全氟烷基化学物与抑郁症的关联

刘婧; 张露露; 贺颖倩; 赵亚楠; 郑山; 王敏珍

doi:10.11836/JEOM22276

摘要:

背景全氟烷基化学物（PFAS）是一类合成有机氟化物，对大脑功能具有不良的健康影响，其对抑郁症的影响研究非常有限。

目的探讨血清PFAS与抑郁症风险的关联性。

方法基于2015—2018年美国全国健康和营养调查（NHANES）数据集，选取20岁及以上人群中相关资料完整者2626名研究对象。logistic回归与限制性立方样条用于分析血清PFAS浓度水平与抑郁症间的关联及剂量-反应关系，并对性别、年龄、种族、教育水平、婚姻状况、贫困程度、适度运动、肥胖程度、饮酒状况进行亚组分析。

结果 2626名研究对象中轻度以上抑郁症患者共666名（25.4%）。调整种族、教育水平、婚姻状况、肥胖程度、适度运动、饮酒史、可替宁及其他种类PFAS后，血清全氟辛烷磺酸（PFOS）与抑郁症患病风险为正相关（OR=1.85，95%CI：1.14~3.02），且呈非线性剂量-反应关系（χ²=6.37，P_非线性=0.012）。全氟壬酸（PFNA）与抑郁症患病风险为负相关（OR=0.23，95%CI：0.14~0.39），呈线性剂量-反应关系（P_趋势< 0.001，χ²=35.13，P_总体<0.001）。亚组分析后发现，男性、20~39岁和40~64岁人群对PFNA暴露敏感性更高（OR=0.15，95%CI：0.06~0.37；OR=0.16，95%CI：0.06~0.40；OR=0.18，95%CI：0.08~0.39）。PFOS仅在20~39岁人群（OR=3.00，95%CI：1.14~7.94）中表现具有统计学意义的健康影响。除性别和年龄分组外，在非西班牙裔黑人、同居者、当前饮酒者、高中以上学历者、肥胖患者中，PFAS暴露与抑郁症患病风险关联更显著。

结论 PFOS暴露可能与抑郁程度增加有关，而PFNA暴露则呈保护作用。

Abstract:

Background Perfluorinated alkyl substances (PFAS) are a class of synthetic organic fluorides, which have adverse health effects on brain function, and limited research has been conducted on their effects on depression.

Objective To assess potential correlation between serum PFAS and depression.

Methods Using the 2015—2016 and 2017—2018 National Health and Nutrition Examination Survey (NHANES) datasets, 2626 subjects with complete relevant information in people ≥20 years old were selected. Logistic regression and restricted cubic splines were used to analyze the association and dose-response relationship between serum PFAS concentration and depression. Subgroup analysis was performed on sex, age, race, education level, marital status, family income to poverty ratio, moderate exercise, body mass index, and drinking status.

Results Among the 2626 subjects, there were 666 patients (25.4%) with mild or above depression. After adjusting for race, education level, marital status, body mass index, moderate exercise, drinking history, cotinine, and other types of PFAS, serum perfluorooctane sulfonate (PFOS) was positively associated with the risk of depression (OR=1.85, 95%CI: 1.14, 3.02), and showed a nonlinear dose-response relationship (χ²=6.37, P_nonlinear=0.012). Perfluorononanoic acid (PFNA) was inversely associated with the risk of depression (OR=0.23, 95%CI: 0.14, 0.39), and showed a linear dose-response relationship (P_trend<0.001, χ²=35.13, P_overall<0.001). After subgroup analysis, it was found that males, 20-39 year-olds and 40-64 year-olds were more sensitive to PFNA exposure (OR=0.15, 95%CI: 0.06, 0.37; OR=0.16, 95%CI: 0.06, 0.40; OR=0.18, 95%CI: 0.08, 0.39). PFOS only showed a statistically significant health effect in people aged 20-39 years (OR=3.00, 95%CI: 1.14, 7.94). In addition, among subgroups of non-Hispanic blacks, cohabitants, current drinkers, high school graduates, and obese patients, exposure to PFAS was significantly associated with the risk of depression.

Conclusion PFOS exposure may be associated with increased levels of depression, whereas PFNA exposure may be protective.

全氟烷基化学物与抑郁症的关联

Association between perfluorinated alkyl substances and depression