孕妇邻苯二甲酸酯内暴露水平及影响因素研究

Levels of phthalate internal exposure levels in pregnant women and influencing factors

目的分析孕妇（孕周≤16周）邻苯二甲酸酯内暴露水平及其影响因素。方法选取2013年4—6月在厦门市思明区妇幼保健院建立孕产妇保健手册的1020名孕妇（孕周≤16周）纳入研究，采用调查问卷收集孕妇人口学信息、孕期生活方式以及产检信息，并收集其尿样，最终完成问卷调查并收集尿样的孕妇共998名。以此为抽样人群，采用系统抽样的方法，从中随机抽取100名孕妇作为研究对象。应用固相萃取一高效液相色谱串联质谱技术检测研究对象尿液中5种邻苯二甲酸单酯的含量，包括邻苯二甲酸单甲酯（MMP）、邻苯二甲酸单乙酯（MEP）、邻苯二甲酸单丁酯（MBP）、邻苯二甲酸单苄基酯（MBzP）和邻苯二甲酸-单一乙基己基酯（MEHP），同时结合调查问卷信息，采用多因素logistic回归模型分析孕妇各邻苯二甲酸单酯水平的影响因素。结果100份孕妇（孕周≤16周）尿样中，5种邻苯二甲酸单酯MMP、MEP、MBP、MBzP和MEHP的检m率分别为94％、93％、87％、83％、99％，含量的中位数分别为20．56、17．62、10．15、2．03、5．12ng／ml，经尿比重校正后分别为20．81、20．36、12．88、2．58、5．00ng／ml。多因素logistic回归分析结果显示：随着文化程度的提高，孕妇尿液中MMP、MEP、MBP、MBzP和MEHP含量均呈下降的趋势，OR（95％CI）值分别为0．495（0．253～0．966）、0．380（0．191～0．755）、0．379（0．186～0．774）、0．401（0．196～0．819）、0．373（0．183～0．762）；孕期烫染头发会使尿液中MBP和MBzP的含量增加，0R（95％CI）值分别为12．867（1．240-q33．525）、15．982（1．367-186．911）；孕期使用化妆品会使尿液中MEP和MBP的含量增加，OR（95％C／）值分别为2．977（1．012-8．757）、4．440（1．485-13．272）；饮用水类型与尿液中MEP和MEHP含量的增加有关，饮用桶装、瓶装水会增加其含量，OR（95％C1）值分别为3．780（1．417～10．083）、2．699（1．039～7．010）；随着家庭年收入的提高，尿液中MMP的含量呈下降趋势，OR（95％CI）值为0．597（0．372～0．959）；孕期服用药物使尿液中MEHP的含量增加，OR（95％CI）值为4．853（1．084～21．732）。结论孕妇（孕周≤16周）普遍暴露于邻苯二甲酸酯，孕期邻苯二甲酸酯内暴露水平与多种因素存在关联性，且不同邻苯二甲酸酯内暴露水平的影响因素不尽相同。

Objective To investigate the levels and influencing factors of phthalate intenlal exposure in pregnant women（gestation age ≤16 weeks）. Methods During April to June in 2013, 1 020 pregnant women（gestation age ≤16 weeks） who had established the maternal care manual were recruited in maternal and child health hospital of Siming District, Xiamen city. Participators were asked to complete a questionnaire to obtain information on socio-demographic characteristics, lifestyle behaviors, and antenatal examination and to provide a urine sample. Finally, 998 pregnant women who provided a urine sample and completed the questionnaire were enrolled. Adopting systematic sampling method, 100 ones were selected randomly among 998 pregnant women. High performance liquid chromatography-eleetrospray ionization-tandern mass was used to determine the concentration of five phthalate monoesters in each urine, including mono-n-methyl phthalate （MMP）, mono-ethyl phthalate （MEP）, mono-butyl phthalate （MBP）, mono-benzyl phthalate （MBzP）, mono-ethylhexyl phthalate （MEHP）. Based on the measurements and questionnaire data, multivariate logistic regression was used to analyze the association between the phthalate monoester levels and potential influential factors. Results The detection rates of MMP, MEP, MBP, MBzP and MEHP in 100 pregnant urine samples were 94%, 93%, 87%, 83%, 99%, respectively. And the urinary median uncorrected concentrations of MMP, MEP, MBP, MBzP and MEHP in 100 urine samples were 20.56, 17.62, 10.15, 2.03, and 5.12 ng/ml, respectively. Specific gravity-corrected concentration were 20.81, 20.36, 12.88, 2.58, 5.00 ng/ml, respectively. The results of muhivariate logistic regression analysis indicated that： education degree was negatively associated with urinary concentration of MMP, MEP, MBP, MBzP and MEHP, OR （95%C/） were 0.495 （0.253-0.966）, 0.380 （0.191-0.755）, 0.379 （0.186-0.774）, 0.401 （0.196- 0.819）, 0.373（0.183-0.762）, respectively. Participants who had hair permed and dyed during pregnancy had higher urinary level of MBP and MBzP, OR （95% Co were 12.867 （1.240-133.525）, 15.982 （1.367- 186.911）, respectively; Participants who use cosmetics during pregnancy had higher urinary level of MEP and MBP, OR （95%CI） were 2.977 （1.012-8.757）, 4.440 （1.485-13.272）, respectively; plastic bottled water consumption was positively associated with urinary concentrations of MEP and MEHP, OR （95% CI） were 3.780 （1.417-10.083）, 2.699 （1.039-7.010）, respectively; annual household income was negatively associated with urinary concentration of MMP, OR （95%CI） was 0.597 （0.372-0.959）; individuals who took medications during pregnancy had higher urinary level of MEHP than non-takers, OR （95% CO was 4.853 （1.084-21.732）. Conclusion Pregnant women whose gestation age was less than 16 weeks are generally exposed to phthalate. Phthalate internal exposure levels are significantly associated with most measured factors and the influencing factors with different phthalates internal exposure levels are different.