Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
Environ Int. 2021 Apr;149:106395. doi: 10.1016/j.envint.2021.106395. Epub 2021 Jan 25.
The immunosuppressive properties of PFASs are widely recognized. Early-life exposure to PFAS has been linked to reduced immune response to childhood vaccinations and increased rates of common infectious diseases, but implications for hospitalizations are unclear.
To investigate the association between maternal serum concentrations of five PFASs during pregnancy and the child's rate of hospitalization due to common infectious diseases between birth and 4 years of age.
Serum samples from first trimester pregnant women from the Odense Child Cohort (OCC) collected in 2010-2012 were analyzed for concentrations of perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and three other PFASs. Data on child hospitalizations with an ICD-10 code for infectious disease was obtained from the Danish National Patient Register. The following were identified: upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), gastrointestinal infections (GI), and other infections. The Andersen-Gill Cox proportional hazard model for recurrent events was used to investigate the association between PFAS exposure and hospitalizations. The resulting estimates were hazard ratios (HRs), which express the relative change in the instantaneous risk of hospitalization with a doubling in maternal PFAS concentration.
A total of 1,503 mother-child pairs were included, and 26% of the children were hospitalized at least once for infectious disease. A doubling in maternal PFOS concentration was associated with a 23% increase in the risk of hospitalization due to any infection (HR: 1.23 (95% CI: 1.05, 1.44). There was indication of an interaction between child sex and PFOS (p = 0.07) and PFDA (p = 0.06), although in opposite directions. Further, every doubling of PFOA or PFOS increased the risk of LRTI by 27% (HR: 1.27 (1.01, 1.59)) and 54% (HR: 1.54 (1.11, 2.15)), respectively. Similar tendencies were seen for URTI and the group of other infections. For GIs, the opposite pattern of association was seen as HR's were consistently below 1 (PFOA, HR: 0.55 (0.32, 0.95)).
We found an association between PFOS and the overall risk of infectious disease, and between PFOS and PFOA exposures and the risk of LRTI's. These results are in agreement with previous findings from the OCC, in which maternal PFOS and PFOA concentrations were positively associated with the number of days that the children experienced fever, thereby suggesting that PFOS and PFOA may affect the prevalence of both mild and more severe infectious diseases even in a rather low-exposed population.
全氟辛烷磺酸（PFAS）具有免疫抑制特性，这已得到广泛认可。早期接触 PFAS 与儿童对疫苗的免疫反应降低以及常见传染病发病率增加有关，但对住院的影响尚不清楚。
调查孕妇妊娠期间五种 PFAS 血清浓度与儿童出生至 4 岁期间因常见传染病住院率之间的关系。
2010-2012 年从奥登塞儿童队列（OCC）中采集的孕妇在妊娠早期的血清样本，用于分析全氟辛烷磺酸（PFOS）、全氟辛酸（PFOA）和其他三种 PFAS 的浓度。通过丹麦国家患者登记处获得儿童因传染病的 ICD-10 代码住院的数据。确定以下疾病：上呼吸道感染（URTI）、下呼吸道感染（LRTI）、胃肠道感染（GI）和其他感染。采用 Andersen-Gill 复发性事件 Cox 比例风险模型来研究 PFAS 暴露与住院之间的关系。结果表示为风险比（HR），表示母体 PFAS 浓度加倍时，住院的瞬时风险的相对变化。
共纳入 1503 对母婴，26%的儿童至少因传染病住院一次。PFOS 浓度加倍与任何感染导致的住院风险增加 23%相关（HR：1.23（95%CI：1.05，1.44））。虽然方向相反，但存在儿童性别与 PFOS（p=0.07）和 PFDA（p=0.06）之间的交互作用的迹象。此外，PFOA 或 PFOS 浓度加倍均使 LRTI 的风险分别增加 27%（HR：1.27（1.01，1.59））和 54%（HR：1.54（1.11，2.15））。URTI 和其他感染组也出现了类似的趋势。对于 GI，关联模式相反，HR 始终低于 1（PFOA，HR：0.55（0.32，0.95））。
我们发现 PFOS 与传染病的总体风险之间存在关联，PFOS 和 PFOA 暴露与 LRTI 风险之间也存在关联。这些结果与 OCC 的先前研究结果一致，在该研究中，母亲的 PFOS 和 PFOA 浓度与儿童发热天数呈正相关，这表明即使在暴露水平较低的人群中，PFOS 和 PFOA 也可能影响轻度和更严重传染病的患病率。
