血清双酚A浓度与高血压发生风险的关联
Association between serum bisphenol A concentration and incident risk of hypertension
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摘要:
背景 现有的研究表明双酚A暴露可能与高血压风险相关，但大多数为横断面研究，且结论尚不一致。
目的 探讨双酚A暴露与高血压发生风险的关联。
方法 基于东风-同济队列的一项纳入1990名研究对象的巢式病例对照研究，在排除基线887名高血压患者和随访后血压数据缺失的23名研究对象后，共有1080名研究对象纳入本研究。通过问卷调查获得流行病学资料，采用高效液相色谱串联质谱仪检测血清双酚A质量浓度（后简称为浓度）。采用logistic回归模型分析血清双酚A水平与高血压发生风险的关联，线性回归模型分析血清双酚A水平与基线和随访血压变化值的关联。
结果 1080名研究对象的平均年龄为（62.03±7.45）岁，其中41.1%为男性。在经过随访之后，共有477人（44.2%）新发高血压。总人群中血清双酚A中位数浓度为3.15 μg·L−1，新发病例组基线双酚A浓度（3.24 μg·L−1）高于对照组（2.98 μg·L−1）（
P <0.05）。在调整所有协变量之后，自然对数转换的双酚A浓度每增加一个单位，高血压的发生风险增加12%（OR=1.12，95%CI：1.02~1.22）；基线与随访的收缩压和舒张压的变化值分别增加1.88（95%CI：1.08~2.69） mmHg和1.14（95%CI：0.68~1.61） mmHg。根据血清双酚A三分位数将研究对象分为三组，与第一分位组相比，第二和第三分位组的高血压发生风险分别增加39%（OR=1.39，95%CI：1.01~1.91）和40%（OR=1.40，95%CI：1.02~1.93），第二分位与第三分位的收缩压变化量分别增加5.91（95%CI：3.06~8.76） mmHg和5.71（95%CI：2.82~8.59） mmHg，舒张压变化量分别增加3.09（95%CI：1.44~4.75） mmHg和2.89（95%CI：1.22~4.57） mmHg（P 趋势<0.001）。在女性、不吸烟/戒烟、不饮酒/戒酒、无高血压家族史、有体育锻炼和基线高血压前期的人群中发现血清双酚A水平与高血压存在正向关联（所有P 趋势<0.05），但未发现分层变量与双酚A水平对高血压发生存在交互作用（所有P 交互>0.05）。结论 双酚A暴露与高血压发生风险存在正向关联。
Abstract:Background Previous studies have shown that bisphenol A exposure is associated with the risk of hypertension; however, most of them are cross-sectional and the conclusions are not consistent.
Objective To evaluate the association between bisphenol A exposure and the incident risk of hypertension.
Methods Based on a nested case-control design involving 1990 subjects derived from the Dongfeng-Tongji cohort, a total of 1080 subjects were included in this study after excluding 887 hypertensive cases at baseline and 23 subjects with missing blood pressure data in follow-up visits. Epidemiological information was collected through questionnaire survey, and serum bisphenol A concentration was detected by high performance liquid chromatography tandem mass spectrometry. Logistic regression model was used to analyze the potential association between serum bisphenol A level and the risk of hypertension incidence, and linear regression model was used to analyze the association between serum bisphenol A level and blood pressure changes between baseline and follow-up.
Results The average age of the 1 080 participants was (62.03±7.45) years, of which 41.1% were male. During the follow-up period, a total of 477 (44.2%) developed hypertension. The median serum concentration of bisphenol A in the total population was 3.15 μg·L−1, and the baseline bisphenol A concentration in the new case group (3.24 μg·L−1) was higher than that in the control group (2.98 μg·L−1) (
P <0.05). After adjustment for selected covariates, the risk of hypertension increased by 12% (OR=1.12, 95%CI: 1.02, 1.22) for each unit increase in naturally log-transformed bisphenol A; the systolic blood pressure and diastolic blood pressure increased by 1.88 (95%CI: 1.08, 2.69) mmHg and 1.14 (95%CI: 0.68, 1.61) mmHg, respectively. Compared with the low bisphenol A tertile group, the risk of hypertension in the middle tertile and high tertile groups increased by 39% (OR=1.39, 95%CI: 1.01, 1.91) and 40% (OR=1.40, 95%CI: 1.02, 1.93) respectively; the systolic blood pressure increased by 5.91 (95%CI: 3.06, 8.76) mmHg and 5.71 (95%CI: 2.82, 8.59) mmHg, and the diastolic blood pressure increased by 3.09 (95%CI: 3.06, 8.59) mmHg and 2.89 (95%CI: 1.22, 4.57) mmHg, respectively (P trend<0.001). A positive association between serum bisphenol A level and hypertension was found among those who were female, never/former smokers, never/former drinkers, without family history of hypertension, with physical exercise, and with prehypertension at baseline (P trend<0.05). There was no interaction between selected stratified variables and bisphenol A levels on hypertension (P interaction>0.05).Conclusion Bisphenol A exposure is positively associated with the risk of hypertension.
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