Han M, Liu S, Ji J R, Wu Y F, Chang K W, Zhang J Y, Wei J N
Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China.
Department of Obstetrical, The First Hospital of Shanxi Medical University, Taiyuan 030001, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2023 Feb 6;57(2):193-199. doi: 10.3760/cma.j.cn112150-20220322-00274.
To analyze the contribution and interaction of polycyclic aromatic hydrocarbons (PAH)-DNA adducts and changes of telomere length (TL) on missed abortion. From March to December 2019, patients with missed abortion in the First Hospital of Shanxi Medical University and pregnant women with normal pregnancy but voluntary abortion in the same department during the same period were selected and divided into a case group and a control group. Questionnaire was used to investigate the general situation and the pregnancy situation of the subjects. The abortion villi were collected and the content of PAH-DNA adducts and TL was detected. Logistic regression model was used to analyze the associated factors of missed abortion. R epiR package and Mediation package were used to analyze the effect and relationship between PAH-DNA adducts and TL on missed abortion. The age of the subjects was(29.92±5.69)years old. The (,)of PAH-DNA adducts was 453.75(404.61, 504.72) pg/ml. The (,)of TL was 1.21(0.77, 1.72). The content of PAH-DNA adducts in the case group was higher than that in the control group (=-2.10, =0.036), while the TL was lower than that in the control group (=-4.05, <0.001). Multivariate logistic regression showed that low, medium and high levels of PAH-DNA adducts (=3.17,95%:1.41-7.14;=2.85,95%:1.25-6.52;=2.46,95%:1.07-5.64), and long, medium and short levels of TL (=2.50,95%:1.11-5.63;=3.32,95%:1.45-7.56;=3.22,95%:1.42-7.26) were all risk factors for missed abortion. The medium level of PAH-DNA adducts had a 2.76-fold higher risk of shortened TL than those with the lowest level, and no mediating role of TL was found. The stratified analysis showed that when the TL level was longer (>1.21), the low and high levels of PAH-DNA adducts were associated with missed abortion (all <0.05); when the TL level was shorter (<1.21), the medium level of PAH-DNA adducts was associated with abortion (=0.025). At lower levels of PAH-DNA adducts, no effect of TL on missed abortion was observed, while, at higher levels, TL was strongly associated with missed abortion (=7.50,95%:1.95-28.82;=6.04,95%:1.54-23.65;=9.05,95%:2.34-35.04). The interaction analysis found that the was 0.72 (95%: 0.46-0.99), and the was 5.21 (95%: 2.30-11.77). The high level of PAH-DNA adducts and shortened TL may increase the risk of missed abortion, and there may be a positive additive interaction between the two factors on missed abortion.
分析多环芳烃（PAH）-DNA加合物及端粒长度（TL）变化对稽留流产的影响及其相互作用。选取2019年3月至12月在山西医科大学第一医院就诊的稽留流产患者及同期在同一科室自愿要求终止妊娠的正常孕妇，分为病例组和对照组。采用问卷调查法收集研究对象的一般情况及妊娠情况。采集流产绒毛，检测PAH-DNA加合物含量及TL。采用Logistic回归模型分析稽留流产的相关因素，运用R语言epiR包和Mediation包分析PAH-DNA加合物及TL对稽留流产的作用及关系。研究对象年龄为（29.92±5.69）岁，PAH-DNA加合物含量中位数为453.75（404.61，504.72）pg/ml，TL中位数为1.21（0.77，1.72）。病例组PAH-DNA加合物含量高于对照组（=-2.10，=0.036），TL低于对照组（=-4.05，<0.001）。多因素Logistic回归分析显示，PAH-DNA加合物低、中、高水平（=3.17，95%CI：1.41-7.14；=2.85，95%CI：1.25-6.52；=2.46，95%CI：1.07-5.64）及TL长、中、短水平（=2.50，95%CI：1.11-5.63；=3.32，95%CI：1.45-7.56；=3.22，95%CI：1.42-7.26）均是稽留流产的危险因素。PAH-DNA加合物中等水平组TL缩短风险是最低水平组的2.76倍，未发现TL的中介作用。分层分析显示，当TL水平较长（>1.21）时，PAH-DNA加合物低、高水平与稽留流产有关（均<0.05）；当TL水平较短（<1.21）时，PAH-DNA加合物中等水平与流产有关（=0.025）。在PAH-DNA加合物较低水平时，未观察到TL对稽留流产的影响，而在较高水平时，TL与稽留流产密切相关（=7.50，95%CI：1.95-28.82；=6.04，95%CI：1.54-23.65；=9.05，95%CI：2.34-35.04）。交互作用分析发现，交互作用P值为0.72（95%CI：0.46-0.99），归因交互作用P值为5.21（95%CI：2.30-11.77）。PAH-DNA加合物高水平及TL缩短可能增加稽留流产风险，二者在稽留流产发生上可能存在正向相加作用。
