我国职业性铅接触对作业女工生殖健康影响的Meta分析

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

目的综合分析职业性铅接触对作业女工生殖功能的影响,取得敏感性生殖效应指标。方法检索和收集1979—2008年国内发表的关于职业性铅接触对作业女工生殖功能影响的文献,经严格的筛选后,应用Rev man软件对入选文献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分析合并相对危险度（RR）值作为各项目的总效应指标。结果共纳入16篇文献。与对照组比较,职业性铅接触与女性月经周期异常（RR=1.78,95%CI：1.5-2.09）、经量过少（RR=1.46,95%CI：1.20-1.78）、经前期综合征（RR=1.71,95%CI：1.19-2.45）、痛经（RR=1.42,95%CI：1.09-2.23）、妊娠高血压（RR=4.47,95%CI：1.50-13.32）、妊娠合并贫血（RR=3.23,95%CI：1.07-9.78）、早产（RR=3.39,95%CI：2.22-5.19）、自然流产（RR=3.51,95%CI：2.38-5.19）、死胎死产（RR=5.25,95%CI：3.38-8.14）及女工子代低体质量出生（RR=2.80,95%CI：1.19-6.61）和出生缺陷（RR=4.72,95％CI：3．11～7．16）的正相关有显著性（P〈0．05）。结论职业性铅接触可以引起女工月经周期异常和经量减少，增加痛经和经前期综合征的发生，同时还会影响妊娠及其子代发育，表现为增加妊娠合并高血压、妊娠合并贫血、早产、自然流产和死胎死产的发生，并导致其子代出生低体质量和出生缺陷。

Objective To analyze and evaluate the reproductive effects of occupational exposure to lead on female workers and to identify the relative sensitive indicators. Methods Documents which were published in Chinese during 1979-2008 and related to occupational exposure to lead and reproductive effects on female workers were collected. After strict selection, homogeneity test and integrated analysis for the abstracted data of the ehgible 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, 16 original research papers were included. Compared with the controls, the occupational exposure to lead was significantly associated with abnormality of female menstrual cycle （ RR = 1.78,95 % CI： 1.51 - 2.09） , the decrease of menstrual blood volume （ RR = 1.46, 95 % CI： 1.20 - 1.78 ） , the premenstrual syndrome （ RR = 1.71,95% CI： 1.19 - 2.45 ） , the dysmenorrhea （ RR = 1.42,95 % CI： 1. 09 - 2.23 ） , pregnancy-induced hypertension （ RR = 4.47,95 % CI： 1.50 - 13.32 ）, anemia in pregnancy （ RR = 3.23,95 % CI： 1.07 - 9. 78 ） , premature birth （ RR = 3.39,95 % CI： 2. 22 - 5.19 ） , spontaneous abortion （ RR = 3.51,95 % CI ： 2. 38 - 5.19 ） , stillbirths （ RR = 5.25,95% CI： 3.38 - 8, 14）, low birth weight （ RR = 2. 80,95% CI： 1.19 - 6. 61 ） and birth defect （ RR = 4. 72,95% CI： 3.11 -7. 16 ） of female offspring （P 〈 0. 05 ）. Conclusion Occupational exposure to lead can cause dysfunction of menstrual cycle, and decrease of the menstrual blood volume, as well as dysmenorrhea and premenstrual syndrome. Adverse reproductive outcomes arc also appeared, including pregnancy-induced hypertension and anemia, stillbirth, spontaneous abortion, premature birth and birth defects of their offspring.