Bisphenol A exposure and risk of thyroid nodules in Chinese women: A case-control study
Bisphenol A exposure and risk of thyroid nodules in Chinese women: A case-control study
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中国女性双酚A暴露与甲状腺结节风险：病例对照研究
DOI：
10.1016/j.envint.2019.02.026
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发表时间：
2019-05-01
影响因子：
11.8
通讯作者：
Wang, Yan
中科院分区：
文献类型：
--
作者：
Li, Lu;Ying, Yingxia;Wang, Yan
背景：甲状腺结节（TN）在世界范围内高度流行，且女性居多。双酚A（BPA）是一种内分泌干扰物，可导致对人类健康的不利影响。然而，揭示BPA暴露与TNs之间关联的流行病学研究有限，结果不一致。我们的目的是研究尿BPA和TNs之间的关联，在妇女谁更容易TNs.Methods：我们进行了一项病例对照研究，1416名妇女年龄在18岁或以上（705例，711对照）。所有参与者都接受了甲状腺超声检查。使用HPLC-MS/MS定量尿总BPA（游离和结合）浓度。我们使用粗和多变量逻辑回归模型分析尿BPA浓度与TN风险之间的关联。参与者进一步分层为甲状腺自身抗体阳性组（至少一个阳性）和甲状腺自身抗体阴性组根据甲状腺球蛋白抗体（TGAb）和甲状腺过氧化物酶抗体（TPOAb）水平测定尿BPA（均为阴性），并应用约束三次样条回归分析尿BPA与TNs之间可能存在的非线性关系。与第一个四分位数的女性相比，TN的几率为72%（调整后OR = 1.72，95% CI：1.25 - 2.35）第二四分位数的患者，54%（调整后OR = 1.54，95% CI：1.12至2.12），第三四分位数的患者更高，108%在校正年龄、BMI、教育程度、HDL-C、LDL-C、甘油三酯、总胆固醇、尿碘、TGAb和TPOAb后，第四四个四分位数的患者（校正OR = 2.08，95%CI：1.50 - 2.90）更高。当研究人群被分层为甲状腺自身抗体阳性组和甲状腺自身抗体阴性组时，我们发现只有在阳性组中，关联在模型1中是显著的（粗OR = 2.80; 95% CI = 1.90 - 4.12），模型2（调整后OR = 2.84; 95% CI = 1.91 - 4.22），模型3（调整后OR = 4.01; 95% CI = 2.57 - 6.27）和模型4（调整后OR = 3.71; 95% CI = 2.36 - 5.83）。多变量调整的限制性三次样条分析显示了类似的结果，在甲状腺自身抗体阳性组中，尿BPA与TNs风险之间的关系接近线性（P-总体< 0.001; P-非线性= 0.054）。此外，这种关联接近线性，表明BPA暴露的任何增加都与TNs风险升高有关。
Background: Thyroid nodules (TNs) are highly prevalent worldwide and have a pattern of female predominance. Bisphenol A (BPA) is an endocrine disruptor that can lead to adverse effects in human health. However, epidemiologic studies revealing the association between BPA exposure and TNs are limited and the results are inconsistent. We aimed to examine the association between urinary BPA and TNs in women who are more susceptible to TNs.Methods: We conducted a case-control study with 1416 women aged 18 years or older (705 cases, 711 controls). All participants underwent thyroid ultrasonography. Urinary total BPA (free and conjugated) concentration was quantified using the HPLC-MS/MS. We analyzed the association between urinary BPA concentration and the risk of TNs using crude and multivariable logistic regression models. Participants were further stratified into thyroid autoantibody positive group (at least one positive) and thyroid autoantibody negative group (both negative) according to the thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) levels, and restricted cubic spline regression was also applied to determine the possible nonlinear relationship between urinary BPA and TNs.Results: Compared with women in the first quartile, the odds of TNs was 72% (adjusted OR = 1.72, 95% CI: 1.25 to 2.35) higher for those in the second quartile, 54% (adjusted OR = 1.54, 95% CI: 1.12 to 2.12) higher for those in the third quartile, and 108% (adjusted OR = 2.08, 95% CI: 1.50 to 2.90) higher for those in the fourth quartile after adjusting for age, BMI, education, HDL-C, LDL-C, triglyceride, total cholesterol, urinary iodine, TGAb and TPOAb. When the study population was stratified into thyroid autoantibody positive group and thyroid autoantibody negative group, we found that only in the positive group, the association was significant in model 1 (crude OR = 2.80; 95% CI = 1.90 to 4.12), model 2 (adjusted OR = 2.84; 95% CI = 1.91 to 4.22), model 3 (adjusted OR = 4.01; 95% CI = 2.57 to 6.27) and model 4 (adjusted OR = 3.71; 95% CI = 2.36 to 5.83). Multivariable-adjusted restricted cubic spline analysis demonstrated a similar result that in the thyroid autoantibody positive group, the association between urinary BPA and TNs risk was near linear (P-overall < 0.001; P-non-linear = 0.054).Conclusion: In Chinese women, higher urinary BPA concentration was associated with increased risk of TNs only in those with positive thyroid autoantibodies. Moreover, this association was near linear, indicating that any rise in BPA exposure was associated with elevated TNs risk.