农药与阿尔茨海默症关联性研究的Meta分析

Meta-analysis of the effect of pesticide exposure on Alzheimer's disease

目的利用国内外发表的关于农药暴露与阿尔茨海默症(AD)有关的文献,探讨农药暴露是否为AD的危险因素。方法采用Cochrane系统评价方法,根据PICOs原则提出关键词,在CBM、万方、维普、CNKI、PubMed、EMBASE、CENTRAL数据库中检索国内外公开发表的相关文献。利用Endnote X7文献管理软件管理文献,运用Cochrane协作网推荐的NOS偏倚风险评价工具进行文献质量评价,设计表格提取相关信息。分析主要结局指标为阿尔茨海默病例及其农药暴露或血清中农药的含量,采用RevMan 5.3软件进行Meta分析。病例对照研究的效应值为暴露的比值比(OR)以及95%可信区间(95%CI),队列研究的效应值为相对危险度(RR值)及95%CI,根据异质性检验结果选择相应的合并模型。结果最终纳入4篇文章,病例对照研究和队列研究各2篇。纳入的2篇病例对照研究的异质性为无,I2为27%(P=0.24),合并结果为OR=2.41,95%CI(1.47~3.94,P=0.008)。纳入的2篇队列研究的异质性为中度,I2为58%(P=0.12),合并结果为RR为1.75,95%CI(1.22~2.50,P=0.002)。结论目前证据支持农药暴露是阿尔茨海默症的危险因素。

Objective To explore whether pesticide exposure is a risk factor for Alzheimer’s disease by search and analysis the published papers about it.Methods Using the Cochrane systematic review method,key words were proposed according to the principle of PICOs,related literature published in CBM,Wanfang,VIP,CNKI,PubMed,EMBASE,Central were searched and retrieved.Using endnote X7software to manage literature,NOS bias risk assessment tools for quality assessment of the literature were recommended by the Cochrane Collaboration,self-designed table was used to extract relevant information.The main outcome about Alzheimer's cases and pesticide exposure or serum pesticide levels were studied,Meta-analysis was performed using the software RevMan5.3.The effect of the case-control study was the ratio of exposure(OR)and95%confidence interval(95%CI);while the effect values of the cohort study were relative risk(RR)and95%confidence interval(95%CI).The combined model was selected based on the heterogeneity test.Results A total of4papers were enrolled in the study,including2papers of cohort studies and2papers of case-control studies.Heterogeneity of2case-control studies was0,I2was58%(P=0.24),the combined results were OR=2.41,95%CI(1.47-3.94)(P=0.008).Heterogeneity of2cohort studies was medium,I2was27%(P=0.12),the combined results were RR=1.75,95%CI(1.22-2.50)(P=0.002).Conclusions Current evidence supports that pesticide exposure is a risk factor for Alzheimer's disease.