双酚A暴露水平与学龄期女童特发性性早熟风险之间的关系

doi:10.11852/zgetbjzz2019-1846

摘要/Abstract

摘要： 目的分析学龄女童接触双酚A(BPA)与特发性中枢性性早熟(ICPP)之间的关系,为预防女童特发性性早熟提供依据。方法选取2016年7月-2018年9月于扬州大学附属医院就诊且被诊断为ICPP的110例6～9岁女童为研究对象。根据女童的年龄和体重指数(BMI)相匹配,选取110名健康女童作为对照组。检测所有女童尿BPA浓度,并测试其与ICPP风险的关系。实验室检查包括血清雌二醇(E2)水平,基础和促性腺激素释放激素(GnRH)刺激的促黄体激素(LH),促卵泡激素(FSH)水平,骨龄(BA),子宫和卵巢大小。结果 ICPP组和对照组的尿BPA中位数浓度分别为6.25 μg/g Cr和1.07 μg/g Cr(Z=-3.845,P<0.001)。调整混杂因素后,与BPA浓度最低的女童相比,最高浓度女童ICPP风险是其9.07倍(OR=9.07,95％CI:2.82～29.14) 。在ICPP组中,尿BPA浓度与FSH基础水平(r=-0.235,P=0.005)或FSH峰值水平(r=-0.171,P=0.044)呈负相关。结论 BPA暴露与学龄女童ICPP风险升高有关,潜在的机制可能归因于相对较低的FSH水平。

关键词: 尿双酚A, 特发性中枢性性早熟, 女童

Abstract: Objectives To analyze the relationship between exposure to bisphenol A (BPA) and idiopathic central precocious puberty (ICPP) in school-age girls,thus to provide a basis for preventing ICPP in girls. Methods Totally 110 school-age children diagnosed with ICPP in the Affiliated Hospital of Yangzhou University were enrolled in this study from July 2016 and September 2018,meanwhile 110 healthy girls were selected as controls matched with age and body mass index (BMI).Urinary BPA concentrations of all girls were tested and its association with the risk of ICPP was analyzed.Laboratory examinations including serum estradiol (E2) level,basal and gonadotropin-releasing hormone (GnRH) stimulated luteinizing hormone(LH),and follicle-stimulating hormone (FSH) levels,bone age (BA),and uterine and ovarian sizes were conducted in ICPP girls. Results Median concentrations of urinary BPA in ICPP group and control group were 6.25 μg/g Cr and 1.07 μg/g Cr,respectively (Z=-3.845,P＜0.001).After adjustment for confounders,the risk of ICCP in girls with highest concentrations of BPA was 9.07 times higher than those with the lowest concentrations of BPA(OR=9.07,95%CI:2.82-29.14).Moreover,negative correlations were found between urinary BPA concentrations and basal FSH level (r=-0.235,P=0.005) or peak FSH level (r=-0.171,P=0.044) in girls with ICCP. Conclusion BPA exposure is associated with an increasing risk of ICPP in school-age girls,and the potential mechanism may be attributed to the relatively low level of FSH.

Key words: urine bisphenol A, idiopathic central precocious puberty, school-age girls

中图分类号:

R725.8

周兰梅, 王琼瑾, 季翠芳. 双酚A暴露水平与学龄期女童特发性性早熟风险之间的关系[J]. 中国儿童保健杂志, 2020, 28(11): 1250-1254.

ZHOU Lan-mei, WANG Qiong-jin, JI Cui-fang. Relationship between exposure levels of bisphenol A and the risk of idiopathic precocious puberty in school-age girls[J]. journal1, 2020, 28(11): 1250-1254.

参考文献

[1] 葛伟,王海莲,邵鸿家,等.特发性中枢性性早熟童血浆kisspeptin、神经激肽B及强啡肽浓度的变化研究[J].中国儿童保健杂志,2019,27(3):258-261.
[2] 王琰华,赵忻.GnGHa治疗对特发性中枢性性早熟女童血清P1NP、β-CTX、N-MID水平的影响及其临床意义[J].中国儿童保健杂志,2017,25(12):1288-1289,1310.
[3] 许慧洁,叶进,袁雪晶,等.促性腺激素释放激素类似物改善特发性中枢性性早熟女童成年身高及相关因素分析[J].中国儿童保健杂志,2019,27(3):262-264,295.
[4] 罗宿星,伍远辉,代小容,等.聚碳酸酯塑料瓶材中双酚A的氧化石墨烯修饰玻碳电极快速测定法[J].环境与健康杂志,2012,29(11):1042-1044.
[5] D'Antuono A,Dall'Orto VC,Lo Balbo A,et al.Determination of bisphenol A in food-simulating liquids using LCED with a chemically modified electrode[J].J Agric Food Chem,2001,49(3):1098-1101.
[6] 吴海瑛.双酚A与女童单纯乳房早发育及中枢性性早熟关系的临床观察研究[D].苏州:苏州大学,2013.
[7] Scinicariello F,Buser MC.Serum testosterone concentrations and urinary bisphenol A,benzophenone-3,triclosan andparaben levels in maleand female children and adolescents:NHANES 2011-2012[J].Environ Health Perspect,2016,124:1898-1904.
[8] Lee SH,Kang SM,Choi MH,et al.Changes in steroid metabolism among girls with precocious puberty may not be associated with urinary levels of bisphenol A[J].Reprod Toxicol,2014,44:1-6.
[9] Nah WH,Park MJ,Gye MC.Effects ofearly prepubertal exposure tobisphenol A on the onset of puberty,ovarian weights,and estrous cycle in female mice[J].Clin Exp Reprod Med,2011,38:75-81.
[10] Philippat C,Wolff MS,Calafat AM,et al.Prenatal exposure to environmental phenols:concentrations in amniotic fluid and variability in urinary concentrations during pregnancy[J].Environ Health Perspect,2013,121 (10):1225-1231.
[11] Ozgen IT,Torun E,Bayraktar-Tanyeri B,et al.The relation of urinary bisphenol A with kisspeptin in girls diagnosed with central precocious puberty and premature thelarche[J].J Pediatr Endocrinol Metab,2016,29:337-341.
[12] He YH,Miao MH,Herrinton LJ,et al.Bisphenol A levels in blood and urine in a Chinese population and the personal factors affecting the levels[J].Environ Res,2009,109:629-633.
[13] 石珏.双酚A暴露方式对线虫生长生殖发育及凋亡的影响[D].合肥:中国科学技术大学,2018.
[14] Bulus AD,Asci A,Erkekoglu P,et al.The evaluation of possible role of endocrine disruptors in central and peripheral precocious puberty[J].Toxicol Mech Methods,2016,26:493-500.
[15] Durmaz E,Asci A,Erkekoglu P,et al.Urinary bisphenol A levels in girls with idiopathic central precocious puberty[J].J Clin Res Pediatr Endocrinol,2014,6:16-21.
[16] 梁敏红.双酚A职业暴露对女性生殖功能影响的研究[D].上海:复旦大学,2009.
[17] 吴海瑛,陈临琪,王凤云,等.双酚A与女童性早熟的关系[J].临床儿科杂志,2015,33(2):155-159.
[18] Miao MH,Yuan W,Yang F,et al.Associations between bisphenol A exposure and reproductive hormones among female workers[J].Int J Environ Res Public Health,2015,12:13240-13250.
[19] Peper JS,Brouwer RM, van Leeuwen M,et al.HPG-axis hormones during puberty:a study of the association with hypothalamic and pituitary volumes[J].Psychoneuroendocrinology,2010,35:133-140.
[20] Roseweir AK,Millar RP.The role of kisspeptin in the control of gonadotrophin secretion[J].Hum Reprod Update,2009,15:203-212.
[21] Pescovitz OH,Hench KD,Barnes KM,et al.Premature thelarche and central precocious puberty:the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone[J].J Clin Endocrinol Metab,1988,67:474-479.
[22] Huo X,Chen D,He Y,et al.Bisphenol-A and female infertility:a possible role of gene-environment interactions[J].Int J Environ Res Public Health,2015,12:11101-11116.