Hygiene and environmental health advances最新文献

A longitudinal panel study exploring associations of urinary phthalate metabolites mixture with renal function in Chinese children 探索中国儿童尿液中邻苯二甲酸酯代谢物混合物与肾功能关系的纵向小组研究

Hygiene and environmental health advances

Pub Date : 2024-11-13 DOI: 10.1016/j.heha.2024.100116

Yudan Zheng , Lei Zhao , Yuming Zheng , Wenya Bai , Xuefeng Lai , Liangle Yang , Xiaomin Zhang , Miao Liu

Evidence from longitudinal studies examining the associations between urinary phthalate metabolites (mPAEs) and early kidney damage in children has been limited, and the underlying mechanisms still remain unclear. We carried out a longitudinal panel study involving up to 3 repeated visits, and each visit across 4 consecutive days, with 142 children aged 4-12 years from Guangzhou. mPAEs were determined in morning urine of each day and early kidney damage indicators were detected on the 4^th day. We employed linear mixed-effect models (LMEs), and Bayesian kernel machine regression (BKMR) models to evaluate associations of mPAEs as individual and mixture with early kidney damage, and the interaction of thyroid hormones with mPAEs in such associations. We found that each 1-fold increment of mono-n-butyl phthalate (MBP) at health examination day (Lag0) was significantly associated with 4.734% (95% confidence interval: 1.313%, 8.155%) reduction of Cystatin-C (CysC)-based estimated glomerular filtration rate (eGFR_CysC) (FDR< 0.05) and such relationships were in dose-response manner. Meanwhile, BKMR models showed the relations of mPAEs mixture with increased CysC and Beta-2-microglobulin (β2MG), and reduced eGFR_CysC were dominated by MBP. Moreover, thyroid hormones were linked to early kidney damage, and free thyroxin (FT4) modified the associations of MBP and β2MG, which was more obvious in children with low level of FT4. Interactions of age group and gender with MBP were significant, the effect of MBP on early kidney damage was stronger in primary school children and boys. In summary, our findings indicated that urinary mPAEs as individual and mixture were associated with early kidney damage indicators, which contributed to MBP were modified by FT4.

对儿童尿液中邻苯二甲酸酯类代谢物（mPAEs）与早期肾损伤之间关系的纵向研究证据有限，其潜在机制仍不清楚。我们对广州 142 名 4-12 岁的儿童进行了一项纵向小组研究，其中包括最多 3 次重复访问，每次访问连续 4 天。我们采用线性混合效应模型（LMEs）和贝叶斯核机器回归模型（BKMR）来评估mPAEs作为个体和混合物与早期肾损伤的关系，以及甲状腺激素与mPAEs在这种关系中的相互作用。我们发现，在健康检查日（Lag0），邻苯二甲酸单丁酯（MBP）每增加 1 倍，基于胱抑素-C（CysC）的估算肾小球滤过率（eGFRCysC）就会显著降低 4.734%（95% 置信区间：1.313%，8.155%）（FDR< 0.05），并且这种关系呈剂量反应型。同时，BKMR 模型显示，mPAEs 混合体与 CysC 和β-2-微球蛋白（β2MG）的增加有关，而 eGFRCysC 的降低则以 MBP 为主。此外，甲状腺激素与早期肾损伤有关，游离甲状腺素（FT4）改变了 MBP 和 β2MG 的相关性，这在 FT4 水平低的儿童中更为明显。年龄组和性别与 MBP 的交互作用显著，MBP 对早期肾损害的影响在小学生和男孩中更强。总之，我们的研究结果表明，尿液中的mPAEs作为个体和混合物与早期肾损伤指标相关，而FT4会改变MBP的贡献。

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引用次数: 0

Artificial intelligence in environmental monitoring: Advancements, challenges, and future directions 环境监测中的人工智能：进步、挑战和未来方向

Hygiene and environmental health advances

Pub Date : 2024-10-18 DOI: 10.1016/j.heha.2024.100114

David B. Olawade , Ojima Z. Wada , Abimbola O. Ige , Bamise I. Egbewole , Adedayo Olojo , Bankole I. Oladapo

The application of Artificial Intelligence (AI) in environmental monitoring offers accurate disaster forecasts, pollution source detection, and comprehensive air and water quality monitoring. This article provides an overview of the value of environmental monitoring, the challenges of conventional methods, and potential AI-based solutions. Several significant AI applications in environmental monitoring are highlighted, showcasing their contributions to effective environmental management. AI technologies enhance environmental monitoring by enabling better understanding, prediction, and mitigation of environmental risks. However, realizing the full potential of AI faces hurdles such as a shortage of specialized AI experts in the environmental sector and challenges related to data access, control, and privacy. These issues are more pronounced in regions with developing technological infrastructure. The paper advocates for proactive data governance measures by governments to protect sensitive information. Despite these challenges, the future of AI in environmental monitoring remains promising, with advancements in AI algorithms, data collection techniques, and computing power expected to further improve accuracy and efficiency in pollution monitoring and management.

人工智能（AI）在环境监测中的应用可提供准确的灾害预测、污染源检测以及全面的空气和水质监测。本文概述了环境监测的价值、传统方法面临的挑战以及基于人工智能的潜在解决方案。文章重点介绍了人工智能在环境监测领域的几项重要应用，展示了它们对有效环境管理的贡献。人工智能技术能够更好地理解、预测和缓解环境风险，从而加强环境监测。然而，充分发挥人工智能的潜力面临着各种障碍，例如环境领域缺乏专业的人工智能专家，以及与数据访问、控制和隐私相关的挑战。这些问题在技术基础设施不断发展的地区更为突出。本文倡导政府采取积极的数据治理措施，以保护敏感信息。尽管存在这些挑战，人工智能在环境监测领域的前景依然广阔，人工智能算法、数据收集技术和计算能力的进步有望进一步提高污染监测和管理的准确性和效率。

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引用次数: 0

A prospective study on the cardiorespiratory effects of air pollution among residents of the Tibetan Plateau 关于空气污染对青藏高原居民心肺功能影响的前瞻性研究

Hygiene and environmental health advances

Pub Date : 2024-10-18 DOI: 10.1016/j.heha.2024.100115

Xin Meng , Qiaoyi Hua , Ruiwei Xu , Yunxiu Shi , Yi Zhang , Meilin Yan , Wu Chen , Yifan Xu , Yunfei Fan , Yuan Yao , Teng Wang , Yidan Zhang , Haonan Li , Yaqi Yu , Xiaoyu Cui , Qianqian Chai , Ailin Li , Mengshuang Sheng , Rui Tang , Ruohong Qiao , Tong Zhu

The Tibetan Plateau is characterized by high ozone concentration which poses a significant public health concern. However, the causal evidence linking ozone pollution to adverse cardiopulmonary health impacts, as well as the understanding of its underlying biological mechanisms, remains limited. Additionally, exposure levels to particulate and other gaseous air pollutants along with their associated health effects in this region are largely unknown. To address these gaps, we conducted a prospective follow-up study in Tibet from May 2021 to November 2021. In consideration of the potential synergistic effects of chronic hypobaric hypoxia, two Tibetan cities with different altitudes, Lhasa (3650 m) and Nyingchi (3000 m), were chosen to implement atmospheric monitoring and health measurement. We employed cutting-edge, high-precision instruments at stationary monitoring sites to measure ambient air pollution and collected particle samples. Portable devices were used to monitor personal exposure levels of ozone and black carbon. A total of 212 healthy Tibetan college students participated in up to four clinical visits, yielding 774 visits in total, during which functional endpoints were measured and biological samples were collected. The primary aim of this study is to evaluate the cardiorespiratory effects of ambient ozone under hypoxic conditions, where its impact may be amplified due to the region's unique environmental characteristics. The secondary aim is to provide a comprehensive assessment of other air pollutants, including their exposure levels, sources, and health effects. By addressing these aims, the study offers valuable insights into air quality and its health implications in this unique high-altitude setting. This paper outlines the research motivation, measurement framework, and preliminary findings.

青藏高原的臭氧浓度较高，对公众健康造成了严重影响。然而，臭氧污染与不良心肺健康影响之间的因果关系证据以及对其潜在生物机制的了解仍然有限。此外，该地区的颗粒物和其他气态空气污染物的暴露水平及其对健康的相关影响在很大程度上也是未知的。为了填补这些空白，我们于 2021 年 5 月至 2021 年 11 月在西藏开展了一项前瞻性随访研究。考虑到慢性低压缺氧的潜在协同效应，我们选择了西藏两个不同海拔的城市--拉萨（3650 米）和宁蒗（3000 米）--进行大气监测和健康测量。我们在固定监测点使用尖端的高精度仪器测量环境空气污染并采集颗粒物样本。便携式设备用于监测臭氧和黑碳的个人暴露水平。共有 212 名健康的藏族大学生参加了最多四次临床访问，共计 774 次访问，期间测量了功能终点并采集了生物样本。本研究的主要目的是评估环境臭氧在缺氧条件下对心肺功能的影响。次要目的是全面评估其他空气污染物，包括其暴露水平、来源和对健康的影响。通过实现这些目标，该研究为了解这一独特的高海拔环境中的空气质量及其对健康的影响提供了宝贵的见解。本文概述了研究动机、测量框架和初步结果。

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引用次数: 0

Associations between exposure to multiple environmental chemicals and metabolic syndrome: A mixture analysis 接触多种环境化学物质与代谢综合征之间的关系：混合分析

Hygiene and environmental health advances

Pub Date : 2024-10-05 DOI: 10.1016/j.heha.2024.100112

Ruiqiang Li , Xiaoyi Lin , Tingyu Lu , Jiao Wang , Ying Wang , Lin Xu

Exposure to environmental chemicals is prevalent. While previous studies reported associations between multiple chemical exposures and metabolic syndrome (MetS), they did not comprehensively account for correlations among exposures. We used machine learning methods including Boruta algorithm and least absolute shrinkage and selection operator (LASSO) regression, combined with weighted quartiles sum (WQS) regression to investigate the associations of phenols, polycyclic aromatic hydrocarbons (PAHs), metals, and phthalates with MetS and its components. Data were drawn from the 2005–2012 National Health and Nutrition Examination Survey (NHANES). The mean (standard deviation (SD)) age of 2596 participants was 48.4 (17.9) years. After adjusting for age, sex, body mass index, race/ethnicity, marital status, education, poverty income ratio, physical activity, smoking, and alcohol, higher 2-Phenanthrene (2-PHE) and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) concentrations were associated with a higher odds of the MetS (odds ratio (OR) = 4.26, 95 % confidence interval (CI) 2.40–7.58 per ng/mL, and 3.24, 1.75–6.02 per ng/L, respectively). WQS index for environmental chemicals was positively associated with the MetS (OR = 1.31, 95 % CI 1.09–1.57). Moreover, we observed consistent and stronger positive associations with MetS (OR = 1.54, 95 % CI 1.04–2.30) in current smokers. Exposure to phenols, PAHs, metals, and phthalates was positively associated with an increase in metabolic syndrome and its components, which was more pronounced in current smokers.

暴露于环境化学物质是一种普遍现象。虽然之前的研究报告了多种化学物质暴露与代谢综合征（MetS）之间的关系，但这些研究并未全面考虑暴露之间的相关性。我们采用了机器学习方法，包括 Boruta 算法和最小绝对收缩与选择算子（LASSO）回归法，并结合加权四分位数总和（WQS）回归法，研究了酚类、多环芳烃（PAHs）、金属和邻苯二甲酸盐与 MetS 及其成分的关系。数据来自 2005-2012 年美国国家健康与营养调查（NHANES）。2596 名参与者的平均年龄为 48.4 (17.9)岁（标准差 (SD)）。在对年龄、性别、体重指数、种族/民族、婚姻状况、教育程度、贫困收入比、体育活动、吸烟和饮酒等因素进行调整后，2-菲（2-PHE）和邻苯二甲酸单（2-乙基-5-羟基己酯）（MEHHP）浓度越高，患 MetS 的几率越高（几率比（OR）= 4.26，95 % 置信区间 (CI) 分别为每纳克/毫升 2.40-7.58 和每纳克/毫升 3.24、1.75-6.02）。环境化学物质的 WQS 指数与 MetS 呈正相关（OR = 1.31，95 % CI 1.09-1.57）。此外，我们还观察到当前吸烟者与 MetS 存在一致且更强的正相关性（OR = 1.54，95 % CI 1.04-2.30）。接触酚类、多环芳烃、金属和邻苯二甲酸盐与代谢综合征及其组成部分的增加呈正相关，这在当前吸烟者中更为明显。

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引用次数: 0

Assessing the multi-dimensional effects of air pollution on maternal complications and birth outcomes: A structural equation modeling approach 评估空气污染对产妇并发症和分娩结局的多维影响：结构方程模型法

Hygiene and environmental health advances

Pub Date : 2024-10-05 DOI: 10.1016/j.heha.2024.100113

Boubakari Ibrahimou , Ning Sun , Sophie Dabo-Niang

Objective

This cross-sectional study aims to investigate the direct and indirect relationships between exposure to a metal mixture in air and adverse pregnancy outcomes across gestational stages.

Methods

With 46,829 births in 2021 in two Florida counties and Air Quality System data, structural equation modeling was used to construct latent metal mixtures in PM_2.5 and unravel their effects on pregnancy complications (preeclampsia and gestational diabetes) and birth outcomes (low birth weight and preterm birth risks).

Results

A latent variable featuring seven metals (Aluminum, Calcium, Iron, Magnesium, Manganese, Silicon, Vanadium) was identified through the measurement model. The latent metal mixture exposure had direct effects on gestational diabetes and preterm birth (1st trimester, 2nd trimester), low birth weight (1st trimester), and preeclampsia (2nd trimester). When considering total effects, the effects on low birth weight in the 1st trimester and on preeclampsia in 2nd trimester were masked, and the latent metal mixture increased the low-birth-weight risk in 2nd trimester by 2 % (OR = 1.02, 95 % CI = [1.00, 1.03]).

Conclusion

This study reveals time-dependent associations between a metal mixture in PM_2.5 exposure and adverse pregnancy outcomes, highlights the need to address dust in PM_2.5, and provides additional evidence for understanding the pathway of the pollution effects on fetal health.

本横断面研究旨在调查暴露于空气中的金属混合物与各妊娠阶段不良妊娠结局之间的直接和间接关系。方法利用 2021 年佛罗里达州两个县的 46829 例新生儿和空气质量系统数据，采用结构方程模型构建 PM2.5 中的潜在金属混合物，并揭示其对妊娠并发症（子痫前期和妊娠糖尿病）和出生结局（低出生体重和早产风险）的影响。结果通过测量模型确定了一个由七种金属（铝、钙、铁、镁、锰、硅、钒）组成的潜在变量。潜在的金属混合物暴露对妊娠糖尿病和早产（妊娠前三个月、妊娠后三个月）、低出生体重（妊娠前三个月）和子痫前期（妊娠后三个月）有直接影响。在考虑总效应时，第 1 个孕期对低出生体重和第 2 个孕期对子痫前期的效应被掩盖，而潜在金属混合物使第 2 个孕期的低出生体重风险增加了 2%（OR = 1.02，95 % CI = [1.00，1.03]）。结论本研究揭示了 PM2.5 暴露中的金属混合物与不良妊娠结局之间的时间依赖关系，强调了解决 PM2.5 中粉尘问题的必要性，并为了解污染对胎儿健康的影响途径提供了更多证据。

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引用次数: 0

Metabolism disruption induced by high ambient temperature 高环境温度引起的新陈代谢紊乱

Hygiene and environmental health advances

Pub Date : 2024-09-28 DOI: 10.1016/j.heha.2024.100111

Ke Zhang , Gongbo Chen , Wan Liu , Jie He , Mengnan Pan , Zhongyang Chen , Jiahui Tong , Feifei Liu , Hao Xiang

Background

Previous studies have assessed the cardiovascular risk attributable to high ambient temperature. However, the mechanisms underly acute cardiovascular responses associated with high ambient temperature remain incompletely understood.

Objective

To identify acute cardiovascular responses associated with high temperature, and to understand the underlying mechanisms using metabolomics.

Methods

We conducted a prospective panel study on young adults, organizing participants to undergo blood collection and temperature monitoring tautologically. Levels of 10 cardiovascular biomarkers and 4473 serum metabolites were measured. Levels of ambient temperature exposure were recorded by wearing personal monitors. We employed linear mixed-effect models to identify acute cardiovascular responses associated with ambient temperature, including differential biomarkers and metabolites. KEGG pathway analysis was performed on the differential metabolites to identify temperature-associated metabolic processes.

Results

Exposure to elevated ambient temperature was associated with acute cardiovascular responses, including alterations in high-density lipoprotein, interleukin-6, C-reactive protein, diastolic pressure, and heart rate. These observed acute cardiovascular responses are probably attributed to metabolism disturbances, as 129 differential serum metabolites, accompanied by disruptions in 18 pathways, were identified. These differential metabolites and pathways primarily involve glycerophospholipid metabolism, which activates inflammation cytokines and subsequently induces adverse cardiovascular effects.

Conclusions

Our findings suggest that elevated ambient temperature could potentially lead to cardiovascular responses among young adults in China. We propose that high ambient temperature exposure may contribute to acute cardiovascular effects by regulating the glycerophospholipid metabolism pathway.

背景以往的研究评估了环境温度过高对心血管造成的风险。方法我们对青壮年进行了一项前瞻性小组研究，组织参与者进行血液采集和温度监测。测量了 10 种心血管生物标志物和 4473 种血清代谢物的水平。通过佩戴个人监测器记录环境温度暴露水平。我们采用线性混合效应模型来确定与环境温度相关的急性心血管反应，包括不同的生物标志物和代谢物。结果暴露于升高的环境温度与急性心血管反应有关，包括高密度脂蛋白、白细胞介素-6、C 反应蛋白、舒张压和心率的改变。这些观察到的急性心血管反应可能归因于新陈代谢紊乱，因为发现了 129 种不同的血清代谢物，以及 18 种途径的紊乱。这些不同的代谢物和途径主要涉及甘油磷脂代谢，而甘油磷脂代谢会激活炎症细胞因子，进而诱发不良的心血管反应。结论：我们的研究结果表明，环境温度升高有可能导致中国青壮年的心血管反应。我们认为，暴露于高温环境中可能会通过调节甘油磷脂代谢途径导致急性心血管效应。

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引用次数: 0

Positive and negative impacts of COVID-19 on the environment: A critical review with sustainability approaches COVID-19 对环境的积极和消极影响：采用可持续发展方法进行严格审查

Hygiene and environmental health advances

Pub Date : 2024-09-11 DOI: 10.1016/j.heha.2024.100107

Avishek Talukdar , Sayan Bhattacharya , Saptarshi Pal , Pracheta Pal , Soumyajit Chowdhury

Coronavirus, which practically brought the world to a standstill, is a member of the Coronaviridae family of the order Nidovirales, and was termed as the "severe acute respiratory syndrome coronavirus 2″ (SARS-CoV-2) by the International Committee on Taxonomy of Viruses. The COVID-19 pandemic was probably the most critical healthcare and scientific challenge of this century. Apart from health concerns, the pandemic has also resulted in certain long-lasting social, economic, and environmental issues. The article, for the first time, executes a multidisciplinary assessment of the effects of COVID-19 on the environment, highlighting future research approaches and the possible ways to achieve sustainability in the post-COVID era. Both positive and negative impacts of COVID-19 pandemic are discussed in this context. While there are certain positive impacts of COVID-19 on the environment (including reduced air, water and noise pollution with cleaner landscapes), the negative impacts (increased production and consumption of plastics, increase in waste generation because of online consumption, decrease in waste recycling, energy consumption in vaccine manufacturing) pose considerable threats to the environment. We highlight urgent research priorities, and also discuss potential means of tackling any such pandemic in the future without hampering sustainable lifestyle or jeopardizing the environment and ecosystem dynamics. The findings will help to identify the possible areas of concern of pandemic management and can help in formulation of policies which will be helpful to reduce the impact of future pandemics on the environment.

冠状病毒是尼多病毒目冠状病毒科的一种病毒，被国际病毒分类委员会称为 "严重急性呼吸系统综合征冠状病毒 2"（SARS-CoV-2）。COVID-19 大流行可能是本世纪最严峻的医疗保健和科学挑战。除健康问题外，大流行还造成了一些长期的社会、经济和环境问题。本文首次对 COVID-19 对环境的影响进行了多学科评估，强调了未来的研究方法以及在后 COVID 时代实现可持续发展的可能途径。在此背景下讨论了 COVID-19 大流行的积极和消极影响。尽管 COVID-19 对环境有一定的积极影响（包括减少空气、水和噪音污染，使景观更清洁），但其负面影响（塑料生产和消费增加、在线消费导致废物产生量增加、废物回收利用减少、疫苗生产过程中的能源消耗）也对环境构成了相当大的威胁。我们强调了当务之急的研究重点，并讨论了在不妨碍可持续生活方式或危害环境和生态系统动态的情况下，应对未来任何此类流行病的潜在方法。研究结果将有助于确定大流行病管理的可能关注领域，并有助于制定有助于减少未来大流行病对环境影响的政策。

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引用次数: 0

Occupational chemical safety and management: A case study to identify best practices for sustainable advancement of Bangladesh 职业化学品安全与管理：确定孟加拉国可持续发展最佳做法的案例研究

Hygiene and environmental health advances

Pub Date : 2024-09-10 DOI: 10.1016/j.heha.2024.100110

Amit Hasan Anik , Mohammad Toha , Shafi M Tareq

Bangladesh has experienced numerous tragedies and casualties in the chemical industry, resulting in unparalleled losses in terms of human, social, and economic adversity, primarily attributed to the absence of effective occupational health and safety management. Despite having various sectoral legislative frameworks, there is a notable absence of a comprehensive legal framework specifically addressing chemical safety management issues. Moreover, the existing regulations have not successfully established a nexus between chemical safety, employee well-being, potential opportunities, and task performance. This highlights the insufficient attention given to occupational health and chemical safety issues at the policy level, with limited research dedicated to these critical concerns. Consequently, this critical review aims to identify optimal strategies for the long-term sustainable development of Bangladesh in the realm of occupational chemical safety and management. The review critically evaluates the current state of Bangladesh's national chemical management, offering a policy trajectory for consideration. It meticulously analyzes the disjunctions and incongruities between prescribed guidelines and actual practices in chemical management within the Bangladeshi context. Furthermore, it establishes a comprehensive framework for a nationwide chemical management system, aligning with global best practices and guidelines. The study also delineates existing gaps and challenges while outlining future priorities that warrant immediate government attention and sustained commitment to enhance chemical safety management. Therefore, this study serves as a foundational reference for policymakers not only in Bangladesh but also for those in other developing economies grappling with escalating chemical demands, providing guidance for constructing an appropriate infrastructure and legal framework for enduring chemical management.

孟加拉国的化学工业经历了无数的悲剧和伤亡，造成了巨大的人员、社会和经济损失，这主要归咎于缺乏有效的职业健康和安全管理。尽管有各种部门立法框架，但明显缺乏专门针对化学品安全管理问题的全面法律框架。此外，现有法规也没有成功地在化学品安全、员工福利、潜在机会和任务绩效之间建立联系。这凸显了政策层面对职业健康和化学品安全问题的关注不够，而专门针对这些关键问题的研究也很有限。因此，本评论旨在确定孟加拉国在职业化学品安全和管理领域长期可持续发展的最佳战略。评论对孟加拉国国家化学品管理的现状进行了批判性评估，提出了供考虑的政策轨迹。它细致地分析了孟加拉国化学品管理的规定准则与实际做法之间的脱节和不协调。此外，它还根据全球最佳做法和准则，为全国化学品管理系统建立了一个综合框架。本研究还划定了现有的差距和挑战，同时概述了政府应立即关注并持续致力于加强化学品安全管理的未来优先事项。因此，本研究不仅可作为孟加拉国决策者的基础参考资料，也可作为其他发展中经济体决策者应对不断升级的化学品需求的基础参考资料，为构建适当的基础设施和法律框架以实现持久的化学品管理提供指导。

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引用次数: 0

Black box analysis with linear regression on global warming 关于全球变暖的线性回归黑箱分析

Hygiene and environmental health advances

Pub Date : 2024-09-03 DOI: 10.1016/j.heha.2024.100109

Yoshiyasu Takefuji

This paper demonstrates that the conclusions drawn from datasets on global temperature anomaly and atmospheric CO2 from NOAA can vary depending on the range of investigated periods. By examining the data from both macroscopic and microscopic perspectives, the study reveals that different levels of analysis can produce different outcomes from the same datasets based on statistics.

本文表明，从 NOAA 提供的全球温度异常和大气二氧化碳数据集得出的结论会因调查时段范围的不同而不同。通过从宏观和微观角度对数据进行研究，本研究揭示了不同层次的分析可以从基于统计的相同数据集中得出不同的结果。

引用次数: 0

Expansion of a versatile pathogen: Clostridioides difficile 一种多用途病原体的扩展：艰难梭菌

Hygiene and environmental health advances

Pub Date : 2024-09-03 DOI: 10.1016/j.heha.2024.100108

Tereena Lucas , Brent Brown

Clostridioides difficile is a gram positive and spore forming bacterium responsible for significant global morbidity and mortality. There is increasing incidence of C. difficile disease that constitutes a deviation from the traditionally understood toxin-mediated colonic disease. Comprehensive literature review has determined a conservative increase of over 600 cases of C. difficile extra–intestinal and small–intestinal disease detailed in >200 papers over the past 20 years. Chronic colonization with increased intestinal permeability that permits the translocation of toxins and metabolites may partially explain this expanded disease manifestation. Currently there is little evidence in support of a role for toxins however, and greater evidence to support the role of metabolites in extra-intestinal disease pathogenesis. Specifically, increased levels of p-cresol, p-cresyl sulfate, indoxyl sulfate and ammonia are associated with C. difficilecolonization. One important health consideration involves ongoing biotransformation of such metabolites, together with the overall metabolic load from all endogenous and exogenous sources, that can result in glutathione depletion. Chronic glutathione depletion in turn increases oxidative stress and is correlated with neurological compromise across all age groups, and a host of other conditions. Key factors supporting chronic colonization with C. difficile in susceptible hosts include widespread and indiscriminate use of antimicrobials, pharmaceuticals, pesticides, intensive agricultural practices, diet, food additives, and gastrointestinal disturbances. Appreciation of the role of the exposome in C. difficile disease expansion will further emphasize the importance of decreasing environmental contamination, antimicrobial resistance, inter-species transmission, and individual toxic metabolite burdens.

艰难梭状芽孢杆菌是一种革兰氏阳性芽孢杆菌，在全球范围内造成了严重的发病率和死亡率。难辨梭状芽孢杆菌疾病的发病率越来越高，这与传统理解的毒素介导的结肠疾病有所不同。综合文献回顾显示，在过去 20 年中，艰难梭菌肠道外和小肠疾病保守估计增加了 600 多例，详情见 200 篇论文。慢性定植导致肠道通透性增加，使毒素和代谢物得以转移，这可能是疾病表现扩大的部分原因。不过，目前支持毒素作用的证据很少，而支持代谢物在肠道外疾病发病机制中作用的证据则更多。具体来说，对甲酚、对甲酚硫酸盐、吲哚硫酸盐和氨水平的升高与艰难梭菌感染有关。一个重要的健康考虑因素是这些代谢物的持续生物转化，以及所有内源性和外源性来源的总体代谢负荷，这些都可能导致谷胱甘肽耗竭。谷胱甘肽的慢性消耗反过来又会增加氧化应激，并与所有年龄组的神经系统损伤和其他一系列疾病相关。支持艰难梭菌在易感宿主中长期定植的关键因素包括抗菌素、药品、杀虫剂的广泛和滥用、集约化农业实践、饮食、食品添加剂和胃肠功能紊乱。认识到暴露体在艰难梭菌疾病扩展中的作用，将进一步强调减少环境污染、抗菌药耐药性、物种间传播和个体毒性代谢物负担的重要性。

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