中国职业性汞暴露对女工生殖功能影响的Meta分析

Reproductive effects of occupational exposure to mercury on female workers in China:a Meta-analysis

目的综合分析职业性汞暴露对女工生殖功能的影响,筛选汞暴露的敏感生殖效应指标。方法运用计算机和手工检索收集1989-2006年间国内发表的关于职业性汞暴露与女工生殖功能关系的文献,经严格筛选后,应用Rev Man软件对入选文献的研究结果进行一致性检验并采用相应的数学模型进行数据合并,采用Meta分析合并RR值作为各项目的总效应指标。结果纳入14篇文献(暴露组2148人,对照组2044人),与对照组比较,职业性汞暴露与女性月经经期(RR=1.82,95%CI:1.45～2.30)、月经周期(RR=2.03,95%CI:1.74～2.37)、月经量的改变(RR=2.06,95%CI:1.47～2.09)、痛经(RR=2.14,95%CI:1.54～2.99)、妊娠高血压(RR=2.17,95%CI:1.32～3.57)、死产死胎(RR=2.54,95%CI:1.41～4.56)及女工子代低体重出生(RR=3.39,95%CI:1.38～8.33)和出生缺陷(RR=2.67,95%CI:1.55～4.60)等的正相关有显著的统计学意义(P<0.05)。结论职业性汞暴露可以引起女工月经经期、周期和经量改变,增加痛经,同时还会影响妊娠及其子代发育,表现为增加妊娠高血压和死产死胎的发生,并导致其子代低体重和发生出生缺陷。

Objective To analyze and evaluate the reproductive effects of occupational exposure to mercury among female workers and to identify relative sensitive indicators. Methods Documents on the relations of occupational exposure to mercury and reproductive effects on female workers were collected through computer and manually that were published in Chinese language during 1989-2006. After strict selection, homogeneity test and integrated analysis for the abstracted data of the eligible studies were conducted using Review Manager Statistic Software. Combined RR value was used as the index for total effect on each project for Meta-analysis. Results In total, 14 original research papers were included （totally 2148 subjects and 2044 controls）. When comparing to the controls, the occupational exposure to mercury was significantly associated with longer menstrual period （ RR 1.82,95 % CI ： 1.45- 2.30 ）, menstrual cycle delay （ RR = 2.03,95 % CI ： 1.74- 2.37） and the changes of menstrual blood volume （ RR = 2.06, 95 % CI ： 1.47- 2.09 ）, dysmenorrhea （ RR = 2.14,95 % CI ： 1.54- 2.99 ）, pregnancy-induced hypertension （RR=2.17,95% CI：1.32-3.57）,stillbirths （RR= 2.54,95% CI：1.41-4.56） and low birth weight （RR-3.39,95%CI：l.38-8.33）/birthdefect （RR 2.67,95%CI：1.55-4.60） of their offspring （P〈 0.05）. Conclusion Occupational exposure to mercury could cause dysfunction of the menstrual period, menstrual cycle, menstrual blood volume, as well as dysmenorrhea for female workers being exposed to mercury and inducing adverse reproductive outcomes, including pregnancy-induced hypertension, stillbirth, low birth weight and birth defects of their offspring.