Abstract：
A number of biocidal disinfectant chemicals are used as household products to prevent spread of pathogens. People are commonly exposed to multiple chemicals through those disinfectants. However, effects of interactions (e.g., synergism) between disinfectants on human health outcomes have been rarely studied. In this study, we aimed to investigate associations of a mixture of chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT) and polyhexamethylene guanidine (PHMG), which had been used as humidifier disinfectants (HDs) in South Korea, with HD-associated lung injury (HDLI) in a Korean population (n = 4058) with HD exposure through use of HD products. Exposure to HD was retrospectively assessed by an interview-based standardized survey, and HDLI was determined by clinical assessment. After adjusting for covariates, PHMG-specific exposure indices (e.g., amount of use, indoor air concentration, and weekly exposure level) were dose-dependently associated with HDLI (their odds ratios for the comparison of third tertile versus first tertile were 1.95, 1.77, and 2.16, respectively). CMIT/MIT exposure was not observed to have a significant association with HDLI in a single chemical exposure model; however, associations between PHMG exposure and HDLI were strengthened by co-exposure to CMIT/MIT in combined chemical exposure models, where synergistic interactions between CMIT/MIT use and PHMG indices (amount of use and weekly exposure level) were observed (p-interaction in additive scale: 0.02 and 0.03, respectively). Our findings imply that adverse effects of PHMG exposure on lung injury among HD users might be worsened by co-exposure to CMIT/MIT. Given that plenty of household products contain disinfectants on global markets, epidemiological and toxicological investigations are warranted on interaction effects of co-exposure to disinfectants.
摘要：
许多杀生物消毒剂化学品被用作家用产品以防止病原体的传播。人们通常通过这些消毒剂暴露于多种化学物质。然而,相互作用的影响(例如，消毒剂之间的协同作用）对人类健康结果的研究很少。在这项研究中,我们旨在研究氯甲基异噻唑啉酮/甲基异噻唑啉酮（CMIT/MIT）和聚六亚甲基胍（PHMG）的混合物的关联，在韩国曾被用作加湿器消毒剂(HDs)，通过使用HD产品暴露于HD的韩国人群（n=4058）中的HD相关肺损伤（HDLI）。通过基于访谈的标准化调查对HD的暴露进行回顾性评估，和HDLI通过临床评估确定。在调整协变量后，PHMG特定暴露指数(例如，使用量,室内空气浓度,和每周暴露水平）与HDLI呈剂量依赖性相关（第三三分位数与第一三分位数的比值比分别为1.95、1.77和2.16）。在单一化学暴露模型中，未观察到CMIT/MIT暴露与HDLI有显著关联；然而，在联合化学暴露模型中，通过共同暴露于CMIT/MIT，加强了PHMG暴露与HDLI之间的关联，其中观察到CMIT/MIT使用与PHMG指数（使用量和每周暴露水平）之间的协同相互作用（累加规模的p相互作用：分别为0.02和0.03）。我们的发现表明，PHMG暴露对HD使用者肺损伤的不利影响可能会因共同暴露于CMIT/MIT而恶化。鉴于全球市场上大量家用产品含有消毒剂，流行病学和毒理学调查是必要的共同接触消毒剂的相互作用的影响。
