全氟和多氟烷基物质 (PFAS) 与美国成年人抑郁之间的关联：NHANES 2005 年至 2018 年的横断面研究。
Association between per- and polyfluoroalkyl substances (PFAS) and depression in U.S. adults: A cross-sectional study of NHANES from 2005 to 2018.
机构信息
Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, 410078, China.
Experimental Physics Department, Institute of Physics and Technology, Ural Federal University, Ekaterinburg, Russia.
出版信息
Environ Res. 2023 Dec 1;238(Pt 2):117188. doi: 10.1016/j.envres.2023.117188. Epub 2023 Sep 27.
BACKGROUND
Per- and polyfluoroalkyl substances (PFAS) are widespread persistent organic pollutants (POPs) associated with diseases including osteoporosis, altered immune function and cancer. However, few studies have investigated the association between PFAS mixture exposure and Depression in general populations.
METHODS
Nationally representative data from the National Health and Nutrition Examination Survey (NHANES) (2005-2018) were used to analyze the association between PFAS and Depression in U.S. adults. Total 12,239 adults aged 20 years or older who had serum PFAS measured and answered Patient Health Questionnaire-9 (PHQ-9) were enrolled in this study. PFAS monomers detected in all 7 investigation cycles were included in the study. Generalized additive model (GAM) was used to fit smooth curves and threshold effect analysis was carried out to find the turning point of smooth curves. Generalized linear model (GLM) was used to describe the non-linear relationship between PFAS and depression and unconditioned logistic regression was used to risk analysis.
RESULTS
The median of total serum PFAS concentration was 14.54 ng/mL. The curve fitting results indicated a U-shaped relationship between total serum PFAS and depression: PFAS< 39.66 ng/mL, A negative correlation between PHQ-9 score and serum PFAS concentration was observed (β 0.047,95%CI -0.059, -0.036). The depression PHQ-9 score decreased with the increase of serum PFAS concentration. PFAS ≥ 39.66 ng/mL, A positive correlation was observed between PFAS and PHQ-9 score (β 0.010,95% CI 0.003, 0.017). The depression PHQ-9 score increased with the increase of serum PFAS concentration.
CONCLUSIONS
Our study provides new clues to the association of PFAS with depression, and large population-based cohort studies that can validate the causal association as well as toxicological mechanism studies are needed for validation.
背景
全氟和多氟烷基物质（PFAS）是广泛存在的持久性有机污染物（POPs），与骨质疏松症、免疫功能改变和癌症等疾病有关。然而，很少有研究调查 PFAS 混合物暴露与一般人群中抑郁症之间的关系。
方法
本研究使用来自全国健康和营养检查调查（NHANES）（2005-2018 年）的全国代表性数据，分析了美国成年人中 PFAS 与抑郁症之间的关系。共纳入了 12239 名年龄在 20 岁或以上、血清 PFAS 检测和回答患者健康问卷-9（PHQ-9）的成年人。本研究纳入了所有 7 个调查周期中检测到的 PFAS 单体。采用广义加性模型（GAM）拟合平滑曲线，并进行阈值效应分析以找到平滑曲线的转折点。采用广义线性模型（GLM）描述 PFAS 与抑郁之间的非线性关系，采用无条件逻辑回归进行风险分析。
结果
总血清 PFAS 浓度的中位数为 14.54ng/mL。曲线拟合结果表明，总血清 PFAS 与抑郁之间呈 U 型关系：PFAS<39.66ng/mL 时，PHQ-9 评分与血清 PFAS 浓度呈负相关（β0.047，95%CI-0.059，-0.036）。随着血清 PFAS 浓度的增加，抑郁 PHQ-9 评分降低。PFAS≥39.66ng/mL 时，PFAS 与 PHQ-9 评分呈正相关（β0.010，95%CI0.003，0.017）。随着血清 PFAS 浓度的增加，抑郁 PHQ-9 评分升高。
结论
本研究为 PFAS 与抑郁症之间的关系提供了新的线索，需要进行大规模的基于人群的队列研究来验证因果关系以及毒理学机制研究。
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