孕期环境空气污染物暴露和先天性心脏病关系的Meta分析

Prenatal exposure to ambient air pollution and congenital heart disease： a Meta-analysis

目的 探讨孕期空气污染物暴露与先天性心脏病（先心病）发生的关系，为先心病的一级预防提供循证医学证据。方法 收集国内外发表的有关孕期空气污染物暴露与先心病有关的流行病学研究文章，对连续性增长和高浓度对比低浓度的污染物与先心病亚型的关系效应值分别进行合并。使用Stata 12.0软件对文献进行Meta分析。结果 共纳入20篇英文文献。Meta分析结果显示，CO暴露增加法洛四联症的发生风险（高浓度对比低浓度OR=1.22，95%CI：1.03-1.44））；NO2暴露增加主动脉缩窄的发生风险（浓度每升高10 mm3/m3 OR=1.01，95%CI：1.01-1.20）；O3暴露增加房间隔缺损的发生风险（浓度每升高10 mm3/m3 OR=1.14，95%CI：1.03-1.26）；PM10暴露增加房间隔缺损的发生风险（浓度每升高10 μg/m3 OR=1.10，95%CI：1.03-1.19）。此外，还发现CO暴露和房间隔缺损的发生，PM10暴露和室间隔缺损的发生存在负相关。结论 孕期暴露于空气污染物CO、O3、NO2、PM10可能会增加先心病的发生风险。

Objective To explore the association between exposure to ambient air pollution during pregnancy and congenital heart disease so as to provide evidence for primary prevention of congenital heart disease. Methods Epidemiologic studies on ambient air pollution and congenital heart diseases were reviewed. Summary risk estimates were calculated at high versus low exposure levels and risk per-unit-increase in continuous pollutant concentration. Meta-analysis was conducted with Stata 12.0 software. Results A total of 20 articles in English were qualified for inclusion. Results from Meta-analysis showed that CO exposures were related to the increase on the risk of tetralogy of fallot （high versus low exposure level OR=1.22, 95%CI：1.03-1.44）, while the exposures to NO2 were related to the increase on risk of coarctation of aorta （per 10 mm3/m3 OR=1.01, 95%CI：1.01-1.20）. Exposures to O3 were related to the increase on risk of atrial septal defect （per 10 mm3/m3 OR=1.14, 95%CI：1.03-1.26）, and PM10 exposures were related to the increase on risk of atrial septal defect （per 10 μg/m3 OR=1.10, 95%CI：1.03-1.19）. In addition, there were inverse associations between CO and atrial septal defect and between PM10 and ventricular septal defect. Conclusion Exposures to CO, NO2, O3, PM10 during pregnancy seemed to be associated with congenital heart diseases.