美国女性中多种内分泌干扰物暴露与子宫肌瘤和子宫内膜异位症的联合作用。

Combined Exposure to Multiple Endocrine Disruptors and Uterine Leiomyomata and Endometriosis in US Women.

机构信息

Department of Women Health Care, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.

Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.

出版信息

Front Endocrinol (Lausanne). 2021 Aug 20;12:726876. doi: 10.3389/fendo.2021.726876. eCollection 2021.

DOI:10.3389/fendo.2021.726876

PMID:34489871

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8418539/

Abstract

BACKGROUND

Uterine leiomyomata (UL) and endometriosis (EM) are common gynecological diseases damaging the reproductive health of fertile women. Among all the potential factors, environmental endocrine-disrupting chemicals are insufficiently addressed considering the multiple pollutants and mixture exposure.

METHODS

Women aged 20 to 54 years old in the National Health and Nutrition Examination Survey (NHANES) 2001-2006, having a complete measurement of ten commonly exposed endocrine-disrupting chemicals (including urinary phthalate metabolites, equol, and whole blood heavy metals) and answered questions about UL and EM were included (N=1204). Multivariable logistic regression model, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were implemented to analyze the combined effect of chemicals on the overall association with UL and EM.

RESULTS

In single chemical analysis, equol (OR: 1.90, 95% CI: 1.11, 3.27) and mercury (Hg) (OR: 1.91, 95% CI: 1.14, 3.25) were found positively associated with UL in tertile 3 . tertile 1. In WQS regression and BKMR models, the significant positive association between WQS index and UL (OR: 2.54, 95% CI: 1.52, 4.29) was identified and the positive relationship between equol and Hg exposure and UL were further verified. Besides, the mixture evaluation models (WQS and BKMR) also found MEHP negatively associated with UL. Although none of the single chemicals in tertile 3 were significantly associated with EM, the WQS index had a marginally positive association with EM (OR: 2.01, 95% CI: 0.98, 4.15), and a significant positive association was identified in subanalysis with participants restricted to premenopausal women (OR: 2.18, 95% CI: 1.03, 4.70). MIBP and MBzP weighted high in model of EM and MEHP weighted the lowest.

CONCLUSION

Comparing results from these three statistical models, the associations between equol, Hg, and MEHP exposure with UL as well as the associations of MIBP, MBzP, and MEHP exposure with EM warrant further research.

摘要

背景

子宫肌瘤（UL）和子宫内膜异位症（EM）是常见的妇科疾病，会损害育龄妇女的生殖健康。在所有潜在因素中，环境内分泌干扰化学物质的问题尚未得到充分解决，因为存在多种污染物和混合物暴露。

方法

纳入 2001-2006 年全国健康和营养检查调查（NHANES）中年龄在 20 至 54 岁之间、有十种常见内分泌干扰化学物质完整测量值（包括尿液邻苯二甲酸代谢物、大豆苷元和全血重金属）且回答了 UL 和 EM 相关问题的女性（N=1204）。采用多变量逻辑回归模型、加权分位数总和（WQS）回归和贝叶斯核机器回归（BKMR）模型分析化学物质联合效应对 UL 和 EM 的整体关联。

结果

在单一化学物质分析中，大豆苷元（OR：1.90，95%置信区间：1.11，3.27）和汞（Hg）（OR：1.91，95%置信区间：1.14，3.25）在第三三分位与 UL 呈正相关。 tertile 1。在 WQS 回归和 BKMR 模型中，发现 WQS 指数与 UL 之间存在显著正相关（OR：2.54，95%置信区间：1.52，4.29），并且进一步验证了大豆苷元和 Hg 暴露与 UL 之间的正相关关系。此外，混合物评价模型（WQS 和 BKMR）还发现 MEHP 与 UL 呈负相关。尽管第三三分位的任何单一化学物质与 EM 均无显著关联，但 WQS 指数与 EM 呈边缘正相关（OR：2.01，95%置信区间：0.98，4.15），在仅限于绝经前妇女的亚分析中，发现存在显著正相关（OR：2.18，95%置信区间：1.03，4.70）。MIBP 和 MBzP 在 EM 模型中的权重较高，而 MEHP 的权重最低。