邻苯二甲酸盐与女性围绝经期高血压的相关性：基于美国国家健康与营养调查数据

Association between phthalates and hypertension in perimenopausal women: a study based on data from the National Health and Nutrition Examination Survey

    摘要
  • 摘要:
    目的 探讨邻苯二甲酸盐与女性围绝经期高血压的相关性。
    方法 从2011—2012、2013—2014、2015—2016、2017—2018年美国国家健康与营养调查（NHANES）数据库10 911名调查者中，筛选具有血压和邻苯二甲酸盐检测数值的围绝经期女性790例作为研究对象。根据美国心脏病学会/美国心脏协会指南高血压的定义（收缩压≥130 mmHg和/或舒张压≥80 mmHg）将研究对象分为高血压组（n=298）和非高血压组（n=492）。采用高效液相色评法测定尿液中邻苯二甲酸盐代谢产物。分析两组邻苯二甲酸盐代谢产物的差异。采用Spearman相关分析方法分析总邻苯二甲酸盐代谢产物与血压的相关性。采用多因素logistic分析方法分析女性围绝经期高血压的影响因素。采用限制性立方样条模型分析总邻苯二甲酸盐代谢产物与血压的剂量-反应关系。采用受试者操作特征（ROC）曲线分析总邻苯二甲酸盐代谢产物对女性围绝经期合并高血压的预测价值。
    结果 女性围绝经期高血压组邻苯二甲酸盐代谢产物均高于非高血压组邻苯二甲酸盐代谢物总和：118.290 (45.120, 318.283)比132.940 (59.120, 332.813) ng/L，U=21.428，P＜0.001。Spearman相关性分析显示，总邻苯二甲酸盐代谢产物与收缩压（r=0.328）和舒张压（r=0.319）呈正相关（均P＜0.05）。多因素logistic回归分析结果显示，总邻苯二甲酸盐代谢产物（OR=1.732，95%CI 1.374～2.182）是女性围绝经期高血压的影响因素。限制性立方样条模型分析结果显示，总邻苯二甲酸盐代谢产物与女性围绝经期高血压的风险具有明显的剂量依赖关系（P＜0.01）。ROC曲线分析表明，总邻苯二甲酸盐代谢产物预测女性围绝经期高血压的ROC曲线下面积（AUC）为0.727（95%CI 0.701～0.753）。
    结论 邻苯二甲酸盐与女性围绝经期高血压相关。

     

    Abstract:
    Objective To investigate the association between phthalates and hypertension in perimenopausal women.
    Methods From the 2011–2012, 2013–2014, 2015–2016, and 2017–2018 National Health and Nutrition Examination Survey (NHANES) databases (10 911 participants), 790 perimenopausal women with available blood pressure measurements and phthalate metabolite data were included. Participants were categorized into hypertension (n=298) and non-hypertension (n=492) groups based on the American College of Cardiology/American Heart Association guidelines (systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥80 mmHg). High-performance liquid chromatography was used to determine the metabolites of phthalates in urine. The differences in phthalate metabolites between two groups were analyzed. Spearman correlation analysis was used to assesse the relationship between total phthalate metabolites and blood pressure. Multivariate logistic regression analysis was used to identify the factors influencing hypertension. Restricted cubic spline models were used to analyz the dose-response relationship between total phthalate metabolites and blood pressure. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of total phthalate metabolites on hypertension.
    Results Phthalate metabolite levels were significantly higher in the hypertension group than in that in the non-hypertension group total phthalate metabolites: 132.940 (59.120, 332.813) vs 118.290 (45.120, 318.283) ng/L, U=21.428, P＜0.001. Spearman analysis revealed positive correlations between total phthalate metabolites and both systolic (r=0.328) and diastolic blood pressure (r=0.319) (both P＜0.05). Multivariate logistic regression showed that total phthalate metabolites was in influencing factors for hypertension in perimenopausal women (OR=1.732, 95% CI: 1.374–2.182). Restricted cubic spline analysis demonstrated a significant dose-dependent relationship between total phthalate metabolites and hypertension risk (P＜0.01). ROC analysis showed that the area under the curve (AUC) was 0.727 (95% CI: 0.701–0.753) for total phthalate metabolites predicting hypertension.
    Conclusion Phthalate exposure is associated with hypertension in perimenopausal women.

     

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