| 摘要: | 雙酚A (Bisphenol A, 簡稱BPA)及對羥基苯甲酸酯 (Parabens, 簡稱PBs)為孩童在日常生活中普遍暴露到的內分泌干擾物質，孩童使用之沐浴乳、乳液、塑膠玩具及容器中皆含有BPA/PBs。在動物試驗中，BPA/PBs會影響子代大腦及神經發育，BPA亦具耳毒性作用，會導致動物內耳外毛細胞受損，進而影響聽力。目前關於孩童內分泌干擾物質、環境噪音暴露/共暴露與聽力損失的研究相對較少，因此，本研究目標如下：(1) 調查孩童BPA/PBs暴露濃度及居家、校園環境噪音暴露程度。(2) 探索BPA/PBs、環境噪音暴露與兒童聽力損失之間的相關性。(3) 探討BPA.PBs/噪音暴露是否影響兒童內耳外毛細胞活性。
本研究為橫斷式研究，經過人體試驗委員會審查通過，透過海報招募356名6歲至12歲的學齡兒童，在合格的聽力檢查室進行，收案期間為2021年9月至2023年8月。受試孩童及其家長簽署同意書後，透過問卷訪視收集孩童基本資料、生活習慣、居家環境等資訊，並收集孩童尿液。依照純音聽力檢測結果判斷孩童是否具聽力損失。液相層析串聯質譜儀量測受試者尿液中BPA、甲基對羥基苯甲酸甲酯 (Methylparaben, 簡稱MetPB)、甲基對羥基苯甲酸乙酯 (Ethylparaben, 簡稱EthPB)、甲基對羥基苯甲酸丙酯(Propylparaben, 簡稱PropPB)、甲基對羥基苯甲酸丁酯濃度(Butylparaben, 簡稱ButPB)。使用羅吉斯回歸分析孩童BPA/PBs和環境噪音暴露與聽力損失的風險、多變項迴歸分析BPA/PBs/環境噪音與毛細胞在不同頻率之關係。
排除傳導性聽力損失、未進行純音聽力檢測、未填寫問卷之孩童後，統計分析共納入331位孩童，其中54 名兒童患有聽力損失，發生率為16.3%。尿液中BPA、MetPB、EthPB、PropPB、ButPB檢出率為44.1、100、86.4、54.9及16.9%，中位數濃度分別為0.01、5.39、0.95、0.21及0.01μg/g cre.，PBs暴露濃度與個人保健用品使用頻率具顯著差異性。孩童尿液BPA/PBs與左耳1K Hz、1.5K Hz及3K Hz頻率毛細胞活性及右耳2K及3K頻率毛細胞活性具顯著負相關性，環境噪音與兩耳毛細胞活性則無顯著相關性。此外，將孩童環境噪音數值依中位數分組，暴露於相對較高噪音之孩童BPA及PropPB暴露會增加微聽損風險至3.14 (OR=3.14, p=0.02)及2.64 (OR=2.64, p=0.02)。
本研究顯示兒童暴露BPA/PBs會降低兩耳外毛細胞活性，並增加其罹患聽力損失的風險，值得一提的是，聽損孩童皆無噪音型聽力損失。
Bisphenol A (BPA) and parabens (PBs) are endocrine-disrupting chemicals exposed frequently by children in their daily lives. BPA and PBs can be found in children's shampoos, lotions, plastic toys, and containers. Animal studies have shown that BPA and PBs could affect brain and nerve development in offspring. Co-exposure to noise and harmful substances would generate an interactive effect on hearing loss. Ototoxic effect of BPA was also proved and would causes damage to outer hair cells in the inner ear, leading to hearing impairment. Currently, research on endocrine disrupting chemicals and hearing loss is relatively limited, especially for young children. Therefore, the objectives of this study are: (1) To determine the exposure levels of BPA/PBs and environmental noise in children. (2) To explore the associations of exposure to BPA/PBs, and environmental noise with hearing loss in children. (3) To determine whether exposure to BPA/PBs and environmental noise influence the activity of outer hair cell in children.
This cross-sectional study, approved by the human subjects review committee, recruited 356 school-aged children aged 6 to 12 years through posters. The study was conducted in a certified audiometric examination room, and the enrollment period is from September 2021 to August 2023. After obtaining consent forms from the children and their parents, information on the children’s basic demographics, lifestyle habits, and home environment was collected via questionnaires, along with urine samples. Hearing loss in the children was determined based on pure-tone audiometry results. The concentrations of BPA, methylparaben (MetPB), ethylparaben (EthPB), propylparaben (PropPB), and butylparaben (ButPB) in the urine samples were measured by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Using logistic regression analysis, the risk of hearing loss in children was assessed in relation to BPA/PBs and environmental noise exposure. Additionally, multiple regression analysis was employed to examine the relationship among BPA/PBs exposure and environmental noise, and outer hair cell activity at different frequencies.
After excluding children with conductive hearing loss, those who did not undergo pure-tone audiometry, and those who did not complete the questionnaire, a total of 331 children were included in the statistical analysis. Among them, 54 children were found to have hearing loss, resulting in a prevalence rate of 16.3%. The detection rates of BPA, MetPB, EthPB, PropPB and ButPB in urine were 44.1, 100, 86.4, 54.9 and16.9%，, with median concentrations of 0.01, 5.39, 0.95, 0.21 and 0.01μg/g cre. respectively. The concentration of BPA/PBs exhibited significantly difference in the frequency of personal care product use. Exposure to BPA/PBs in children's urine is significantly and negatively correlated with hair cell activity at 1K Hz, 1.5K Hz and 3K Hz frequencies in the left ear and at 2K Hz and 3K Hz frequencies in the right ear. There is no significant correlation between environmental noise and hair cell activity in either ear. Additionally, when categorizing children based on median environmental noise levels, those exposed to higher noise levels have an increased risk of slight hearing loss due to BPA and PropPB exposure, with an odds ratio of 3.14 (OR=3.14, p=0.02) and 2.64 (OR=2.64, p=0.02).
This study demonstrates that exposure to BPA and PBs increases the risk of hearing loss in children and causes damage to hair cells. |
