妊娠期全氟化合物暴露与孕妇甲状腺相关激素水平的关联研究
Association between perfluoroalkyl and polyfluoroalkyl substances and maternal thyroid-related hormones in pregnant women
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摘要:
背景 妊娠期全氟化合物（PFAS）暴露可能影响孕妇甲状腺相关激素水平，但以往研究大多关注含8~10碳的PFAS，缺乏对含更长碳链PFAS的研究。
目的 评估血浆多种PFAS暴露和妊娠期甲状腺相关激素浓度的关联。
方法 基于2016年9月—2018年4月开展的嘉善出生队列，以781例孕妇为研究对象，应用高效液相色谱串联质谱法检测其外周血中13种常见PFAS的浓度，按照各化合物浓度的三分位数将其分为“低浓度组”“中浓度组”和“高浓度组”。应用电化学发光免疫法测定总三碘甲状腺原氨酸（T3）、总甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、甲状腺球蛋白抗体（TG-Ab）和甲状腺过氧化物酶抗体（TPOAb）的浓度。采用多元线性回归，评估多种PFAS浓度和甲状腺相关激素浓度之间的关系。
结果 与全氟十二烷酸（PFDoA）低浓度组相比，PFDoA高浓度组T3浓度变化值为−0.10 nmol·L−1，其95%CI为−0.20~0 nmol·L−1；FT3浓度变化值为−0.15 pmol·L−1，其95%CI为−0.28~−0.02 pmol·L−1；FT4浓度变化值为−3.02 pmol·L−1，其95%CI为−5.66~−0.39 pmol·L−1。与全氟十三烷酸（PFTrDA）低浓度组相比，PFTrDA高浓度组T3浓度变化值为−0.10 nmol·L−1，其95%CI为−0.20~0 nmol·L−1。而与全氟己烷磺酸（PFHxS）低浓度组相比，PFHxS中浓度组T4浓度变化值为6.10 nmol·L−1，其95%CI为0.44~11.75 nmol·L−1。未发现PFAS与TSH浓度之间有统计学意义的关联。另外，在TG-Ab和/或TPOAb阳性的孕妇中，发现PFAS和甲状腺相关激素浓度之间的负相关关系更明显。
结论 妊娠期PFAS暴露可影响孕妇甲状腺相关激素稳态，其效应在TG-Ab和/或TPOAb阳性孕妇中更强。
Abstract:Background Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) during pregnancy might affect thyroid-related hormone levels in pregnant women. However, most previous studies focused on the effects of PFAS containing 8-10 carbon atoms, and few studies have estimated the associations between PFAS with longer carbon chain and thyroid-related hormone levels.
Objective To examine the associations between PFAS exposure and thyroid-related hormones in pregnant women.
Methods The present study was based on the Jiashan Birth Cohort from September 2016 to April 2018. We analyzed 13 PFAS in maternal blood samples (
n =781) by high-performance liquid chromatography-tandem mass spectrometry, as well as total triiodothyronine (T3), total thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), and thyroid peroxidase antibody (TPOAb) by electrochemiluminescence immunoassay. PFAS were divided into three groups:low concentration, medium concentration and high concentration according to the tertile of their concentrations. We estimated the associations between PFAS concentrations and thyroid-related hormones in pregnant women by multiple linear regression.Results In the multiple linear regression models, a change in perfluorododecanoic acid (PFDoA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3, −0.15 (95%CI: −0.28, −0.02) pmol·L−1 change in FT3, and −3.02 (95%CI: −5.66, −0.39) pmol·L−1 change in FT4, respectively. A change in perfluorotridecanoic acid (PFTrDA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3. Compared with the low concentration group, the concentration of T4 in the medium concentration group of perfluorohexane sulfonate (PFHxS) increased by 6.10 (95%CI: 0.44, 11.75) nmol·L−1. No statistically significant associations were found between PFAS and TSH concentration. The negative associations of PFAS with thyroid-related hormones were more pronounced in pregnant women with positive TG-Ab and/or TPOAb.
Conclusion Exposure to PFAS during pregnancy may affect thyroid-related hormone homeostasis in pregnant women, and the effect is stronger in TG-Ab and/or TPOAb-positive pregnant women.
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