张嘉宇, 籍静茹, 刘莎, 武嫣斐, 常可为, 韩梅, 魏俊妮. 不良妊娠史和多环芳烃-DNA加合物对胎停育的交互作用[J]. 环境与职业医学, 2022, 39(6): 659-664. DOI: 10.11836/JEOM21473
引用本文: 张嘉宇, 籍静茹, 刘莎, 武嫣斐, 常可为, 韩梅, 魏俊妮. 不良妊娠史和多环芳烃-DNA加合物对胎停育的交互作用[J]. 环境与职业医学, 2022, 39(6): 659-664. DOI: 10.11836/JEOM21473
ZHANG Jiayu, JI Jingru, LIU Sha, WU Yanfei, CHANG Kewei, HAN Mei, WEI Junni. Interaction between adverse pregnancy history and polycyclic aromatic hydrocarbon-DNA adducts on missed abortion[J]. Journal of Environmental and Occupational Medicine, 2022, 39(6): 659-664. DOI: 10.11836/JEOM21473
Citation: ZHANG Jiayu, JI Jingru, LIU Sha, WU Yanfei, CHANG Kewei, HAN Mei, WEI Junni. Interaction between adverse pregnancy history and polycyclic aromatic hydrocarbon-DNA adducts on missed abortion[J]. Journal of Environmental and Occupational Medicine, 2022, 39(6): 659-664. DOI: 10.11836/JEOM21473

不良妊娠史和多环芳烃-DNA加合物对胎停育的交互作用

Interaction between adverse pregnancy history and polycyclic aromatic hydrocarbon-DNA adducts on missed abortion

  • 摘要: 背景 胎停育发生率逐年上升,但病因尚未完全阐明,不良妊娠史及多环芳烃(PAHs)的暴露均有可能增加胎停育的发病风险。

    目的 探讨不良妊娠史和PAHs暴露对孕早期胚胎停育的影响及交互作用,为胎停育病因研究提供依据。

    方法 选取2019年3—12月在山西医科大学第一医院产科诊断为胚胎停育的114名孕妇作为病例组,选择同医院同期自愿要求人工流产的139名正常妊娠妇女作为对照组,收集研究对象的基本情况及流产、死胎和宫内生长发育迟缓等不良妊娠史,采集流产绒毛组织检测组织中PAH-DNA加合物水平,按孕次及不良妊娠史分层并以四分位数法进行分组,依次为Q1(< 404.61 ng·L−1)、Q2(404.61~453.75 ng·L−1)、Q3(453.76~506.72 ng·L−1)、Q4(≥506.73 ng·L−1)。采用SPSS 25.0统计软件进行χ2检验和多因素logistic回归,采用相加和相乘模型探讨不良妊娠史和PAH-DNA加合物对胎停育影响的交互作用。将PAH-DNA加合物按三分位数法和四分位数法分组,分别以P33P50P67P75作数据切点进行敏感性分析。

    结果 怀孕次数≥2次的160名研究对象中,病例组孕妇不良妊娠史占比(57.81%)高于对照组(17.71%)(P < 0.001)。按孕次分层对两组间不同PAH-DNA加合物水平进行 χ2检验,结果显示孕≥2次者PAH-DNA加合物水平与胎停育有关(χ2=10.14,P=0.017)。在孕次≥2次的研究对象中进一步按有无不良妊娠史分层分析,无不良妊娠史者PAH-DNA加合物与胎停育有关(χ2=9.70,P=0.021)。调整变量后多因素logistic回归分析结果表明不良妊娠史(OR=5.88,95%CI:2.79~12.39)和PAH-DNA加合物(OR=3.01,95%CI:1.22~7.40)可能会增加胎停育发生的风险 ,但未发现两者的交互作用,交互作用超额相对危险度(RERI)、交互作用归因百分比(AP)、交互作用指数(SI)及其95%CI分别为0.60(−0.58~1.77)、0.74(−0.83~2.30)、0.20(0.01~5.43)。

    结论 不良妊娠史和PAH-DNA加合物可能会增加胎停育的风险,但尚未发现两者与胎停育的发生存在交互作用。

     

    Abstract: Background The incidence rate of missed abortion is increasing year by year, but the etiology has not been fully elucidated. Adverse pregnancy history and exposure to polycyclic aromatic hydrocarbons (PAHs) may increase the risk of missed abortion.

    Objective To investigate the interaction between adverse pregnancy history and PAHs exposure on missed abortion in early pregnancy, and to provide evidence for the etiologic research of missed abortion.

    Methods A total of 114 pregnant women diagnosed with missed abortion in the Department of Obstetrics of the First Hospital of Shanxi Medical University from March to December 2019 were selected as the case group, and 139 pregnant women who visited the same hospital for voluntary induced abortion in the same period as the control group, to collect basic information and medical information of abortion, stillbirth, intrauterine growth retardation, and other adverse pregnancy history. Abortion villus tissues were collected to detect PAH-DNA adducts levels, stratified by pregnancy and adverse pregnancy history and grouped by quartile method: Q1 (< 404.61 ng·L−1), Q2 (404.61−453.75 ng·L−1), Q3 (453.76−506.72 ng·L−1), and Q4 (≥506.73 ng·L−1). SPSS 25.0 statistical software was used for χ2 test and multiple logistic regression, and additive and multiplicative models were used to investigate the interaction between adverse pregnancy history and PAH-DNA adducts level on missed abortion. The PAH-DNA adducts were grouped by tertiles and quartiles, and P33, P50, P67 andP75 were used as data cut points for sensitivity analysis.

    Results The proportion of adverse pregnancy history in the case group (32.46%) was higher than that in the control group (12.23%) (P < 0.001). Among 160 subjects with≥2 pregnancies, the proportion of adverse pregnancy history in the case group (57.81%) was higher than that in the control group (17.71%) ( P < 0.001). The results of χ2 test stratified by pregnancy for different PAH-DNA adducts levels between the two groups showed that the PAH-DNA adducts level was associated with missed abortion in subjects with≥2 pregnancies (χ2=10.14, P=0.017). Being further stratified by adverse pregnancy history, the PAH-DNA adducts level in subjects with no adverse pregnancy history was associated with missed abortion (χ2=9.70, P=0.021). The results of logistic regression analysis showed that adverse pregnancy history (OR=5.88, 95%CI: 2.79−12.39) and PAH-DNA adducts (OR=3.01, 95%CI: 1.22−7.40) increased the risk of missed abortion, but no interaction between them was found. The relative excess risk of interaction (RERI), the attributable percentage of interaction (AP), and the synergy index (SI) and its 95%CI were 0.60 (95%CI: −0.58−1.77), 0.74 (95%CI: −0.83−2.30), and 0.20 (95%CI: 0.01−5.43), respectively.

    Conclusions Adverse pregnancy history and PAH-DNA adducts in pregnant women may increase the risk of missed abortion. The effect of the interaction between them on the occurrence of missed abortion is not supported by the current study.

     

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