PMID- 36155031
OWN - NLM
STAT- MEDLINE
DCOM- 20221122
LR  - 20221122
IS  - 1879-1026 (Electronic)
IS  - 0048-9697 (Linking)
VI  - 855
DP  - 2023 Jan 10
TI  - The association between exposure to multiple toxic metals and the risk of 
      endometriosis: Evidence from the results of blood and follicular fluid.
PG  - 158882
LID - S0048-9697(22)05981-2 [pii]
LID - 10.1016/j.scitotenv.2022.158882 [doi]
AB  - BACKGROUND: Endometriosis affects up to 10 % of women of reproductive age and can 
      lead to infertility. Research investigating whether combined exposure to arsenic 
      (As), cadmium (Cd), lead (Pb) and mercury (Hg) is related to an increased risk of 
      endometriosis, especially using different biological samples to validate the 
      association, is very limited. OBJECTIVE: This investigation aimed to evaluate the 
      associations between the concentrations of As, Cd, Pb and Hg in blood and 
      follicular fluid and the risk of endometriosis. METHODS: A total of 609 
      endometriosis cases and controls seen at the reproductive center of the First 
      Affiliated Hospital of Anhui Medical University in Hefei, China, between April 
      2020 and December 2021 were included in our study. Blood (217 cases and 234 
      controls) and follicular fluid (182 cases and 203 controls) samples were 
      collected from these subjects. The concentrations of Cd, Hg, As and Pb in the 
      blood and follicular fluid were determined by inductively coupled plasma-mass 
      spectrometry (ICP-MS). Unconditional logistic regression models were used to 
      assess the associations between Cd, Hg, As or Pb levels and the risk of 
      endometriosis; Bayesian kernel machine regression (BKMR) was used to evaluate the 
      combined effect of metals on the risk of endometriosis. RESULTS: We found 
      significant associations between blood concentrations of As (highest vs. lowest 
      tertile: aOR = 5.53, 95 % CI: 2.97, 10.30), Cd (second vs. lowest tertile: aOR = 
      1.96, 95 % CI: 1.07, 3.58; highest vs. lowest tertile: aOR = 3.21, 95 % CI: 1.79, 
      5.77), Pb (highest vs. lowest tertile: aOR = 2.73, 95 % CI: 1.56, 4.78) and Hg 
      (high-level group vs. low-level group: aOR = 13.10, 95 % CI: 6.74, 25.44; second 
      vs. lowest tertile: aOR = 15.27, 95 % CI: 4.96, 46.97; highest vs. lowest 
      tertile: aOR = 35.66, 95 % CI: 11.99, 106.08) and increased risk of endometriosis 
      adjusting for confounders. Follicular fluid As (highest vs. lowest tertile: aOR = 
      2.42, 95 % CI: 1.35, 4.33), Hg (highest vs. lowest tertile: aOR = 1.86, 95 % CI: 
      1.05, 3.29), Cd (second vs. lowest tertile: aOR = 2.45, 95 % CI: 1.29, 4.65; 
      highest vs. lowest tertile: aOR = 3.12, 95 % CI: 1.67, 5.83), and Pb (second vs. 
      lowest tertile: aOR = 1.97, 95 % CI: 1.11, 3.52) concentrations were positively 
      associated with endometriosis risk. The BKMR analyses showed linear associations 
      between the metal mixtures and the risk of endometriosis. Both in blood and in 
      follicular fluid, As exhibited the highest contribution. CONCLUSION: The data 
      from this study suggest that toxic metals, individually and as a mixture, play a 
      role in the risk of endometriosis, thus providing a novel idea for endometriosis 
      prevention.
CI  - Copyright (c) 2022. Published by Elsevier B.V.
FAU - Shen, Lingchao
AU  - Shen L
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Liang, Chunmei
AU  - Liang C
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; School of Public Health, Anhui 
      Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Li, Danyang
AU  - Li D
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Zhang, Zhikang
AU  - Zhang Z
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Wang, Xin
AU  - Wang X
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Jiang, Tingting
AU  - Jiang T
AD  - School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 
      230032, Anhui, China.
FAU - Su, Xun
AU  - Su X
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Yin, Tao
AU  - Yin T
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Zou, Weiwei
AU  - Zou W
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Wang, Xiaolei
AU  - Wang X
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Liu, Yajing
AU  - Liu Y
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Liang, Dan
AU  - Liang D
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China.
FAU - Wei, Zhaolian
AU  - Wei Z
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China. Electronic address: 
      weizhaolian@ahmu.edu.cn.
FAU - Cao, Yunxia
AU  - Cao Y
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China. Electronic address: 
      caoyunxia5972@ahmu.edu.cn.
FAU - Ji, Dongmei
AU  - Ji D
AD  - Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui 
      Medical University, No 218 Jixi Road, Hefei 230022, Anhui, China; NHC Key 
      Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical 
      University, No 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of 
      Population Health Across Life Cycle (Anhui Medical University), Ministry of 
      Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, 
      Anhui, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, 
      No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Engineering 
      Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, 
      Hefei 230032, Anhui, China; Anhui Provincial Institute of Translational Medicine, 
      No 81 Meishan Road, Hefei 230032, Anhui, China. Electronic address: 
      jidongmei@ahmu.edu.cn.
LA  - eng
PT  - Journal Article
DEP - 20220922
PL  - Netherlands
TA  - Sci Total Environ
JT  - The Science of the total environment
JID - 0330500
RN  - 00BH33GNGH (Cadmium)
RN  - 2P299V784P (Lead)
RN  - N712M78A8G (Arsenic)
RN  - FXS1BY2PGL (Mercury)
RN  - 0 (Metals, Heavy)
SB  - IM
MH  - Humans
MH  - Female
MH  - Follicular Fluid
MH  - Cadmium
MH  - *Endometriosis/chemically induced/epidemiology
MH  - Bayes Theorem
MH  - Lead
MH  - Heavy Metal Poisoning
MH  - *Arsenic
MH  - *Mercury
MH  - *Metals, Heavy
OTO - NOTNLM
OT  - BKMR
OT  - Endometriosis
OT  - Heavy metal
OT  - Trace element
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2022/09/27 06:00
MHDA- 2022/11/23 06:00
CRDT- 2022/09/26 15:15
PHST- 2022/05/14 00:00 [received]
PHST- 2022/09/15 00:00 [revised]
PHST- 2022/09/16 00:00 [accepted]
PHST- 2022/09/27 06:00 [pubmed]
PHST- 2022/11/23 06:00 [medline]
PHST- 2022/09/26 15:15 [entrez]
AID - S0048-9697(22)05981-2 [pii]
AID - 10.1016/j.scitotenv.2022.158882 [doi]
PST - ppublish
SO  - Sci Total Environ. 2023 Jan 10;855:158882. doi: 10.1016/j.scitotenv.2022.158882. 
      Epub 2022 Sep 22.