Zhang Hanzhi, Liu Dan, Chen Jingfei
Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Reprod Toxicol. 2024 Dec;130:108719. doi: 10.1016/j.reprotox.2024.108719. Epub 2024 Sep 19.
This study explores the relationship between Di-2-ethylhexyl phthalate (DEHP) exposure and female infertility. The analysis included 998 female participants aged between 18 and 44 years. We analyzed data from the National Health and Nutrition Examination Survey (2013-2018) using multiple logistic regression and generalized linear models to assess the impact of DEHP on infertility. Additionally, we employed curve fitting and two-piecewise linear regression models to investigate potential nonlinear correlations, conducting subgroup analyses based on age, BMI, alcohol consumption, smoking status, hypertension, and diabetes. Our results, after adjusting for confounders, revealed a positive association between DEHP exposure and infertility. This association was significant whether DEHP was treated as a continuous variable (odds ratio OR = 1.28, 95 % confidence interval CI: 1.08-1.52, P = 0.0072) or as a categorical variable (P for trend = 0.0038). A non-linear relationship was identified, with an inflection point at - 3.35 (∑DEHP = 0.0981 × 10 mol/mg creatinine). Effect sizes were 1.55 (1.01-2.36) on the left side of the inflection point and 0.73 (0.43-1.23) on the right side. Subgroup analysis indicated that the correlation was consistent across stratified variables. In conclusion, our findings suggest a non-linear association between DEHP exposure and female infertility, with a positive correlation within a specific dose range, but no further increase in risk beyond a certain threshold.
本研究探讨邻苯二甲酸二(2-乙基己基)酯(DEHP)暴露与女性不孕之间的关系。分析纳入了998名年龄在18至44岁之间的女性参与者。我们使用多重逻辑回归和广义线性模型分析了国家健康与营养检查调查(2013 - 2018年)的数据,以评估DEHP对不孕的影响。此外,我们采用曲线拟合和两段式线性回归模型来研究潜在的非线性相关性,并根据年龄、体重指数、饮酒情况、吸烟状况、高血压和糖尿病进行亚组分析。在调整混杂因素后,我们的结果显示DEHP暴露与不孕之间存在正相关。无论将DEHP视为连续变量(优势比OR = 1.28,95%置信区间CI:1.08 - 1.52,P = 0.0072)还是分类变量(趋势P = 0.0038),这种关联都很显著。确定了一种非线性关系,拐点为 - 3.35(∑DEHP = 0.0981×10摩尔/毫克肌酐)。在拐点左侧效应大小为1.55(1.01 - 2.36),右侧为0.73(0.43 - 1.23)。亚组分析表明,在各分层变量中相关性是一致的。总之,我们的研究结果表明DEHP暴露与女性不孕之间存在非线性关联,在特定剂量范围内呈正相关,但超过一定阈值后风险不再进一步增加。