Association between Liver Function, Hepatic Fibrosis Index and Urinary Thiodiglycolic Acid in School-Aged Children Living near a Petrochemical Complex

摘要

Background/Aim Whether children are susceptible to hepatotoxicity when exposed to vinyl chloride monomer (VCM) is unknown. Epidemiological studies revealed high prevalence of liver fibrosis and abnormal liver function in high VCM/PVC exposed workers, and previous study indicated that using urinary thiodiglycolic acid (TDGA) as a biomarker of VCM metabolites is reliable in children living near VCM/PVC factories. We aim to assess the association among urinary TDGA levels, liver function, and hepatic fibrosis in school-aged children. Methods 303 school-aged children (aged >6-<13 years) were recruited in central Taiwan. First morning urine and blood samples were collected in each participants, and urinary TDGA levels were analyzed by LC/MS-MS. Liver function was determined by subclinical abnormal serum aspirate aminotransferase (AST) and alanine aminotransferase (ALT). Hepatic fibrosis was assessed by AST to platelet ratio index (APRI), and fibrosis-4 score (FIB-4). Results Median levels of all subjects urinary TDGA (range), AST/ALT (range; subclinical^ abnormal rate) were 95.2 μg/g-creatinine, 26.0 IU/L (17.0-99.0; 26%)/15.0 IU/L (7.0-211.0; 6%), respectively. Third quartile of urinary TDGA levels in children (Q3: ≥ 95.2 - <160.0 μg/g-creatinine) and highest quartile (Q4: > 160.0 μg/g-creatinine) had significantly increased the odds ratio (OR) (Q3: OR= 3.54, 95% confidence interval (CI): 1.35-9.30; Q4: 0R= 5.26, 95% CI: 1.93-14.31) of subclinically abnormal AST compared with those in the lowest quartile after adjustment for elementary schools, age, sex, BMI, annual family income, physical activity, and passive smoking. A trend for a dose-response (p for trend= 0.001) was also observed. Conclusions Our findings supported the hypothesis that urinary TDGA levels in children living near VCM/PVC industries are associated with susceptibility to hepatotoxicity.