使用贝叶斯和加权回归评估特发性少弱畸精子症与精浆金属混合物之间的关联。 - Suppr | 超能文献

Abstract

Idiopathic oligoastenoteratozoospermia (iOAT) affects 30% of infertile men of reproductive age. However, the associations between Cr, Fe, Cu, Se or Co levels and iOAT risk have not been determined. This research aimed to assess the associations between Cr, Fe, Cu, Se and Co levels as well as their mixtures in seminal plasma and the risk of iOAT and severe iOAT. Therefore, a case‒control study including 823 participants (416 iOAT patients and 407 controls) recruited from October 2021 to August 2022 at the reproductive medicine center of the First Affiliated Hospital of Anhui Medical University was conducted in Anhui, China. The concentrations of Cr, Fe, Cu, Se and Co in seminal plasma were detected via inductively coupled plasma‒mass spectrometry. Binary logistic regression models were used to assess the associations between the levels of Cr, Fe, Cu, Se and Co and the risk of iOAT and severe iOAT; additionally, Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) regressions were performed to evaluate the joint effect of seminal plasma levels of Cr, Fe, Cu, Se and Co on the risk of iOAT and explore which elements contributed most to the relationship. We found significant associations between the concentrations of Fe, Cu and Se in seminal plasma and iOAT risk after adjusting for covariates (Fe, lowest tertile vs. second tertile: aOR = 1.86, 95% CI = 1.31, 2.64; Cu, lowest tertile vs. second tertile: aOR = 1.95, 95% CI = 1.37, 2.76; Se, lowest tertile vs. second tertile: aOR = 1.65, 95% CI = 1.17, 2.35). A lower Se concentration in seminal plasma (lowest tertile vs. second tertile: aOR = 1.84, 95% CI = 1.10, 3.10) was positively associated with the risk of severe iOAT. Additionally, we also observed an association between the concentration of Cr in seminal plasma and the risk of iOAT before adjusting for covariates (Cr, third tertile vs. lowest tertile: OR=1.44, 95% CI: 1.03, 2.02). According to the BKMR analyses, the risk of iOAT increased when the overall concentrations were less than the 25th percentile. The results from the WQS regression indicated that a negative WQS index was significantly associated with the iOAT risk, while a positive WQS index was not. Se and Fe had significant weights in the negative direction. In conclusion, lower Cu, Fe and Se levels in seminal plasma were positively associated with iOAT risk, while higher Cr levels in seminal plasma were positively associated with iOAT risk according to the single element model, and lower levels of Se were related to a greater risk of severe iOAT; when comprehensively considering all the results from BKMR and WQS regression, Fe, Se and Cr levels contributed most to this relationship.

摘要

特发性少弱畸精子症（iOAT）影响30%的育龄不育男性。然而，铬（Cr）、铁（Fe）、铜（Cu）、硒（Se）或钴（Co）水平与iOAT风险之间的关联尚未确定。本研究旨在评估精浆中Cr、Fe、Cu、Se和Co水平及其混合物与iOAT和重度iOAT风险之间的关联。因此，在中国安徽进行了一项病例对照研究，该研究于2021年10月至2022年8月在安徽医科大学第一附属医院生殖医学中心招募了823名参与者（416例iOAT患者和407名对照）。通过电感耦合等离子体质谱法检测精浆中Cr、Fe、Cu、Se和Co的浓度。采用二元逻辑回归模型评估Cr、Fe、Cu、Se和Co水平与iOAT和重度iOAT风险之间的关联；此外，进行了贝叶斯核机器回归（BKMR）和加权分位数和（WQS）回归，以评估精浆中Cr、Fe、Cu、Se和Co水平对iOAT风险的联合效应，并探索哪些元素对这种关系贡献最大。在调整协变量后，我们发现精浆中Fe、Cu和Se的浓度与iOAT风险之间存在显著关联（Fe，最低三分位数与第二三分位数相比：调整后比值比[aOR]=1.86，95%置信区间[CI]=1.31，2.64；Cu，最低三分位数与第二三分位数相比：aOR=1.95，95%CI=1.37，2.76；Se，最低三分位数与第二三分位数相比：aOR=1.65，95%CI=1.17，2.35）。精浆中较低的Se浓度（最低三分位数与第二三分位数相比：aOR=1.84，95%CI=1.10，3.10）与重度iOAT风险呈正相关。此外，在调整协变量之前，我们还观察到精浆中Cr的浓度与iOAT风险之间存在关联（Cr，第三三分位数与最低三分位数相比：比值比[OR]=1.44，95%CI：1.03，2.02）。根据BKMR分析，当总体浓度低于第25百分位数时，iOAT风险增加。WQS回归结果表明，负的WQS指数与iOAT风险显著相关，而正的WQS指数则不然。Se和Fe在负向具有显著权重。总之，根据单元素模型，精浆中较低的Cu水平、Fe水平和Se水平与iOAT风险呈正相关，而精浆中较高的Cr水平与iOAT风险呈正相关，且较低的Se水平与更高的重度iOAT风险相关；综合考虑BKMR和WQS回归的所有结果，Fe、Se和Cr水平对这种关系贡献最大。