Considerable exposure to the endocrine disrupting chemicals phthalates and bisphenol-A in intensive care unit (ICU) patients
Considerable exposure to the endocrine disrupting chemicals phthalates and bisphenol-A in intensive care unit (ICU) patients
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DOI：
10.1016/j.envint.2015.04.008
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发表时间：
2015-08-01
影响因子：
11.8
通讯作者：
Jorens, Philippe G.
中科院分区：
文献类型：
--
作者：
Huygh, Johan;Clotman, Katrien;Jorens, Philippe G.
重症监护医学在很大程度上受益于含塑料的医疗器械。然而，塑料中存在的双酚A（BPA）和邻苯二甲酸盐可能会从此类器械中浸出。我们假设重症监护室（ICU）患者通过（塑料）医疗器械暴露于BPA和邻苯二甲酸酯。分析成人ICU患者（n = 35）的血清（n = 118）和尿液（n = 102）样本中的总BPA和邻苯二甲酸酯代谢物（PM）。我们的研究结果表明，成人ICU患者持续暴露于邻苯二甲酸酯，如邻苯二甲酸二（2-乙基己基）酯（DEHP），以及BPA，尽管程度较低。这种暴露导致几乎每例患者在每个研究时间点的血清和尿液中可检测到高水平。此外，这些水平显著高于对照组或参考文献。暴露时间顺序显示：术前尿液和血清中DEHP代谢物水平通常低于检测限。含塑料的医疗器械是DEHP暴露的主要来源：接受血液滤过、体外膜肺氧合或两者的术后患者的血清水平比文献中报告的一般人群高100倍或1000倍。DEHP代谢物的血清和一些尿液水平是人类有史以来报告的最高水平;一些在生物学上高度相关的浓度>= 10-50 μ M。尽管法规不断收紧，BPA和DEHP似乎仍然存在于（某些）医疗器械中。由于患者安全是ICU中的一个问题，因此迫切需要对医疗器械释放的这些化学物质的（可能的毒性和临床）影响进行进一步研究。(C)2015爱思唯尔有限公司版权所有。
Critical care medicine has largely benefited from plastic-containing medical devices. However, bisphenol-A (BPA) and phthalates present in the plastics can leach from such devices. We hypothesized that intensive care unit (ICU) patients are exposed to BPA and phthalates through (plastic) medical devices. Serum (n = 118) and urine (n = 102) samples of adult ICU patients (n = 35) were analyzed for total BPA and phthalate metabolites (PMs). Our results showed that adult ICU patients are continuously exposed to phthalates, such as di(2-ethylhexyl)phthalate (DEHP), as well as to BPA, albeit to a lesser extent. This exposure resulted in detectable high serum and urinary levels in almost every patient and at every studied time point. Moreover, these levels were significantly higher than in controls or compared to referenced literature. The chronology of exposure was demonstrated: pre-operative urinary and serum levels of the DEHP metabolites were often below the detection limit. Plastic-containing medical devices were the main source of DEHP exposure: post-operative patients on hemofiltration, extracorporeal membrane oxygenation or both showed serum levels 100-or 1000-fold higher than the levels in the general population reported in the literature. The serum and some of the urinary levels of the DEHP metabolites are the highest ever reported in humans; some at biologically highly relevant concentrations of >= 10-50 mu M. Despite the continuously tightening-regulations, BPA and DEHP appear to be still present in (some) medical devices. Because patient safety is a concern in the ICU, further research into the (possibly toxic and clinical) effects of these chemicals released from medical devices is imperiously necessary. (C) 2015 Elsevier Ltd. All rights reserved.