背景:随着工业化的发展,公众接触有毒金属可能无处不在,最终影响个体的生殖系统,甚至胚胎,并导致早期妊娠丢失。该研究的目的是确定普通人群中孕妇的有毒金属水平,并确定胚胎中金属毒性的生物标志物。
方法:2016-2018年北京协和医院对孕妇进行病例对照研究。在妊娠12周内经历自然流产的妇女包括病例组,对照组包括有胎儿心脏活动的孕妇,这些孕妇几乎同时要求人工流产。血液和尿液样本检测镉的浓度,铬,硒,砷,和水银。
结果:共纳入195名患者,病例组95例,对照组100例。妊娠的显着差异,奇偶校验,流产史,平均血镉水平,两组之间存在平均尿铬水平(P1=0.013,P2=0.000,P3=0.000,P4=0.002,P5=0.046);血镉>0.4µg/L的自然流产的比值比,尿铬>2微克/升,重力<3,胎次<2,流产史>1与人工流产组相比为1.26(1.09,1.85),1.56(1.23,2.53),1.39(1.17,1.98),1.72(1.21,4.62),和1.18(1.06,1.65),P值分别为0.003、0.031、0.003、0.247和0.001。
结论:血镉和尿铬水平是一般人群中毒性金属胚胎毒性的两个可能的生物标志物,这意味着在普通人群中,血镉>0.4µg/L或尿铬>2µg/L可能提示自然流产风险增加.
BACKGROUND: With the development of industrialization, public exposure to toxic metals could occur everywhere, eventually affecting individuals\' reproductive systems and even embryos and leading to early pregnancy loss. The aim of the study was to determine the profile of toxic metal levels in pregnant women in the general population and to identify biomarkers for metal toxicity in embryos.
METHODS: A case-control study with pregnant women was conducted at Peking Union Medical College Hospital in 2016-2018. Women who experienced spontaneous abortion within 12 weeks of gestation comprised the case group, and women with pregnancies showing fetal cardiac activity who requested an induced abortion almost simultaneously were included in the control group. Blood and urine specimen were tested for concentrations of cadmium, chromium, selenium, arsenic, and mercury.
RESULTS: A total of 195 patients were enrolled, with 95 in the case group and 100 in the control group. Significant differences in gravidity, parity, history of miscarriage, mean blood cadmium levels, and mean urine chromium levels were present between the two groups (P1 = 0.013, P2 = 0.000, P3 = 0.000, P4 = 0.002, P5 = 0.046); the odds ratios in the spontaneous abortion with blood cadmium >0.4 µg/L, urine chromium >2 µg/L, gravity <3, parity <2, and history of miscarriage >1 compared with the induced abortion group were 1.26 (1.09, 1.85), 1.56 (1.23, 2.53), 1.39 (1.17, 1.98), 1.72 (1.21, 4.62), and 1.18 (1.06, 1.65), with P-values of 0.003, 0.031, 0.003, 0.247, and 0.001, respectively.
CONCLUSIONS: Blood cadmium and urine chromium levels are two possible biomarkers of toxic metal embryotoxicity in the general population, which means that in the general population, blood cadmium >0.4 µg/L or urine chromium >2 µg/L might indicate an increased risk of spontaneous abortion.