Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Obstetrics & Gynecology, E-Da Hospital, Kaohsiung, Taiwan.
Chemosphere. 2021 Jun;272:129925. doi: 10.1016/j.chemosphere.2021.129925. Epub 2021 Feb 10.
Exposure to either melamine or phthalate, two common toxicants, during pregnancy may cause adverse health effects, including kidney damage.
We investigated the independent and interactive effect of exposure to melamine and phthalates, particularly di-(2-ethylhexyl) phthalate (DEHP), on markers of early renal injury in women their third trimester of pregnancy in one nationwide birth cohort, the Taiwan Maternal and Infant Cohort Study (TMICS).
Between October, 2012 and May, 2015, participants were administered questionnaires, physical examinations, and blood and urine tests during their third trimester. One-spot overnight urine specimens were used to simultaneously measure melamine, 11 phthalate metabolites, and two markers of renal injury, microalbumin and N-acetyl-beta-D-glucosaminidas (NAG). Estimated daily DEHP intake was calculated based on measurement of three urinary DEHP metabolites. Microalbuminuria was defined as having a urinary albumin/creatinine ratio (ACR) higher than 3.5 mg/mmol.
Total 1433 pregnant women were analyzed. The median value for urinary melamine was 0.63 μg/mmol Cr and estimated DEHP intake was 1.84 μg/kg/day. We found subjects in the highest quartile of estimated DEHP intake to have significantly higher urinary ACR (β = 0.095, p = 0.043) and the prevalence of microalbuminuria (adjusted OR = 1.752, 95% confidence interval = 1.118-2.746), compared to those in the lowest quartile. In addition, there was a significant interactive effect between urinary melamine and estimated DEHP intake on urinary ACR and NAG.
Our results suggest these two ubiquitous chemicals together may be associated with markers of early kidney injury in pregnant women.
孕期接触三聚氰胺或邻苯二甲酸酯这两种常见的有毒物质，可能会对健康造成不良影响，包括肾脏损伤。
我们在一个全国性的出生队列——台湾母婴队列研究（TMICS）中，调查了孕妇在妊娠晚期暴露于三聚氰胺和邻苯二甲酸酯（尤其是邻苯二甲酸二（2-乙基己基）酯（DEHP））及其交互作用对早期肾损伤标志物的影响。
2012 年 10 月至 2015 年 5 月，在孕妇妊娠晚期，通过问卷调查、体格检查和血液及尿液检测。采集一整夜的尿液标本，同时检测三聚氰胺、11 种邻苯二甲酸代谢物和两种肾脏损伤标志物——微量白蛋白和 N-乙酰-β-D-氨基葡萄糖苷酶（NAG）。根据三种尿液中 DEHP 代谢物的测量结果，计算 DEHP 的日估计摄入量。将尿白蛋白/肌酐比值（ACR）高于 3.5mg/mmol 定义为微量白蛋白尿。
共分析了 1433 名孕妇。尿液中三聚氰胺的中位数为 0.63μg/mmol Cr，DEHP 的日估计摄入量为 1.84μg/kg/d。我们发现，DEHP 日估计摄入量最高四分位组的尿液 ACR 显著升高（β=0.095，p=0.043），微量白蛋白尿的患病率也更高（调整后的 OR=1.752，95%置信区间为 1.118-2.746），与最低四分位组相比。此外，尿液三聚氰胺和 DEHP 日估计摄入量之间存在显著的交互作用，对尿液 ACR 和 NAG 有影响。
我们的结果表明，这两种普遍存在的化学物质可能与孕妇早期肾脏损伤标志物有关。
