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

王鑫; 杨岚; 王志凯; 冯星; 纪红蕾; 梁红; 宋秀霞; 苗茂华

doi:10.11836/JEOM22314

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

摘要

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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