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Article(id=1241049975988212189, tenantId=1146029695717560320, journalId=1234093305789726721, issueId=1241049962679694215, articleNumber=null, orderNo=null, doi=null, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718640000000, receivedDateStr=2024-06-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773818971869, onlineDateStr=2026-03-18, pubDate=1737302400000, pubDateStr=2025-01-20, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773818971869, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773818971869, creator=13701087609, updateTime=1773818971869, updator=13701087609, issue=Issue{id=1241049962679694215, tenantId=1146029695717560320, journalId=1234093305789726721, year='2025', volume='45', issue='1', pageStart='1', pageEnd='592', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773818968696, creator=13701087609, updateTime=1773819749443, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241053237428671382, tenantId=1146029695717560320, journalId=1234093305789726721, issueId=1241049962679694215, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241053237428671383, tenantId=1146029695717560320, journalId=1234093305789726721, issueId=1241049962679694215, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=322, endPage=330, ext={EN=ArticleExt(id=1241049976617357819, articleId=1241049975988212189, tenantId=1146029695717560320, journalId=1234093305789726721, language=EN, title=Association between perfluoroalkyl and polyfluoroalkyl substances mixture exposure and hyperuricemia, columnId=1234106388687934088, journalTitle=China Environmental Science, columnName=Environmental Toxicology and Environmental Health, runingTitle=null, highlight=null, articleAbstract=

To evaluate the association and combined effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) and mixtures on hyperuricemia (HUA) and identify key components, this study analyzed data from 2,564 subjects in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016 using logistic regression, weighted quantile sum regression, and Bayesian kernel machine regression. Higher levels of perfluorononanoic acid (PFNA), n-perfluorooctane sulfonic acid (n-PFOA), and perfluoromethylheptane sulfonic acid isomers (Sm-PFOS) were positively associated with HUA when PFAS was exposed as a single source (P<0.05). When considered as mixture exposure, PFAS mixtures were positively associated with HUA overall, with a 39.6% increase in the risk of HUA for each quartile increase in PFAS mixtures (WQS index) (OR=1.396,95%CI: 1.180~1.651, P<0.001), and this association was only observed in the female population. n-PFOA and Sm-PFOS were identified as key components, while linear perfluorooctane sulfonic acid (n-PFOS) and perfluorohexane sulfonic acid (PFHxS) may be negatively associated with HUA in the mixture. Potential interactions between various PFAS were also observed. The research findings can provide the latest epidemiological evidence for the study of the association between PFAS exposure and the risk of hyperuricemia, offering a basis for screening key populations.

, correspAuthors=Hong-bo LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Yu FENG, Shao-wei PU, Zhu-mei CHEN, Jun-liang ZHU, Wei-jie CAI, Hong-bo LIU), CN=ArticleExt(id=1241049985584780145, articleId=1241049975988212189, tenantId=1146029695717560320, journalId=1234093305789726721, language=CN, title=PFAS混合暴露与高尿酸血症关联性研究, columnId=1234106394006311784, journalTitle=中国环境科学, columnName=环境毒理与健康, runingTitle=null, highlight=null, articleAbstract=

为评估全氟和多氟烷基物质(PFAS)及其混合物对高尿酸血症(HUA)的关联及综合效应并识别其中的关键组分，基于美国国家健康和营养检查调查(NHANES)数据，使用Logistic回归、加权分位数和回归、贝叶斯核机器回归对2013~2016年2564名研究对象进行分析.当PFAS作为单一污染源暴露时，较高水平的全氟烷基壬酸(PFNA)、直链全氟烷基辛酸(n-PFOA)和单甲基支链全氟辛烷磺酸异构体(Sm-PFOS)与HUA存在正向关联(P<0.05).将其视为混合物暴露时，PFAS混合物与HUA总体呈正相关，PFAS混合物(WQS指数)每增加一个四分位数，HUA患病风险增加39.6%(OR=1.396，95%CI:1.180~1.651，P<0.001)，且这种关联仅存在于女性人群中.n-PFOA和Sm-PFOS是其中的关键组分，直链全氟辛烷磺酸(n-PFOS)和全氟己烷磺酸(PFHxS)在混合物中可能与HUA呈负相关，多种PFAS之间可能存在潜在的交互作用.研究结果可为PFAS与高尿酸血症患病风险研究提供最新流行病学证据，为重点人群筛查提供依据.

, correspAuthors=刘红波, authorNote=null, correspAuthorsNote=
*责任作者，教授，
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冯雨(1998-)，男，内蒙古呼和浩特人，硕士研究生，主要从事环境流行病学研究.发表论文1篇..

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冯雨(1998-)，男，内蒙古呼和浩特人，硕士研究生，主要从事环境流行病学研究.发表论文1篇..

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冯雨(1998-)，男，内蒙古呼和浩特人，硕士研究生，主要从事环境流行病学研究.发表论文1篇..

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Chemosphere，2015，129:87-99., articleTitle=A review of sources，multimedia distribution and health risks of perfluoroalkyl acids (PFAAs) in China, refAbstract=null), Reference(id=1241050014483534825, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, doi=null, pmid=null, pmcid=null, year=2016, volume=18, issue=6, pageStart=34, pageEnd=null, url=null, language=null, rfNumber=[29], rfOrder=28, authorNames=Hyndman D, Liu S, Miner J N, journalName=Curr. Rheumatol. Rep., refType=null, unstructuredReference=Hyndman D，Liu S，Miner J N. Urate Handling in the Human Body [J]. Curr. Rheumatol. Rep.，2016，18(6):34., articleTitle=Urate Handling in the Human Body, refAbstract=null), Reference(id=1241050014785524726, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, doi=null, pmid=null, pmcid=null, year=2023, volume=131, issue=7, pageStart=76002, pageEnd=null, url=null, language=null, rfNumber=[30], rfOrder=29, authorNames=Niu S, Cao Y, Chen R, journalName=Environ. Health Perspect, refType=null, unstructuredReference=Niu S，Cao Y，Chen R，et al. A State-of-the-science review of interactions of per- and polyfluoroalkyl substances (PFAS) with renal transporters in health and disease: Implications for population variability in PFAS toxicokinetics [J]. Environ. Health Perspect，2023，131(7):76002., articleTitle=A State-of-the-science review of interactions of per- and polyfluoroalkyl substances (PFAS) with renal transporters in health and disease: Implications for population variability in PFAS toxicokinetics, refAbstract=null), Reference(id=1241050015012016129, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, doi=null, pmid=null, pmcid=null, year=2009, volume=27, issue=3/4, pageStart=266, pageEnd=277, url=null, language=null, rfNumber=[31], rfOrder=30, authorNames=Ren H, Vallanat B, Nelson D M, journalName=Reprod. Toxicol., refType=null, unstructuredReference=Ren H，Vallanat B，Nelson D M，et al. Evidence for the involvement of xenobiotic-responsive nuclear receptors in transcriptional effects upon perfluoroalkyl acid exposure in diverse species [J]. Reprod. Toxicol.，2009，27(3/4):266-277., articleTitle=Evidence for the involvement of xenobiotic-responsive nuclear receptors in transcriptional effects upon perfluoroalkyl acid exposure in diverse species, refAbstract=null), Reference(id=1241050015217537031, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, doi=null, pmid=null, pmcid=null, year=2009, volume=39, issue=1, pageStart=76, pageEnd=94, url=null, language=null, rfNumber=[32], rfOrder=31, authorNames=Dewitt J C, Shnyra A, Badr M Z, journalName=Crit. Rev. Toxicol., refType=null, unstructuredReference=Dewitt J C，Shnyra A，Badr M Z，et al. Immunotoxicity of perfluorooctanoic acid and perfluorooctane sulfonate and the role of peroxisome proliferator-activated receptor alpha [J]. Crit. Rev. Toxicol.，2009，39(1):76-94., articleTitle=Immunotoxicity of perfluorooctanoic acid and perfluorooctane sulfonate and the role of peroxisome proliferator-activated receptor alpha, refAbstract=null), Reference(id=1241050015406280728, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, doi=null, pmid=null, pmcid=null, year=2005, volume=587, issue=1/2, pageStart=38, pageEnd=44, url=null, language=null, rfNumber=[33], rfOrder=32, authorNames=Yao X, Zhong L, journalName=Mutat. Res., refType=null, unstructuredReference=Yao X，Zhong L. Genotoxic risk and oxidative DNA damage in HepG2cells exposed to perfluorooctanoic acid [J]. Mutat. Res.，2005，587(1/2):38-44., articleTitle=Genotoxic risk and oxidative DNA damage in HepG2cells exposed to perfluorooctanoic acid, refAbstract=null), Reference(id=1241050015624384545, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, doi=null, pmid=null, pmcid=null, year=2001, volume=173, issue=1, pageStart=56, pageEnd=64, url=null, language=null, rfNumber=[34], rfOrder=33, authorNames=Panaretakis T, Shabalina I G, Grandér D, journalName=Toxicol. Appl. Pharmacol., refType=null, unstructuredReference=Panaretakis T，Shabalina I G，Grandér D，et al. Reactive oxygen species and mitochondria mediate the induction of apoptosis in human hepatoma HepG2cells by the rodent peroxisome proliferator and hepatocarcinogen，perfluorooctanoic acid [J]. Toxicol. Appl. Pharmacol.，2001，173(1):56-64., articleTitle=Reactive oxygen species and mitochondria mediate the induction of apoptosis in human hepatoma HepG2cells by the rodent peroxisome proliferator and hepatocarcinogen，perfluorooctanoic acid, refAbstract=null), Reference(id=1241050015737630759, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, doi=null, pmid=null, pmcid=null, year=2017, volume=125, issue=3, pageStart=416, pageEnd=421, url=null, language=null, rfNumber=[35], rfOrder=34, authorNames=Dhingra R, Winquist A, Darrow L A, journalName=Environ. Health Perspect, refType=null, unstructuredReference=Dhingra R，Winquist A，Darrow L A，et al. A study of reverse causation: Examining the associations of perfluorooctanoic acid serum levels with two outcomes [J]. Environ. Health Perspect，2017，125(3):416-421., articleTitle=A study of reverse causation: Examining the associations of perfluorooctanoic acid serum levels with two outcomes, refAbstract=null)], funds=[Fund(id=1241050002701734483, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, awardId=LJKZ0765, language=CN, fundingSource=辽宁省教育厅科学研究项目(LJKZ0765), fundOrder=null, country=null), Fund(id=1241050002819175005, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, awardId=2021JH4/10200008, language=CN, fundingSource=辽宁省科学技术计划项目(2021JH4/10200008), fundOrder=null, country=null), Fund(id=1241050003020501615, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, awardId=23-506-3-01-21, language=CN, fundingSource=沈阳市科学研究项目(23-506-3-01-21), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241049985828049810, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, xref=1., ext=[AuthorCompanyExt(id=1241049985836438419, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, companyId=1241049985828049810, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.Department of Health Statistics, School of Public Health, China Medical University, Shenyang 110122, China), AuthorCompanyExt(id=1241049985844827031, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, companyId=1241049985828049810, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.中国医科大学公共卫生学院，卫生统计学教研室，辽宁 沈阳 110122)]), AuthorCompany(id=1241049987488994211, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, xref=2., ext=[AuthorCompanyExt(id=1241049987497382819, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, companyId=1241049987488994211, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, China Medical University, Shenyang 110122, China), AuthorCompanyExt(id=1241049987505771428, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, companyId=1241049987488994211, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.中国医科大学，环境应激与慢病防控教育部重点实验室，辽宁 沈阳 110122)])], figs=[ArticleFig(id=1241049997769232766, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=EN, label=Fig.1, caption=Flow chart of the selection of eligible participants, figureFileSmall=N+GHUp61ULPj7UQodDH7Xw==, figureFileBig=HnCOD5V/0cnqc2NJZ/fHVQ==, tableContent=null), ArticleFig(id=1241049997865701767, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=CN, label=图1, caption=研究对象筛选流程图, figureFileSmall=N+GHUp61ULPj7UQodDH7Xw==, figureFileBig=HnCOD5V/0cnqc2NJZ/fHVQ==, tableContent=null), ArticleFig(id=1241049998398378414, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=EN, label=Fig.2, caption=Association of PFAS mixtures with HUA and their weights in the WQS model, figureFileSmall=Oa8N6YEgat6Q7VbJ55l5gw==, figureFileBig=W4V7nw1mVwwCTGAF/7r8Yg==, tableContent=null), ArticleFig(id=1241049998599705021, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=CN, label=图2, caption=WQS模型中PFAS混合物与HUA的关联及其权重

图2(a)和(c)未经调整；图2(b)和(d)调整了年龄、性别、种族、BMI、受教育程度、收入水平、血清可替宁、饮酒状况、体力活动、高血压、糖尿病、血脂异常和慢性肾病

, figureFileSmall=Oa8N6YEgat6Q7VbJ55l5gw==, figureFileBig=W4V7nw1mVwwCTGAF/7r8Yg==, tableContent=null), ArticleFig(id=1241049998742311368, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=EN, label=Fig.3, caption=Association between PFAS mixtures and HUA in the BKMR model, figureFileSmall=Nb8EKTkuwQH6iOq8Hr3MGg==, figureFileBig=1GrZwtvtCKNKC/t7QLXWdg==, tableContent=null), ArticleFig(id=1241049998935249366, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=CN, label=图3, caption=BKMR模型中血清PFAS混合物与HUA的关系

模型调整了年龄、性别、种族、BMI、受教育程度、收入水平、血清可替宁、饮酒状况、体力活动、高血压、糖尿病、血脂异常和慢性肾病

, figureFileSmall=Nb8EKTkuwQH6iOq8Hr3MGg==, figureFileBig=1GrZwtvtCKNKC/t7QLXWdg==, tableContent=null), ArticleFig(id=1241049999274988004, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=EN, label=Fig.4, caption=Association between PFAS mixtures and HUA by gender, figureFileSmall=c/x8zN1nSXmr6bjUTJztqg==, figureFileBig=6UvtoPMcDK5eCmLD70KpKA==, tableContent=null), ArticleFig(id=1241049999472120312, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=CN, label=图4, caption=PFAS混合物与HUA在不同性别人群中的关联

图4(a)，(c)，(f)和(h)未经调整；图4(b)，(d)，(e)，(g)，(i)和(j)调整了年龄、性别、种族、BMI、受教育程度、收入水平、血清可替宁、饮酒状况、体力活动、高血压、糖尿病、血脂异常和慢性肾病

, figureFileSmall=c/x8zN1nSXmr6bjUTJztqg==, figureFileBig=6UvtoPMcDK5eCmLD70KpKA==, tableContent=null), ArticleFig(id=1241050001183396364, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=EN, label=Table 1, caption=

Characteristics of the study participants

, figureFileSmall=null, figureFileBig=null, tableContent=
项目特征总体(n=2564)非HUA患者(n=2120)HUA患者(n=444)P
年龄/岁46.20±17.2145.29±17.0750.54±17.22<0.001
性别，n(%)男性1230(48.0)980(46.2)250(56.3)<0.001
女性1334(52.0)1140(53.8)194(43.7)
种族/民族，n(%)非西班牙裔白人960(37.4)780(36.8)180(40.5)0.011
非西班牙裔黑人576(22.5)461(21.7)115(25.9)
墨西哥裔美国人396(15.4)345(16.3)51(11.5)
其他种族/民族BMI，n(%)632(24.6)534(25.2)98(22.1)<0.001
<25.00753(29.4)690(32.5)63(14.2)
25.00~29.99807(31.5)693(32.7)114(25.7)
≥30.001004(39.2)737(34.8)267(60.1)
受教育程度，n(%)高中以下554(21.6)467(22.0)87(19.6)0.052
高中毕业593(23.1)471(22.2)122(27.5)
高中以上1417(55.3)1182(55.8)235(52.9)
收入水平，n(%)低收入907(35.4)747(35.2)160(36.0)0.511
中等收入796(31.0)651(30.7)145(32.7)
高收入861(33.6)722(34.1)139(31.3)
体力活动，n(%)小于150min1673(65.2)1364(64.3)309(69.6)0.039
大于150min891(34.8)756(35.7)135(30.4)
血清可替宁(ng/mL)，n(%)<1.001792(69.9)1486(70.1)306(68.9)0.682
1.00~9.90103(4.0)82(3.9)21(4.7)
≥10.00669(26.1)552(26.0)117(26.4)
饮酒状况，n(%)不饮酒者647(25.2)545(25.7)102(23.0)0.002
低至中度饮酒者1711(66.7)1423(67.1)288(64.8)
重度饮酒者206(8.0)152(7.2)54(12.2)
慢性肾病，n(%)正常2172(84.7)1862(87.8)310(69.8)<0.001
患病392(15.3)258(12.2)134(30.2)
高血压，n(%)正常1540(60.1)1355(63.9)185(41.7)<0.001
患病1024(39.9)765(36.1)259(58.3)
血脂异常，n(%)正常1897(74.0)1621(76.5)276(62.2)<0.001
异常667(26.0)499(23.5)168(37.8)
糖尿病，n(%)正常1868(72.9)1606(75.8)262(59.0)<0.001
患病696(27.1)514(24.2)182(41.0)
PFAS(ng/mL)，M(P25，P75)PFDA0.20(0.07，0.30)0.20(0.07，0.30)0.20(0.07，0.30)0.591
PFHxS1.30(0.70，2.30)1.30(0.70，2.20)1.50(0.80，2.40)0.001
PFNA0.60(0.40，1.00)0.60(0.40，1.00)0.80(0.50，1.10)<0.001
n-PFOA1.70(1.10，2.60)1.60(1.00，2.50)2.00(1.30，2.90)<0.001
n-PFOS3.50(2.10，6.10)3.40(2.00，6.00)3.90(2.40，6.73)0.001
Sm-PFOS1.50(0.80，2.70)1.40(0.70，2.60)1.90(1.10，3.20)<0.001
), ArticleFig(id=1241050001984508446, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=CN, label=表1, caption=

研究对象的一般特征

, figureFileSmall=null, figureFileBig=null, tableContent=
项目特征总体(n=2564)非HUA患者(n=2120)HUA患者(n=444)P
年龄/岁46.20±17.2145.29±17.0750.54±17.22<0.001
性别，n(%)男性1230(48.0)980(46.2)250(56.3)<0.001
女性1334(52.0)1140(53.8)194(43.7)
种族/民族，n(%)非西班牙裔白人960(37.4)780(36.8)180(40.5)0.011
非西班牙裔黑人576(22.5)461(21.7)115(25.9)
墨西哥裔美国人396(15.4)345(16.3)51(11.5)
其他种族/民族BMI，n(%)632(24.6)534(25.2)98(22.1)<0.001
<25.00753(29.4)690(32.5)63(14.2)
25.00~29.99807(31.5)693(32.7)114(25.7)
≥30.001004(39.2)737(34.8)267(60.1)
受教育程度，n(%)高中以下554(21.6)467(22.0)87(19.6)0.052
高中毕业593(23.1)471(22.2)122(27.5)
高中以上1417(55.3)1182(55.8)235(52.9)
收入水平，n(%)低收入907(35.4)747(35.2)160(36.0)0.511
中等收入796(31.0)651(30.7)145(32.7)
高收入861(33.6)722(34.1)139(31.3)
体力活动，n(%)小于150min1673(65.2)1364(64.3)309(69.6)0.039
大于150min891(34.8)756(35.7)135(30.4)
血清可替宁(ng/mL)，n(%)<1.001792(69.9)1486(70.1)306(68.9)0.682
1.00~9.90103(4.0)82(3.9)21(4.7)
≥10.00669(26.1)552(26.0)117(26.4)
饮酒状况，n(%)不饮酒者647(25.2)545(25.7)102(23.0)0.002
低至中度饮酒者1711(66.7)1423(67.1)288(64.8)
重度饮酒者206(8.0)152(7.2)54(12.2)
慢性肾病，n(%)正常2172(84.7)1862(87.8)310(69.8)<0.001
患病392(15.3)258(12.2)134(30.2)
高血压，n(%)正常1540(60.1)1355(63.9)185(41.7)<0.001
患病1024(39.9)765(36.1)259(58.3)
血脂异常，n(%)正常1897(74.0)1621(76.5)276(62.2)<0.001
异常667(26.0)499(23.5)168(37.8)
糖尿病，n(%)正常1868(72.9)1606(75.8)262(59.0)<0.001
患病696(27.1)514(24.2)182(41.0)
PFAS(ng/mL)，M(P25，P75)PFDA0.20(0.07，0.30)0.20(0.07，0.30)0.20(0.07，0.30)0.591
PFHxS1.30(0.70，2.30)1.30(0.70，2.20)1.50(0.80，2.40)0.001
PFNA0.60(0.40，1.00)0.60(0.40，1.00)0.80(0.50，1.10)<0.001
n-PFOA1.70(1.10，2.60)1.60(1.00，2.50)2.00(1.30，2.90)<0.001
n-PFOS3.50(2.10，6.10)3.40(2.00，6.00)3.90(2.40，6.73)0.001
Sm-PFOS1.50(0.80，2.70)1.40(0.70，2.60)1.90(1.10，3.20)<0.001
), ArticleFig(id=1241050002198417961, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=EN, label=Table 2, caption=

Association between single PFAS and HUA

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PFAS分组Model 1Model 2
OR(95%CI)POR(95%CI)P
PFDAQ1ReferenceReference
Q20.842(0.653~1.088)0.1850.960(0.731~1.266)0.773
Q30.907(0.635~1.280)0.5830.903(0.614~1.315)0.597
Q41.157(0.856~1.560)0.3411.208(0.859~1.695)0.276
P for trend0.2890.352
PFHxSQ1ReferenceReference
Q21.155(0.843~1.581)0.3681.159(0.824~1.629)0.397
Q31.506(1.132~2.011)0.0051.342(0.964~1.872)0.082
Q41.462(1.095~1.958)0.0101.145(0.809~1.621)0.446
P for trend0.0030.388
PFNAQ1ReferenceReference
Q21.035(0.757~1.412)0.8291.068(0.764~1.489)0.701
Q31.347(1.016~1.789)0.0391.303(0.958~1.775)0.092
Q41.635(1.230~2.178)<0.0011.511(1.091~2.097)0.013
P for trend<0.0010.007
n-PFOAQ1ReferenceReference
Q21.054(0.761~1.462)0.7511.168(0.821~1.662)0.388
Q31.525(1.130~2.068)0.0061.692(1.205~2.386)0.003
Q42.003(1.497~2.695)<0.0012.084(1.479~2.953)<0.001
P for trend<0.001<0.001
n-PFOSQ1ReferenceReference
Q21.156(0.843~1.591)0.3701.262(0.897~1.780)0.183
Q31.499(1.108~2.038)0.0091.540(1.098~2.170)0.013
Q41.562(1.157~2.121)0.0041.260(0.885~1.799)0.202
P for trend<0.0010.165
Sm-PFOSQ1ReferenceReference
Q21.374(0.979~1.935)0.0671.573(1.092~2.277)0.016
Q32.170(1.584~2.999)<0.0012.298(1.602~3.320)<0.001
Q42.430(1.787~3.336)<0.0012.110(1.441~3.112)<0.001
P for trend<0.001<0.001
), ArticleFig(id=1241050002391355959, tenantId=1146029695717560320, journalId=1234093305789726721, articleId=1241049975988212189, language=CN, label=表2, caption=

单一PFAS与HUA之间的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
PFAS分组Model 1Model 2
OR(95%CI)POR(95%CI)P
PFDAQ1ReferenceReference
Q20.842(0.653~1.088)0.1850.960(0.731~1.266)0.773
Q30.907(0.635~1.280)0.5830.903(0.614~1.315)0.597
Q41.157(0.856~1.560)0.3411.208(0.859~1.695)0.276
P for trend0.2890.352
PFHxSQ1ReferenceReference
Q21.155(0.843~1.581)0.3681.159(0.824~1.629)0.397
Q31.506(1.132~2.011)0.0051.342(0.964~1.872)0.082
Q41.462(1.095~1.958)0.0101.145(0.809~1.621)0.446
P for trend0.0030.388
PFNAQ1ReferenceReference
Q21.035(0.757~1.412)0.8291.068(0.764~1.489)0.701
Q31.347(1.016~1.789)0.0391.303(0.958~1.775)0.092
Q41.635(1.230~2.178)<0.0011.511(1.091~2.097)0.013
P for trend<0.0010.007
n-PFOAQ1ReferenceReference
Q21.054(0.761~1.462)0.7511.168(0.821~1.662)0.388
Q31.525(1.130~2.068)0.0061.692(1.205~2.386)0.003
Q42.003(1.497~2.695)<0.0012.084(1.479~2.953)<0.001
P for trend<0.001<0.001
n-PFOSQ1ReferenceReference
Q21.156(0.843~1.591)0.3701.262(0.897~1.780)0.183
Q31.499(1.108~2.038)0.0091.540(1.098~2.170)0.013
Q41.562(1.157~2.121)0.0041.260(0.885~1.799)0.202
P for trend<0.0010.165
Sm-PFOSQ1ReferenceReference
Q21.374(0.979~1.935)0.0671.573(1.092~2.277)0.016
Q32.170(1.584~2.999)<0.0012.298(1.602~3.320)<0.001
Q42.430(1.787~3.336)<0.0012.110(1.441~3.112)<0.001
P for trend<0.001<0.001
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PFAS混合暴露与高尿酸血症关联性研究
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冯雨 1 , 浦少威 1 , 陈祝梅 1 , 朱俊亮 1 , 蔡伟杰 1 , 刘红波 1, 2, *
中国环境科学 | 环境毒理与健康 2025,45(1): 322-330
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中国环境科学 | 环境毒理与健康 2025, 45(1): 322-330
PFAS混合暴露与高尿酸血症关联性研究
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冯雨1 , 浦少威1, 陈祝梅1, 朱俊亮1, 蔡伟杰1, 刘红波1, 2, *
作者信息
  • 1.中国医科大学公共卫生学院，卫生统计学教研室，辽宁 沈阳 110122
  • 2.中国医科大学，环境应激与慢病防控教育部重点实验室，辽宁 沈阳 110122

    • 冯雨(1998-)，男，内蒙古呼和浩特人，硕士研究生，主要从事环境流行病学研究.发表论文1篇..

通讯作者:

*责任作者，教授，
Association between perfluoroalkyl and polyfluoroalkyl substances mixture exposure and hyperuricemia
Yu FENG1 , Shao-wei PU1, Zhu-mei CHEN1, Jun-liang ZHU1, Wei-jie CAI1, Hong-bo LIU1, 2, *
Affiliations
  • 1.Department of Health Statistics, School of Public Health, China Medical University, Shenyang 110122, China
  • 2.Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, China Medical University, Shenyang 110122, China
出版时间: 2025-01-20
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摘要
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为评估全氟和多氟烷基物质(PFAS)及其混合物对高尿酸血症(HUA)的关联及综合效应并识别其中的关键组分，基于美国国家健康和营养检查调查(NHANES)数据，使用Logistic回归、加权分位数和回归、贝叶斯核机器回归对2013~2016年2564名研究对象进行分析.当PFAS作为单一污染源暴露时，较高水平的全氟烷基壬酸(PFNA)、直链全氟烷基辛酸(n-PFOA)和单甲基支链全氟辛烷磺酸异构体(Sm-PFOS)与HUA存在正向关联(P<0.05).将其视为混合物暴露时，PFAS混合物与HUA总体呈正相关，PFAS混合物(WQS指数)每增加一个四分位数，HUA患病风险增加39.6%(OR=1.396，95%CI:1.180~1.651，P<0.001)，且这种关联仅存在于女性人群中.n-PFOA和Sm-PFOS是其中的关键组分，直链全氟辛烷磺酸(n-PFOS)和全氟己烷磺酸(PFHxS)在混合物中可能与HUA呈负相关，多种PFAS之间可能存在潜在的交互作用.研究结果可为PFAS与高尿酸血症患病风险研究提供最新流行病学证据，为重点人群筛查提供依据.

高尿酸血症  /  全氟和多氟烷基物质  /  混合物  /  贝叶斯核机器回归  /  加权分位数和回归

To evaluate the association and combined effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) and mixtures on hyperuricemia (HUA) and identify key components, this study analyzed data from 2,564 subjects in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016 using logistic regression, weighted quantile sum regression, and Bayesian kernel machine regression. Higher levels of perfluorononanoic acid (PFNA), n-perfluorooctane sulfonic acid (n-PFOA), and perfluoromethylheptane sulfonic acid isomers (Sm-PFOS) were positively associated with HUA when PFAS was exposed as a single source (P<0.05). When considered as mixture exposure, PFAS mixtures were positively associated with HUA overall, with a 39.6% increase in the risk of HUA for each quartile increase in PFAS mixtures (WQS index) (OR=1.396,95%CI: 1.180~1.651, P<0.001), and this association was only observed in the female population. n-PFOA and Sm-PFOS were identified as key components, while linear perfluorooctane sulfonic acid (n-PFOS) and perfluorohexane sulfonic acid (PFHxS) may be negatively associated with HUA in the mixture. Potential interactions between various PFAS were also observed. The research findings can provide the latest epidemiological evidence for the study of the association between PFAS exposure and the risk of hyperuricemia, offering a basis for screening key populations.

hyperuricemia (HUA)  /  PFAS  /  mixtures  /  BKMR  /  WQS
冯雨, 浦少威, 陈祝梅, 朱俊亮, 蔡伟杰, 刘红波. PFAS混合暴露与高尿酸血症关联性研究. 中国环境科学, 2025 , 45 (1) : 322 -330 .
Yu FENG, Shao-wei PU, Zhu-mei CHEN, Jun-liang ZHU, Wei-jie CAI, Hong-bo LIU. Association between perfluoroalkyl and polyfluoroalkyl substances mixture exposure and hyperuricemia[J]. China Environmental Science, 2025 , 45 (1) : 322 -330 .
正文
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高尿酸血症（HUA）被认为是高血压、糖尿病及心脑血管疾病的一个独立危险因素[1-2]，已逐渐成为一个重要的公共卫生问题.由于饮食习惯、社会经济及遗传的多样性，HUA患病率存在区域差异，发达国家的患病率高于发展中国家[3].全氟和多氟烷基物质（PFAS）是一类人工合成的、难降解的化学物质，广泛应用于工业、商业和消费品中，如食品包装、炊具、家具等，在一般人群中主要通过食物、饮用水和空气等途径进入人体[4].尽管目前其生产和使用受到限制，由于其长期蓄积性，在我国及全球许多国家的人群中仍具有较高的检出率[5-6]，持续接触会导致血压、血脂升高，肝、肾功能异常，免疫功能受损等一系列健康危害[7].
既往研究表明多种PFAS与HUA可能具有正相关关系[8-11]，但大多研究仅关注单一PFAS暴露对HUA的影响.真实情况是人体通常同时暴露于不同来源的、多种高度相关的PFAS，即使在多种低剂量的PFAS暴露下，由于其潜在的相加、协同或拮抗作用，使得单一污染物模型无法准确评估PFAS对HUA的真实影响.因此本研究使用2013~2016年美国国家健康和营养检查调查（NHANES）数据库中的样本，采用Logistic回归、加权分位数和回归（WQS）及贝叶斯核机器回归（BKMR）模型评估多种PFAS及其混合物对HUA的关联及综合效应，识别其中的关键组分，探索PFAS之间可能存在的交互作用，以获得更现实、更准确的健康风险评估.
1 材料和方法
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1.1 研究对象
NHANES是由美国疾病控制和预防中心（CDC）的国家卫生统计中心（NCHS）自1999年以来每两年进行一次、具有全国代表性的多阶段分层抽样健康调查，旨在评估成人和儿童的健康和营养状况[12].NCHS研究伦理审查委员会对所有研究计划给予了批准，所有参与者均签署了知情同意书.
本研究选择了两个NHANES周期（2013~2014年，2015~2016年），共20146名参与者.纳入标准为年龄18~79岁，排除标准为尿酸、血清PFAS信息不完整，协变量信息缺失的参与者，最后共纳入2564名研究对象（图1）.
1.2 暴露和结局的定义
结局变量是HUA状态，由血清尿酸水平决定.高尿酸血症定义为男性血清尿酸水平≥420μmol/L，女性尿酸水平≥360μmol/L[13].
2013~2016年检出率超过70%的6种PFAS包括全氟烷基癸酸（PFDA）、全氟己烷磺酸（PFHxS）、全氟烷基壬酸（PFNA）、直链全氟烷基辛酸（n-PFOA）、直链全氟辛烷磺酸（n-PFOS）和单甲基支链全氟辛烷磺酸异构体（Sm-PFOS）.根据NHANES标准，检出限（LOD）均为0.1ng/mL，低于LOD的血清PFAS用代替其浓度.测定方法已在以往的研究中描述[14]，所有人群血清样本均经CDC统一分析并质控.
1.3 协变量的定义
协变量是根据既往研究中发现与HUA相关的因素，可能影响PFAS浓度与HUA之间的相关性[15-16]，包括年龄、性别、种族、受教育程度、家庭收入水平（家庭收入贫困比<1.37为低收入家庭，1.37~3.25为中等收入水平，≥3.25为高收入家庭）、体质指数（BMI）等人口统计学因素，血清可替宁、饮酒（不饮酒者为1年内饮酒杯数<12杯，轻到中度饮酒者为女性<1杯/d、男性<2杯/d，重度饮酒者为女性≥1杯/d、男性≥2杯/d[17]）、体力活动（每周中等强度体力活动总时间<150min为体力活动不足）等生活方式因素，高血压、糖尿病、血脂异常和慢性肾病等健康状况因素.其中肾小球滤过率（GFR）通过慢性肾脏病流行病学协作（CKD-EPI）公式估算，白蛋白尿被定义为尿白蛋白与肌酐比值高于30mg/g，慢性肾病患者被定义为eGFR<60mL/min/1.73m2和（或）白蛋白尿.所有协变量均从NHANES问卷和实验室测量提取.
1.4 统计分析
连续变量若符合正态分布用表示，采用t检验比较，若为偏态分布用M（P25，P75）表示，选用Mann-Whitney U检验进行比较；分类变量用频数（%）表示，使用Pearson χ2检验比较HUA状态的基线差异.使用Spearman相关系数评估PFAS之间的相关性.Logistic回归根据四分位数将血清PFAS分为四组（Q1：<P25，Q2：P25~P50，Q3：P50~P75，Q4：≥P75），以Q1组为参照组以评估单一PFAS与HUA之间的关联.
通过WQS回归模型定量估计PFAS混合物对HUA的综合效应.40%的数据作为训练集，60%为验证集，执行5000次bootstrap过程，最终的WQS指数由多个bootstrap样本的权重平均得到.分别拟合正向和负向WQS回归模型以探讨PFAS混合暴露与HUA患病风险之间的正相关或负相关关系.采用BKMR模型探索和可视化PFAS混合物暴露对HUA患病风险的总体效应及单一PFAS暴露与HUA的暴露-反应关系以及PFAS之间的潜在相互作用.其模型表达式如下：
式中：Yi为健康结局；zim为暴露变量；h（）为可能存在非线性和相互作用的混合物暴露-反应函数；xi和β分别为协变量及其系数；εi为残差.采用马尔科夫链蒙特卡罗算法对模型进行30000次迭代以确保模型收敛.广义线性模型进一步确定交互作用.采用高尿酸血症的替代定义、排除患有慢性肾病的参与者及删除PFAS高于平均浓度±3SD的异常值进行敏感性分析探究结果的稳定性.研究使用R软件（版本4.2.0）进行所有的统计分析，双侧P≤0.05为差异有统计学意义.
2 结果与分析
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2.1 研究对象的一般特征
本研究共纳入2564人，平均年龄为46.20岁，52%为女性.与非HUA患者相比，HUA患者年龄较大，男性较多，近85%的患者超重或肥胖，体力活动较少，重度饮酒者较多，患有慢性肾病、高血压、糖尿病和血脂异常者较多.受教育程度、收入水平、血清可替宁差异无统计学意义（表1）.
2.2 血清PFAS的分布和相关性
表1所示HUA患者的PFHxS、PFNA、n-PFOA、n-PFOS和Sm-PFOS浓度较高（P<0.05）.两组间PFDA浓度差异无统计学意义（P>0.05）.6种PFAS之间均存在不同程度的正相关，相关系数（rs）范围为0.28~0.80（P<0.001）.
2.3 单一PFAS暴露水平与HUA的关联
表2所示，较高水平的PFNA、n-PFOA和Sm-PFOS与HUA存在正向关联，且随着暴露水平的增加有明显的正向趋势（P for trend<0.05）.
2.4 PFAS混合暴露与HUA的关联
正向WQS模型中（图2（a）和图2（b）），PFAS混合物与HUA患病率呈正相关（未调整模型：OR=1.404，95%CI：1.231~1.602，P<0.001；调整模型：OR=1.396，95%CI：1.180~1.651，P<0.001）.其中Sm-PFOS（49.87%）和n-PFOA（43.08%）在正向关联中发挥主要作用，对混合物暴露总效应的贡献最大.
负向WQS模型中（图2（c）和图2（d）），PFAS混合物与HUA患病率呈负相关（未调整模型：OR=0.782，95%CI：0.667~0.918，P=0.003；调整模型：OR=0.783，95%CI：0.647~0.948，P=0.012）.其中PFDA的贡献权重最高（75.62%），PFNA次之（11.88%），两者在负向关联中发挥主要作用，n-PFOS和PFHxS权重较小.
BKMR模型得到6种PFAS对HUA风险的后验包含概率（PIP）（图3（a）），n-PFOA和Sm-PFOS的PIP值大于0.5，在总体效应中起着最重要的作用.当6种血清PFAS浓度在P55或更高水平时，PFAS混合物对HUA的联合效应高于6种PFAS都处于P50水平（图3（b）），PFAS混合暴露的联合效应与HUA具有统计学意义的正相关.
图3（c）为其他5种血清FPAS浓度都处于中位数水平时，每种PFAS浓度与HUA风险的单变量暴露-反应关系.n-PFOA与HUA呈正相关，PFHxS和n-PFOS与HUA存在潜在的负向关联，PFNA和PFDA曲线在较低和较高水平上趋于平坦，而Sm-PFOS对HUA存在先降低后升高的非线性趋势.图3（d）为当4种PFAS浓度均固定在中位数水平，某种PFAS在另1种PFAS浓度分别处于P25、P50和P75时与HUA的关联.n-PFOA和Sm-PFOS（P交互<0.001），n-PFOA和PFHxS（P交互=0.011），n-PFOA与PFNA（P交互=0.037），PFNA与Sm-PFOS（P 交互=0.029）两两之间可能存在潜在的相互作用，未观察到其他PFAS之间有统计学意义的相互作用.
2.5 亚组分析和敏感性分析
PFAS混合物对HUA患病风险的影响在男性和女性人群中有所不同.根据WQS和BKMR模型的结果综合表明，PFAS混合物对女性HUA的联合效应总体呈现上升趋势（图4（f~j）），而在男性人群中未发现PFAS混合暴露与HUA之间存在统计学关联（图4（a~e））.
当采用高尿酸血症的替代定义、排除患有慢性肾病的参与者（n=392）、删除PFAS浓度高于平均浓度±3SD的异常值（n=179）进行分析时，PFAS混合暴露与HUA的正向关联保持不变，关联结果依然具有统计学意义.
3 讨论
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本研究从不同维度探究PFAS和HUA的关联.作为单一污染源暴露时，较高水平的PFNA、n-PFOA和Sm-PFOS与HUA呈正相关，这与之前单一PFAS与HUA关联的几项研究相似[8-10,18]，这些研究分别显示成人血清PFNA、PFOA、PFOS与HUA具有统计学意义的正相关关系.本研究发现Sm-PFOS与HUA患病风险存在先降低后升高的非线性趋势，这反映了Sm-PFOS在低水平暴露可能引起兴奋效应，高水平暴露导致抑制作用[19]，这种非线性暴露反应关系在PFAS与其他健康结果的关联中较常见，可能与PFAS的内分泌干扰特性、代谢负荷以及肾脏和肝脏的反应有关[20-22].
将PFAS视为混合物暴露时，PFAS混合物与HUA总体呈正相关，PFAS混合物（WQS指数）每增加一个四分位数，HUA患病风险增加39.6%（OR=1.396，95%CI：1.180~1.651，P<0.001）.n-PFOA和Sm-PFOS在总体效应中起着重要的作用，n-PFOS和PFHxS在混合物中可能与HUA呈负相关，而PFDA和PFNA在混合物中的作用较小，这与以往研究结果有所不同.中国成人的横断面研究通过BKMR模型未观察到8种PFAS混合物与尿酸具有统计学关联[23]，女性人群的纵向研究通过分位数g计算方法也未发现PFAS混合暴露与HUA具有统计学意义的关联[11].有关PFAS混合物的研究表明，由于PFAS之间复杂的交互作用，导致PFAS混合物对健康的综合影响较为复杂，这种综合效应会因为混合物成分的不同而表现出不同的交互作用，可能大于或小于单个成分的作用之和[24]，且研究设计、PFAS暴露水平、样本量和种族遗传背景也可能导致结果的差异.同时，本研究在混合暴露的亚组分析中发现PFAS与HUA的关联存在性别差异，仅在女性中有正向关联，而在男性人群中未发现PFAS混合暴露与HUA之间存在统计学关联.类似的性别差异也在PFAS与代谢综合征的关联中表现出来[25].PFAS作为内分泌干扰物，可能通过干扰雌激素而影响肾脏中尿酸转运蛋白的表达和活性，改变尿酸的排泄[26].未来的研究可以在不同特征人群中进一步分析PFAS混合物与HUA之间的关系.
由于暴露时间不同、民众健康风险的提高及政策和法规的实施，特别是2009年《关于持久性有机污染物的斯德哥尔摩公约》将PFAS纳入其中[23]，使得部分国家人体血清PFASs浓度出现下降趋势.本研究中PFDA、PFNA、PFHxS、n-PFOA、n-PFOS和Sm-PFOS的中位血清浓度分别为0.20，0.60，1.30，1.70，3.50，1.50ng/mL，与同期美国人群血清暴露水平近似[27]，低于我国全国性大规模人群调查的结果[6].既往研究表明，中国是PFAS及相关物质生产和消费量最大的国家之一[28]，这可能意味着我国正面临着较大的健康风险.
PFAS与HUA相关的生物学机制目前尚未完全阐明，根据现有研究表明PFAS混合物对HUA的影响机制涉及多个生物学通路和系统.首先，尿酸在肾小管的重吸收和分泌过程中主要受尿酸重吸收转运蛋白和分泌转运蛋白所调控[29].而PFAS的重吸收和分泌由尿酸转运蛋白1（URAT1）、有机阴离子转运蛋白（OAT）1、OAT3和OAT4介导[30]，根据其链长与转运蛋白具有不同程度的亲和力，会与尿酸竞争导致尿酸排泄减少.其次，PFOA和PFOS还会降低SLC17A1mRNA的表达[31]，引发在钠依赖性磷酸转运蛋白（NPT）1减少，最终导致肾脏排泄尿酸减少而发生HUA.此外，PFAS可激活过氧化物酶体增殖物激活受体α（PPARα）途径[32]，进而调控与炎症反应和氧化应激相关的基因，导致血清尿酸水平增加[33-34].多种PFAS进入人体后，由于各组分之间可能存在复杂的交互作用，一些PFAS可能通过竞争性结合同一靶标或通过调节相同的生物途径，增强或削弱彼此的效应.这种交互作用可能导致混合物整体效应不同于单一组分的效应，甚至出现相反的健康结果，仍需要更多实验和人群研究深入探讨具体的生物机制和暴露反应关系.
为了尽可能探究由于PFAS种类所产生的复杂交互作用，本研究选择了NHANES数据库中检出率超过70%的6种PFAS，为一般人群暴露于PFAS混合物与HUA患病风险研究提供了新的证据.鉴于PFAS可能对健康结局有性别特异性影响[25]，因此对性别进行了亚组分析，揭示了不同性别人群的关联差异.除了传统的Logistic回归，还使用了WQS模型和BKMR模型以更准确地揭示混合物暴露的总体效应及权重大小，特别是BKMR能对非线性、非加性的暴露-反应关系及其潜在交互作用做出更符合实际情况的判断.由于之前的研究显示肾功能下降可能导致PFOA排泄减少，继而导致血清中PFOA蓄积增多[35].为了排除肾功能异常对结果的影响，本研究在敏感性分析中排除了患有慢性肾病的参与者.当排除这些参与者后，PFAS与HUA的正向关联依然存在，进一步排除了反向因果的可能性.同时，本研究也存在一些局限性.首先，本研究使用问卷调查和血清样本收集来获取数据，尽管这些方法是常用的研究工具，仍然存在回忆偏倚和测量偏倚的可能性.其次，本研究为横断面设计，难以确定血清PFAS暴露与HUA患病的因果关系.此外，样本采集过程中只测量了一次血清PFAS浓度，不能代表个体长期的PFAS暴露水平，可能影响结果的准确性.尽管本研究已经考虑了多个混杂因素，但未测量的其他混杂因素仍有可能导致结果偏差.为了更好地揭示PFAS混合暴露与HUA之间的真实关系，未来需要开展更多的前瞻性研究，并且在研究设计和统计分析中考虑更多的因素，以更全面、准确地评估PFAS对HUA的影响，以保障公众健康.
4 结语
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较高水平的PFNA、n-PFOA和Sm-PFOS暴露与成人HUA患病风险存在正向关联，Sm-PFOS与HUA患病风险存在非线性趋势，6种PFAS混合暴露与HUA总体呈正相关，混合物每增加一个四分位数，HUA患病风险增加39.6%，且这种关联仅存在于女性人群中.n-PFOA和Sm-PFOS在总体效应中起重要作用，多种PFAS之间存在潜在的相互作用.
基金
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  • 辽宁省教育厅科学研究项目(LJKZ0765)
  • 辽宁省科学技术计划项目(2021JH4/10200008)
  • 沈阳市科学研究项目(23-506-3-01-21)
文献
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  • 接收时间：2024-06-18
  • 首发时间：2026-03-18
  • 出版时间：2025-01-20
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  • 收稿日期：2024-06-18
基金
辽宁省教育厅科学研究项目(LJKZ0765)
辽宁省科学技术计划项目(2021JH4/10200008)
沈阳市科学研究项目(23-506-3-01-21)
作者信息
    1.中国医科大学公共卫生学院，卫生统计学教研室，辽宁 沈阳 110122
    2.中国医科大学，环境应激与慢病防控教育部重点实验室，辽宁 沈阳 110122

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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