血清双酚A含量与复发性流产的1：2病例对照研究

Association between serum bisphenol-A and recurrent spontaneous abortion： a 1 ： 2 case-control study, China

目的探讨血清中双酚A含量与不明原因复发性流产的关系。方法采用以医院为基础的1：2病例对照研究，对62例不明原因复发性流产者按年龄±2岁、同一地区、同一孕周进行匹配。以柱前荧光一高效液相色谱法检测62例不明原因复发性流产者（病例组）和108名正常怀孕妇女（对照组）血清中双酚A的含量。按年龄、体重指数（BMI）、孕周、文化程度、职业分布和吸烟状况进行分组比较。结果病例组和对照组血清双酚A含量（中位数±四分位数间距）分别是（0．009±0．002）、（0．004±0．012）μg／ml，差异有统计学意义（Z=3．506，P=0．0005）。在调整年龄、职业、文化程度、BMI、被动吸烟等因素后，以双酚A浓度≤0．004μg／ml为参比，双酚A浓度在0．004—0．012μg／ml之间的OR值为4．39（95％CI：1．15～16．71），双酚A浓度≥0．012μg／ml的OR值为4．95（95％CI：1．77～13．82），且随着双酚A水平的升高，发生复发性流产的风险也在增加（P=0．0024）；经秩转换方差分析SNK法检验发现，正常妊娠者、复发性流产2次与〉／3次者之间差异有统计学意义（双酚A含量分别为O．004、0．008、0．018μg／ml，F=8．92，P=0．0002）。结论血清中高水平的双酚A含量可能与不明原因复发性流产之间存在关联。

Objective This study was to investigate the association between serum Bisphenol-A （BPA） and unexplained recurrent spontaneous abortion （RSA）. Methods A hospitalbased 1 ： 2 matched case-control study was conducted. Sixty-two patients with unexplained recurrent abortion were included and matched with 2 normal controls by factors as age （ ± 2 years）, living in the same district and the same gestational age. The levels of BPA in serum for 62 cases and 108 controls were detected under high performance liquid chromatography after fluorescent derivatization. Levels of serum BPA in each case was compared with that in control of age, BMI, education levels, occupation, exposure for passive smoking. Results The values of serum BPA in cases and controls were （0.009 ± 0.002） and （0.004± 0.012） μg/ml, respectively. The levels of serum BPA in cases was significantly higher than in controls （Z=3.506, P=0.0005）. After adjusted by age, BMI, education levels, occupation, passive smoking history and other factors, when compared to BPA below 0.004 μg/ml. The adjusted ORs were 4.39 （1.15-16.71） for BPA levels between 0.004 μg/ml and 0.012 p.g/ml, and 4.95 （1.77-13.82） for BPA over 0.012 μg/ml. The risk of unexplained recurrent spontaneous abortion increased progressively with the growth of serum BPA levels （Z=9. 179, trend test P= 0.0024）. There were significant differences on BPA among controls that with histories of two, three or more abortions （the levels were 0.004, 0.008, 0.018 μ g/ml, respectively, F=8.92, P= 0.0002）. Conclusion High BPA level might be associated with unexplained recurrent spontaneous abortion.