PDF(Pubmed)
Abstract：
BACKGROUND: Results of studies investigating associations between individual endocrine-disrupting chemicals (EDCs) and incidence of uterine leiomyomata (UL), a hormone-dependent gynecological condition, have been inconsistent. However, few studies have evaluated simultaneous exposure to a mixture of EDCs with UL incidence.
METHODS: We conducted a case-cohort analysis (n = 708) of data from the Study of the Environment, Lifestyle and Fibroids (SELF), a prospective cohort study. Participants were aged 23-35 years at enrollment, had an intact uterus, and identified as Black or African American. We measured biomarker concentrations of 21 non-persistent EDCs, including phthalates, phenols, parabens, and triclocarban, in urine collected at baseline, 20-month, and 40-month clinic visits. We ascertained UL incidence and characteristics using ultrasounds at baseline and approximately every 20 months through 60 months. We used probit Bayesian Kernel Machine Regression (BKMR-P) to evaluate joint associations between EDC mixtures with cumulative UL incidence. We estimated the mean difference in the probit of UL incidence over the study period, adjusting for baseline age, education, years since last birth, parity, smoking status and body mass index. We converted probit estimates to odds ratios for ease of interpretation.
RESULTS: We observed that urinary concentrations of the overall EDC mixture were inversely associated with UL incidence in the overall mixtures model, with the strongest inverse associations at the 70th percentile of all biomarkers compared with their 50th percentile (odds ratio = 0.59; 95% confidence interval: 0.36, 0.96). Strongest contributors to the joint association for the mixture were bisphenol S (BPS), ethyl paraben (EPB), bisphenol F (BPF) and mono (2-ethyl-5-carboxypentyl) phthalate (MECPP), which each demonstrated inverse associations except for MECPP. There was suggestive evidence of an interaction between MECPP and EPB.
CONCLUSIONS: In this prospective ultrasound study, we observed evidence of an inverse association between the overall mixture of urinary biomarker concentrations of non-persistent EDCs with UL incidence.
METHODS: We conducted a case-cohort analysis (n = 708) of data from the Study of the Environment, Lifestyle and Fibroids (SELF), a prospective cohort study. Participants were aged 23-35 years at enrollment, had an intact uterus, and identified as Black or African American. We measured biomarker concentrations of 21 non-persistent EDCs, including phthalates, phenols, parabens, and triclocarban, in urine collected at baseline, 20-month, and 40-month clinic visits. We ascertained UL incidence and characteristics using ultrasounds at baseline and approximately every 20 months through 60 months. We used probit Bayesian Kernel Machine Regression (BKMR-P) to evaluate joint associations between EDC mixtures with cumulative UL incidence. We estimated the mean difference in the probit of UL incidence over the study period, adjusting for baseline age, education, years since last birth, parity, smoking status and body mass index. We converted probit estimates to odds ratios for ease of interpretation.
RESULTS: We observed that urinary concentrations of the overall EDC mixture were inversely associated with UL incidence in the overall mixtures model, with the strongest inverse associations at the 70th percentile of all biomarkers compared with their 50th percentile (odds ratio = 0.59; 95% confidence interval: 0.36, 0.96). Strongest contributors to the joint association for the mixture were bisphenol S (BPS), ethyl paraben (EPB), bisphenol F (BPF) and mono (2-ethyl-5-carboxypentyl) phthalate (MECPP), which each demonstrated inverse associations except for MECPP. There was suggestive evidence of an interaction between MECPP and EPB.
CONCLUSIONS: In this prospective ultrasound study, we observed evidence of an inverse association between the overall mixture of urinary biomarker concentrations of non-persistent EDCs with UL incidence.
摘要：
背景：调查个体内分泌干扰化学物质（EDC）与子宫平滑肌瘤（UL）发病率之间关联的研究结果，依赖激素的妇科疾病,一直不一致。然而,很少有研究评估同时暴露于具有UL发生率的EDCs混合物。
方法：我们对来自环境研究的数据进行了病例队列分析（n=708），生活方式和纤维（自我），前瞻性队列研究。参与者在注册时年龄为23-35岁，有一个完整的子宫，被认定为黑人或非裔美国人。我们测量了21种非持久性EDC的生物标志物浓度，包括邻苯二甲酸酯,酚类物质,对羟基苯甲酸酯,和三氯卡班,在基线时收集的尿液中，20个月,和40个月的诊所访问。我们在基线和大约每20个月至60个月使用超声波确定UL发生率和特征。我们使用概率贝叶斯内核机回归（BKMR-P）来评估EDC混合物与累积UL发生率之间的联合关联。我们估计了研究期间UL发生率概率的平均差异，调整基线年龄，教育,自上次出生以来，奇偶校验，吸烟状况和体重指数。为了便于解释，我们将probit估计值转换为赔率比。
结果：我们观察到，在总体混合物模型中，总体EDC混合物的尿浓度与UL发生率呈负相关，与所有生物标志物的第50百分位数相比,在所有生物标志物的第70百分位数具有最强的逆关联(比值比=0.59;95%置信区间:0.36,0.96).混合物联合缔合的最强贡献者是双酚S(BPS)，对羟基苯甲酸乙酯(EPB),双酚F（BPF）和单（2-乙基-5-羧基戊基）邻苯二甲酸酯（MECPP），除MECPP外，每个都表现出负相关。有提示证据表明MECPP和EPB之间存在相互作用。
结论：在这项前瞻性超声研究中，我们观察到有证据表明,非持续性EDCs的尿液生物标志物总混合浓度与UL发生率呈负相关.
方法：我们对来自环境研究的数据进行了病例队列分析（n=708），生活方式和纤维（自我），前瞻性队列研究。参与者在注册时年龄为23-35岁，有一个完整的子宫，被认定为黑人或非裔美国人。我们测量了21种非持久性EDC的生物标志物浓度，包括邻苯二甲酸酯,酚类物质,对羟基苯甲酸酯,和三氯卡班,在基线时收集的尿液中，20个月,和40个月的诊所访问。我们在基线和大约每20个月至60个月使用超声波确定UL发生率和特征。我们使用概率贝叶斯内核机回归（BKMR-P）来评估EDC混合物与累积UL发生率之间的联合关联。我们估计了研究期间UL发生率概率的平均差异，调整基线年龄，教育,自上次出生以来，奇偶校验，吸烟状况和体重指数。为了便于解释，我们将probit估计值转换为赔率比。
结果：我们观察到，在总体混合物模型中，总体EDC混合物的尿浓度与UL发生率呈负相关，与所有生物标志物的第50百分位数相比,在所有生物标志物的第70百分位数具有最强的逆关联(比值比=0.59;95%置信区间:0.36,0.96).混合物联合缔合的最强贡献者是双酚S(BPS)，对羟基苯甲酸乙酯(EPB),双酚F（BPF）和单（2-乙基-5-羧基戊基）邻苯二甲酸酯（MECPP），除MECPP外，每个都表现出负相关。有提示证据表明MECPP和EPB之间存在相互作用。
结论：在这项前瞻性超声研究中，我们观察到有证据表明,非持续性EDCs的尿液生物标志物总混合浓度与UL发生率呈负相关.
