Liu Xiao-Ying, Zhang Min, Gu Xiao-Li, Deng Yan-Ling, Liu Chong, Miao Yu, Wu Yang, Li Cheng-Ru, Zeng Jia-Yue, Li Yang-Juan, Liu A-Xue, Zhu Jin-Qin, Li Yu-Feng, Liu Chang-Jiang, Zeng Qiang
Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, PR China.
Sci Total Environ. 2024 Feb 20;912:168729. doi: 10.1016/j.scitotenv.2023.168729. Epub 2023 Nov 24.
Disinfection byproducts (DBPs) as ovarian toxicants have been documented in toxicological studies. However, no human studies have explored the effects of exposure to DBPs on diminished ovarian reserve (DOR).
To assess whether urinary biomarkers of exposure to drinking-water DBPs were associated with DOR risk.
A total of 311 women undergoing assisted reproductive technology were diagnosed with DOR in the Tongji Reproductive and Environmental (TREE) cohort from December 2018 to August 2021. The cases were matched to the controls with normal ovarian reserve function by age in a ratio of 1:1. Urinary trichloroacetic acid (TCAA) and dichloroacetic acid (DCAA) were quantified as biomarkers of drinking-water DBP exposures. The conditional logistic regression and restricted cubic spline (RCS) were used to explore urinary biomarkers of drinking-water DBP exposures in associations with the risk of DOR.
Elevated urinary DCAA levels were associated with higher DOR risk [adjusted odds ratio (OR) = 1.87; 95 % confidence interval (CI): 1.16, 3.03 for the highest vs. lowest quartiles; P for trend = 0.016]. The association was confirmed in the RCS model, with a linear dose-response curve (P for overall association = 0.029 and P for non-linear association = 0.708). The subgroup analysis by age and body mass index (BMI) showed that urinary DCAA in association with DOR risk was observed among women ≥35 years old and leaner women (BMI < 24 kg/m), but the group differences were not statistically significant. Moreover, a U-shaped dose-response curve between urinary TCAA and DOR risk was estimated in the RCS model (P for overall association = 0.011 and P for non-linear association = 0.004).
Exposure to drinking-water DBPs may contribute to the risk of DOR among women undergoing assisted reproductive technology.
消毒副产物（DBPs）作为卵巢毒物已在毒理学研究中得到证实。然而，尚无人体研究探讨接触DBPs对卵巢储备功能减退（DOR）的影响。
评估饮用水中DBPs暴露的尿液生物标志物是否与DOR风险相关。
2018年12月至2021年8月，在同济生殖与环境（TREE）队列中，共有311名接受辅助生殖技术的女性被诊断为DOR。病例与卵巢储备功能正常的对照按年龄1:1匹配。尿中三氯乙酸（TCAA）和二氯乙酸（DCAA）被定量作为饮用水中DBPs暴露的生物标志物。采用条件逻辑回归和受限立方样条（RCS）来探讨饮用水中DBPs暴露的尿液生物标志物与DOR风险的关联。
尿中DCAA水平升高与较高的DOR风险相关[调整后的优势比（OR）=1.87；最高四分位数与最低四分位数相比，95%置信区间（CI）：1.16，3.03；趋势P=0.016]。该关联在RCS模型中得到证实，呈现线性剂量反应曲线（总体关联P=0.029，非线性关联P=0.708）。按年龄和体重指数（BMI）进行的亚组分析显示，在≥35岁的女性和较瘦女性（BMI<24kg/m²）中观察到尿中DCAA与DOR风险相关，但组间差异无统计学意义。此外，在RCS模型中估计了尿中TCAA与DOR风险之间的U形剂量反应曲线（总体关联P=0.011，非线性关联P=0.004）。
接触饮用水中的DBPs可能会增加接受辅助生殖技术的女性发生DOR的风险。
