现了DEHP代谢物，不过，婴儿术后尿液样本中的中位数水平显著升高（增加因子为5至26）。因此，本研究清楚地表明了标准医疗程序对患者体内增塑剂负担的巨大影响。特别是考虑到邻苯二甲酸酯增塑剂DEHP疑似的内分泌干扰活性，心脏手术后婴儿体内该增塑剂及其代谢物水平升高令人担忧。
