全氟烷基物质暴露与脑卒中患者抑郁的相关性:一项基于NHANES的横断面研究

Correlation between exposure to perfluoroalkyl substances and stroke patients’depression:a cross-sectional study based on NHANES

目的探讨全氟烷基物质(perfluoroalkyl substances,PFAS)暴露与脑卒中后抑郁风险之间的潜在关系,为脑卒中后抑郁的预防与管理提供依据。方法基于美国国家健康和营养调查数据库2011—2020年横断面调查数据,选取3411例脑卒中后幸存者作为研究对象,收集全氟辛烷羧酸(perfluorooctanoic acid,PFOA)、全氟辛烷磺酸(perfluorooctane sulfonates,PFOS)、全氟己基磺酸(perfluorohexane sulfonate,PFHxS)和全氟壬酸(perfluorononanoic acid,PFNA)等四类PFAS数据,采用多因素logistic回归分析PFAS与脑卒中后抑郁之间的相关性。结果最终纳入616例脑卒中患者,脑卒中后抑郁患病率为16.72%。抑郁组脑卒中患者PFAS暴露水平均低于非抑郁组,差异有统计学意义(Z=-4.901~-3.488,P<0.05)。多因素logistic回归结果显示,在调整性别、年龄、族裔、BMI等人口学特征和受教育程度、合并高血压、糖尿病、饮酒史、婚姻状态、家庭收入水平、吸烟史等协变量后,PFOA(OR=0.573,95%CI:0.428~0.769)、PFOS(OR=0.832,95%CI:0.759~0.912)、PFHxS(OR=0.710,95%CI:0.559~0.901)以及PFNA(OR=0.210,95%CI:0.098~0.452)暴露水平越高,脑卒中幸存者抑郁患病率越低(P均<0.05)。结论PFOA、PFOS、PFHxS和PFNA暴露与脑卒中后抑郁患病风险呈负向关联,研究结论还需要进一步前瞻性队列研究验证。

Objective To explore the potential relationship between exposure to perfluoroalkyl substances(PFAS)and the risk of post-stroke depression,and to provide a basis for post-stroke depression prevention and management.Methods Statistical data during 2011-2020 based on the US National Health and Nutrition Examination Survey(NHANES)database were used to select 3,411 post-stroke survivors as the study subjects.We collected four types of PFAS,namely,perfluorooctanoic acid(PFOA),perfluorooctane sulfonates(PFOS),perfluorohexane sulfonate(PFHxS)and perfluorononanoic acid(PFNA).Multifactor logistic regression analysis was performed to identify the correlation between PFAS and post-stroke depression.Results Six hundred and sixteen patients with stroke were finally enrolled in the study,and the prevalence rate of post-stroke depression was 16.72%.The levels of PFOA,PFOS,PFHxS and PFNA exposure in the depression group were lower than those in the non-depression group,with statistically significant differences(Z=-4.901--3.488,P<0.05).The results of multifactor logistic regression analysis revealed that after adjusting for demographic characteristics like gender,age,race and body mass index as well as covariates like educational background,combined hypertension,diabetes,history of alcohol consumption,marital status,family income level and history of smoking,the higher the exposure levels of PFOA(OR=0.573,95%CI:0.428-0.769),PFOS(OR=0.832,95%CI:0.759-0.912),PFHxS(OR=0.710,95%CI:0.559-0.901)and PFNA(OR=0.210,95%CI:0.098-0.452),the lower the prevalence rate of depression in the post-stroke survivors(all P<0.05).Conclusion Exposure to PFOA,PFOS,PFHxS and PFNA is negatively associated with the risk of developing post-stroke depression.Further prospective cohort study is needed to validate these findings.