育龄男性空气污染物暴露水平与不育风险关联:重庆市PREBIC队列研究

Association between exposure to air pollutants and risk of infertility in men of childbearing age:a PREBIC cohort study in Chongqing

目的探讨育龄男性的空气污染物(PM_(10)、PM_(2.5)、SO_(2)、O_(3)、NO_(2)、CO)暴露水平与不育风险的关联。方法重庆市孕前生殖健康与出生结局队列(Preconception Reproductive Health and Birth Outcomes Cohort,PREBIC)于2018年11月开始在重庆市妇幼保健院招募进行孕前健康检查的育龄男性建立基线,随后每3个月进行一次随访,12个月无保护性交后未能实现临床妊娠的定义为不育。采用机器学习算法评估研究对象入组前3个月(生精周期)个体化空气污染暴露水平。通过建立Logistic回归单污染物模型分析男性空气污染物暴露对不育的影响及关键易感窗口,双污染物模型进行敏感性分析。采用贝叶斯核机器回归模型分析空气污染物对不育的联合影响及交互作用。结果共有2297名男性研究对象纳入研究。在进行多重检验校正后,男性入组前90 d PM_(10)暴露水平最高四分位数与最低四分位数相比较,不育的相对风险提高29.3%(OR=1.293,95%CI:1.022~1.636,P=0.008)。关键易感窗口的分析中,PM_(10)在0~90 d各阶段均呈现出与不育的关联,未观察到显著的易感窗口。空气污染物的联合效应及交互作用分析中未观察到有统计学意义的结果。结论男性PM_(10)暴露可能会增加不育的风险。

Objective To investigate the association between exposure levels of air pollutants(PM_(10),PM_(2.5),SO_(2),O_(3),NO_(2),and CO)and infertility risk in men of childbearing age.Methods Preconception Reproductive Health and Birth Outcomes Cohort(PREBIC)was subjected by recruiting men of childbearing age who taking pre-pregnancy health examination in Chongqing Maternal and Child Health Hospital since November 2018.The baseline indicators were collected and established after their enrollment.Then they were followed up every 3 months,and failure to achieve a clinical pregnancy after 12 months of unprotected intercourse was defined as infertility.The individualized air pollution exposure levels of the subjects in 3 months prior to enrollment(spermatogenic cycle)were assessed by machine learning algorithm.Logistic regression model was established to determine the effect of air pollutant exposure on infertility and the potential susceptibility windows induced by single pollutant.Sensitivity analysis was carried out using two-pollutant model.The joint effects and interaction of air pollutants on infertility were analyzed by Bayesian kernel machine regression.Results A total of 2297 male subjects were included in the study.After multiple test adjustment,the relative risk of infertility was increased by 29.3%(OR=1.293,95%CI:1.022-1.636,P=0.008)in the highest and lowest quartiles of PM_(10)exposure during the 90 d prior to enrollment.In the analysis of susceptibility windows,PM_(10)was associated with infertility at all stages from 0 to 90 d,and no significant susceptibility window was observed.No significant results were observed in the analysis of the joint effects and interactions of air pollutants.Conclusion Male exposure to PM_(10)may increase the risk of infertility.