背景:子宫内膜异位症是一种常见的妇科疾病,影响大约5%~10%的育龄女性。锌(Zn),硒(Se),铜(Cu),钴(Co)和钼(Mo)是人体必需的微量元素,对人体健康非常重要。然而,关于必需微量元素混合物与子宫内膜异位症风险之间关系的研究有限且不一致.特别是,通过不同样本类型确认关联的研究是有限的。
目的:本研究旨在探讨锌,Se,Cu,在中国人群中,血液和卵泡液(FF)中的Co和Mo浓度与子宫内膜异位症的风险。
方法:总共招募了609名接受体外受精(IVF)的受试者;分析了836个样本,包括451份血液样本(234例对照和217例)和385份FF样本(203例对照和182例)。此外,227名受试者提供血液和FF样品。Zn,Se,Cu,通过电感耦合等离子体质谱法(ICP-MS)定量血液和FF中的Co和Mo浓度。锌水平之间的关联,Se,Cu,使用单元素模型(逻辑回归模型)评估Co和Mo以及子宫内膜异位症的风险,使用多元素模型(贝叶斯核机回归(BKMR)和加权分位数和(WQS)回归)评估了微量元素对子宫内膜异位症风险的综合影响。
结果:基于单元素模型,血液中锌浓度的显著关联(高水平与低水平组:aOR=14.17,95%CI:7.31,27.50)和FF(第一三分位数与第二三位数组:aOR=0.34,95%CI:0.16,0.71;第三三位数与第二三等组:aOR=2.32,95%CI:分别为1.38,3.91)和血液中的Co浓度(第一三等与第二三元组,aOR=0.24,95%CI:0.12,0.48)和FF(第三三元与第二组:aOR=3.87,95%CI:2.19,6.84)在校正所有混杂因素后发现有子宫内膜异位症风险.在FF中,铜和钼的水平明显高于对照组,与子宫内膜异位症风险呈正相关(铜(第一三位数vs.第二三位数组:aOR=0.39,95%CI:0.19,0.81;第三三位数与第二组:aOR=2.73,95%CI:分别为1.61,4.66)和Mo(高水平vs.低水平组:aOR=14.93,95%CI:7.16,31.12))。然而,在血Cu和Mo水平与子宫内膜异位症风险之间未发现相似的关联.此外,根据BKMR分析,血液和FF中这五种必需微量元素混合物的水平与子宫内膜异位症的风险显着相关;血液中Zn和Cu的水平以及FF中Mo的水平与子宫内膜异位症的风险显着相关,血液中Zn和Cu水平和FF中Mo水平的后验包涵概率(PIPs)分别为1.00、0.99和1.00,分别。此外,Zn和Mo是血液和FF中权重最高的元素,分别,根据WQS分析。
结论:子宫内膜异位症的风险与几种必需微量元素(锌,Cu和Co)。这些元素的水平升高可能与子宫内膜异位症的病理机制有关。然而,需要更大样本量的进一步研究来确认这些关联.
BACKGROUND: Endometriosis is a common gynecological disease that affects approximately 5 %∼10 % of reproductive-aged women. Zinc (Zn), selenium (Se), copper (Cu), cobalt (Co) and molybdenum (Mo) are essential trace elements and are very important for human health. However, studies on the relationship between mixtures of essential trace elements and the risk of endometriosis are limited and inconsistent. In particular, studies confirming the association via different sample types are limited.
OBJECTIVE: This
study aimed to investigate the associations between Zn, Se, Cu, Co and Mo concentrations in blood and follicular fluid (FF) and endometriosis risk in a Chinese population.
METHODS: A total of 609 subjects undergoing in vitro fertilization (IVF) were recruited; 836 samples were analyzed, including 451 blood samples (234 controls and 217 cases) and 385 FF samples (203 controls and 182 cases). In addition, 227 subjects provided both blood and FF samples. Zn, Se, Cu, Co and Mo concentrations in blood and FF were quantified via inductively coupled plasma-mass spectrometry (ICP-MS). The associations between the levels of Zn, Se, Cu, Co and Mo and the risk of endometriosis were assessed using single-element models (logistic regression models), and the combined effect of the trace elements on endometriosis risk was assessed using multielement models (Bayesian kernel machine regression (
BKMR) and weighted quantile sum (WQS) regression).
RESULTS: Based on the single-element models, significant associations of Zn concentrations in blood (high-level vs. low-level group: aOR = 14.17, 95 % CI: 7.31, 27.50) and FF (first tertile vs. second tertile group: aOR = 0.34, 95 % CI: 0.16, 0.71; third tertile vs. second tertile group: aOR = 2.32, 95 % CI: 1.38, 3.91, respectively) and Co concentrations in blood (first tertile vs. second tertile group, aOR = 0.24, 95 % CI: 0.12, 0.48) and FF (third tertile vs. second tertile group: aOR = 3.87, 95 % CI: 2.19, 6.84) with endometriosis risk were found after adjustment for all confounders. In FF, Cu and Mo levels were significantly greater among the cases than among the controls, with a positive association with endometriosis risk (Cu (first tertile vs. second tertile group: aOR = 0.39, 95 % CI: 0.19, 0.81; third tertile vs. second tertile group: aOR = 2.73, 95 % CI: 1.61, 4.66, respectively) and Mo (high-level vs. low-level group: aOR = 14.93, 95 % CI: 7.16, 31.12)). However, similar associations between blood Cu and Mo levels and endometriosis risk were not found. In addition, the levels of these five essential trace element mixtures in blood and in FF were significantly and positively associated with endometriosis risk according to the
BKMR analyses; the levels of Zn and Cu in blood and the levels of Mo in FF were significantly related to the risk of endometriosis, and the posterior inclusion probabilities (PIPs) were 1.00, 0.99 and 1.00 for Zn and Cu levels in blood and Mo levels in FF, respectively. Furthermore, Zn and Mo were the highest weighted elements in blood and FF, respectively, according to WQS analyses.
CONCLUSIONS: The risk of endometriosis was associated with elevated levels of several essential trace elements (Zn, Cu and Co). Elevated levels of these elements may be involved in the pathomechanism of endometriosis. However, further studies with larger sample sizes will be necessary to confirm these associations.