Kidney. Int：宁光等发现塑料用品易引发白蛋白尿

近期，上海交通大学医学院附属瑞金医院内分泌代谢科宁光教授等开展的一项研究表明，长期接触双酚A 可致低水平白蛋白尿（尿白蛋白肌酐比值为9.71~29.9 mg/g）风险增加。相关论文发表在Kidney International杂志上。

双酚A 是一种广泛用于塑料制品行业的工业化学物质，常被用来生产聚碳酸酯塑料和环氧树脂，水瓶和很多食品容器中均含有双酚A。

该研究纳入上海3455 例年龄≥ 40 岁的受试者，尿中双酚A 平均含量为0.81 ng/ml， 约11% 的受试者报告有心血管疾病，4.1% 服用血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体拮抗剂（ARB）。根据口服葡萄糖耐量试验（OGTT），31.5% 合并糖尿病，21.6% 存在糖调节受损（IGR）。此外，333 例受试者存在微量白蛋白尿，67 例存在大量白蛋白尿。与尿蛋白排泄量正常者相比，存在低水平白蛋白尿的受试者尿中双酚A 含量明显增加。

3055 例无蛋白尿的受试者纳入最终分析。结果显示，与尿双酚A 含量最低四分位（<0.48ng/ml） 者相比， 最高四分位（≥ 1.45 ng/ml）者出现低水平白蛋白尿的风险明显增加（30.9%vs. 21.1%, P<0.0001）。多元逐步线性回归分析表明，双酚A 是尿白蛋白肌酐比值的独立预测因素之一：尿双酚A 含量≥ 0.82 ng/ml 者低水平白蛋白尿风险显著增加（OR 为1.20~1.23,P ≤ 0.005， 下图）。此外， 上述关系不受年龄、性别、吸烟、饮酒、体质指数、高血压、糖尿病和估算肾小球滤过率（eGFR）等因素的影响。然而，研究者将400 例存在蛋白尿的受试者进行分析后发现，尿双酚A 含量与微量、大量白蛋白尿复合事件无关。

研究者观点

双酚A 是一种微弱的环境雌激素，还能促进细胞（内皮细胞等）增殖。因此，双酚A 可能通过其对内皮功能的非基因促进作用，而影响尿白蛋白排泄。此外，双酚A 还能诱导氧化应激，干扰胰腺的内分泌功能，导致胰岛素抵抗，从而促进尿白蛋白排泄。

doi:10.1038/ki.2012.6
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Exposure to bisphenol A is associated with low-grade albuminuria in Chinese adults

Mian Li, Yufang Bi, Lu Qi, Tiange Wang, Min Xu, Yun Huang, Yu Xu, Yuhong Chen, Jieli Lu, Weiqing Wang and Guang Ning

AbstractBisphenol A is an industrial chemical widely used in plastic products with a consequent exposure to humans. To assess whether exposure to bisphenol A is associated with renal disease, we searched for low-grade albuminuria in 3055 Chinese adults in the Shanghai metropolitan area aged 40 years or older. Using a value for urinary albumin-to-creatinine ratios <30?mg/g, we examined its association with urinary bisphenol A. Participants in the highest compared to the lowest quartile of urinary bisphenol A concentrations were significantly more likely to have low-grade albuminuria. Multivariate stepwise linear regression analysis, adjusted for potential confounding factors, showed that urinary bisphenol A was an independent determinant of the urinary albumin-to-creatinine ratio significantly associated with an increased risk of low-grade albuminuria with an adjusted odds ratio of 1.23 for the highest compared to the lowest concentration quartiles. This association was not modified by conventional risk factors such as age, gender, smoking, alcohol consumption, body mass index, hypertension, diabetes, and the estimated glomerular filtration rate. There was no significant relationship between bisphenol A and combined micro- and macroalbuminuria. Thus, our study lends support to a potential relation between bisphenol A exposure and an increased risk of low-grade albuminuria.