Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Environ Health Perspect. 2024 Jan;132(1):17006. doi: 10.1289/EHP13386. Epub 2024 Jan 23.
Experimental studies have shown that disinfection byproducts (DBPs) including haloacetic acids (HAAs) can cause liver toxicity, but evidence linking this association in humans is sparse.
We aimed to explore the associations between HAA exposures and liver injury.
We included 922 women between December 2018 and January 2020 from the Tongji Reproductive and Environmental (TREE) cohort study in Wuhan, China. Urinary HAA concentrations including trichloroacetic acid (TCAA) and dichloroacetic acid (DCAA) and serum indicators of liver function, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) were measured. Liver injury was defined as if any of serum indicator levels were above the 90th percentile. Multivariate logistic and linear regression models were fitted to assess the associations of urinary HAA concentrations with the risk of liver injury and liver function indicators. Stratified analyses by age, body mass index (BMI), alcohol use, and passive smoking were also applied to evaluate the potential effect modifiers.
There is little evidence of associations of urinary TCAA concentrations with liver injury risk and liver function indicators. However, urinary DCAA concentrations were associated with a higher risk of liver injury [odds ratios (OR) for 1-interquartile range (IQR) increase in natural log (ln) transformed DCAA concentrations: 1.45; 95% confidence interval (CI): 1.07, 1.98]. This association was observed only among nondrinkers (). We also found that a 1-IQR increase in ln-transformed DCAA concentrations was positively associated with ALT levels (percentage ; 95% CI: 0.48%, 11.95%) and negatively associated with AST/ALT (percentage ; 95% CI: , ). In addition, urinary DCAA concentrations in relation to higher GGT levels was observed only among passive smokers ().
Our findings suggest that exposure to DCAA but not TCAA is associated with liver injury among women undergoing assisted reproductive technology. https://doi.org/10.1289/EHP13386.
实验研究表明，消毒副产物（DBPs）包括卤乙酸（HAAs）可导致肝毒性，但将这种关联与人类联系起来的证据很少。
我们旨在探索 HAA 暴露与肝损伤之间的关系。
我们纳入了 2018 年 12 月至 2020 年 1 月期间来自中国武汉同济生殖与环境（TREE）队列研究的 922 名女性。测量了尿液中 HAAs 浓度，包括三氯乙酸（TCAA）和二氯乙酸（DCAA），以及血清肝功能指标，包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和γ-谷氨酰转移酶（GGT）。如果任何血清指标水平超过第 90 百分位数，则定义为肝损伤。采用多变量逻辑和线性回归模型来评估尿液中 HAA 浓度与肝损伤风险和肝功能指标的关系。还进行了按年龄、体重指数（BMI）、饮酒和被动吸烟分层分析，以评估潜在的效应修饰剂。
尿液 TCAA 浓度与肝损伤风险和肝功能指标之间几乎没有关联的证据。然而，尿液 DCAA 浓度与肝损伤风险升高相关[ln 转换 DCAA 浓度每增加 1 个四分位距（IQR）的比值比（OR）：1.45；95%置信区间（CI）：1.07，1.98]。这种关联仅在非饮酒者中观察到（）。我们还发现，ln 转换的 DCAA 浓度每增加 1 个 IQR，与 ALT 水平呈正相关（%；95%CI：0.48%，11.95%），与 AST/ALT 呈负相关（%；95%CI：，）。此外，仅在被动吸烟者中观察到尿液 DCAA 浓度与更高的 GGT 水平相关（）。
我们的研究结果表明，接触 DCAA 而不是 TCAA 与接受辅助生殖技术的女性肝损伤有关。
