Shi Tianshan, Li Di, Li Donghua, Xie Peng, Sun Jin, Wang Tingrong, Li Rui, Zou Zixuan, Li Zhenjuan, Ren Xiaowei
Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China.
Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230000, Anhui, China.
Environ Geochem Health. 2025 Jan 6;47(2):41. doi: 10.1007/s10653-024-02354-z.
It remains unclear whether phthalates are associated with gallstones and whether the associations of phthalate alternatives with gallstones are different from traditional phthalates. In this study, 1735 participants from the NHANES 2017-2018 were included and their urine was used to detect phthalate metabolites. We used logistic and restricted cubic spline regressions to assess individual associations and dose-response relationships between phthalate metabolites and gallstones, quantile g-computation and Bayesian kernel machine regression to assess mixed associations of phthalate metabolites with gallstones, and subgroup analyses to explore potential effect modifiers. We observed that individual associations of cyclohexane-1,2-dicarboxylic acid-mono(carboxyoctyl) ester phthalate (MCOCHP) (OR: 1.423, 95% CI: 1.098-1.844) and cyclohexane 1,2-dicarboxylic acid monohydroxy isononyl ester (MHNCH) (OR: 1.380, 95% CI: 1.080-1.763) with gallstones were linearly positive, mixed association of phthalate metabolites (OR: 2.453, 95% CI: 1.054-5.708) with gallstones was also positive, and MCOCHP and MHNCH had positive weights. The associations of phthalate metabolites with gallstones were higher in the males and participants with age ≥ 60 years, BMI ≥ 30 kg/m, hypertension, and diabetes. MCOCHP and MHNCH had the highest groupPIP (groupPIP: 0.941), mono(2-ethyl-5-carboxypentyl) terephthalate (MECPTP) had the highest condPIP (condPIP: 0.721), and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), MCOCHP, and mono-isobutyl phthalate (MiBP) also had high condPIPs (condPIP > 0.5). The trend in mixed associations of phthalate metabolites with gallstones was positive. Our study suggests that traditional phthalates and phthalate alternatives are associated with gallstones, especially in the elderly, men, obese, hypertensive populations, and diabetic populations, and phthalate alternatives are associated with a higher risk of gallstones.
邻苯二甲酸盐是否与胆结石有关，以及邻苯二甲酸酯替代品与胆结石的关联是否与传统邻苯二甲酸盐不同，目前尚不清楚。在本研究中，纳入了2017 - 2018年美国国家健康与营养检查调查（NHANES）的1735名参与者，并使用他们的尿液检测邻苯二甲酸酯代谢物。我们使用逻辑回归和受限立方样条回归来评估邻苯二甲酸酯代谢物与胆结石之间的个体关联和剂量反应关系，使用分位数g计算和贝叶斯核机器回归来评估邻苯二甲酸酯代谢物与胆结石的混合关联，并进行亚组分析以探索潜在的效应修饰因素。我们观察到，邻苯二甲酸环己烷 - 1,2 - 二羧酸 - 单（羧基辛基）酯（MCOCHP）（比值比：1.423，95%置信区间：1.098 - 1.844）和邻苯二甲酸环己烷1,2 - 二羧酸单羟基异壬酯（MHNCH）（比值比：1.380，95%置信区间：1.080 - 1.763）与胆结石的个体关联呈线性正相关，邻苯二甲酸酯代谢物与胆结石的混合关联（比值比：2.453，95%置信区间：1.054 - 5.708）也呈正相关，且MCOCHP和MHNCH具有正权重。邻苯二甲酸酯代谢物与胆结石的关联在男性以及年龄≥60岁、体重指数（BMI）≥30kg/m²、患有高血压和糖尿病的参与者中更高。MCOCHP和MHNCH的分组后验包含概率（groupPIP）最高（groupPIP：0.941），邻苯二甲酸单（2 - 乙基 - 5 - 羧基戊基）酯（MECPTP）的条件后验包含概率（condPIP）最高（condPIP：0.721），邻苯二甲酸单（2 - 乙基 - 5 - 羧基戊基）酯（MECPP）、MCOCHP和邻苯二甲酸单异丁酯（MiBP）的condPIP也较高（condPIP > 0.5）。邻苯二甲酸酯代谢物与胆结石的混合关联趋势为正。我们的研究表明，传统邻苯二甲酸盐和邻苯二甲酸酯替代品与胆结石有关，尤其是在老年人以及男性、肥胖者、高血压人群和糖尿病患者中，且邻苯二甲酸酯替代品与胆结石的风险更高有关。
