基于病例对照研究的电焊烟尘与肺癌关系meta分析

A meta-analysis on association between welding fumes and lung cancer based on case-control studies

[背景]电焊烟尘是引起我国法定职业病的危险因素之一。2017年国际癌症研究机构将电焊烟尘列为人类致癌物质(第1类),电焊烟尘对作业工人健康危害不容忽视。[目的]探讨电焊烟尘与肺癌发生的关联性及关联强度。[方法]通过中国知网、万方数据库检索中文文献,通过PubMed、Embase和Web of Science数据库检索英文文献,主题词包括"电焊烟尘""电焊工人""肺癌""病例对照""welding fumes""welding""welder""lung cancer""neoplasms""tumor""case-control study""occupational cancer"。按照入选和排除标准严格筛选文献。根据异质性检验结果,选取固定效应模型或随机效应模型进行效应值合并。利用Egger法检验是否存在发表偏倚。[结果]共纳入14篇关于职业性电焊烟尘暴露与肺癌关系的病例对照研究文献。根据异质性检验结果,I2=76.4%,采用随机效应模型合并效应值,合并OR值为1.46(95%CI:1.21~1.77),表明暴露于电焊烟尘可增加肺癌发生风险。Egger法检验结果显示t=0.62,P> 0.05,可认为漏斗图基本对称,不存在发表偏倚。亚组分析结果I2> 50%,并不能证明各亚组之间的研究同质。敏感性分析结果未发生较大改变,说明此次meta分析结果较稳健。[结论]电焊烟尘暴露可能增加肺癌发生风险。

[Background] Welding fumes are a risk factor of prescript occupational diseases in China. In 2017, the International Cancer Research Institute listed welding fumes as a human carcinogen(Group 1);therefore, the hazards of welding fumes to workers’ health cannot be ignored. [Objective] This study aims to evaluate the association between welding fumes and lung cancer. [Methods] We searched Chinese literatures from CNKI and Wanfang databases and English literatures from PubMed, Embase, and Web of Science, using keywords in either Chinese or English such as "welding fumes", "welding", "welder", "lung cancer", "neoplasms", "tumor", "case-control study", and "occupational cancer". The obtained literatures were subject to strict inclusion and exclusion criteria. Either fixed-effect model or random-effect model was selected according to the results of heterogeneity test to combine the included effect values. Egger test was used to test publication bias. [Results] A total of 14 case-control studies on occupational exposure to welding fumes and lung cancer were included. Because I2=76.4%, the random-effect model was used to combine effect values, and the results showed that the combined OR was 1.46(95% CI: 1.21-1.77), indicating that the exposure to welding fumes increased the risk of lung cancer. The results of Egger test showed that t=0.62 and P > 0.05, indicating that the funnel chart was basically symmetrical, suggesting no publication bias. The results of subgroup analysis was I2 > 50%, and did not prove homogeneity across the included studies. The results of sensitivity analysis did not change significantly, indicating robust meta-analysis results. [Conclusion] Exposure to welding fumes may increase the risk of lung cancer.