砷暴露与肺通气功能障碍关系的Meta分析

Meta-analysis of the relationship between arsenic exposure and pulmonary ventilation dysfunction

目的系统评价砷暴露与其所致肺通气功能异常的关系,以期为阐明砷暴露所致肺功能损伤机制、识别砷暴露高危人群提供依据。方法通过PubMed、Embase、Web of Science、中国生物医学文献数据库(CBM)、中国知网数据库(CNKI)、万方全文数据库(WanFang Data)和维普中文期刊服务平台(VIP)进行文献检索,全面收集国内外发表的砷暴露与肺功能损伤有关的流行病学研究,检索时限为建库至2020年3月。由两名评价者按纳入排除标准对所获文献独立进行筛选、资料提取。采用Review Manager 5.3软件进行Meta分析,计量资料采用均数差(MD)为效应指标,根据异质性结果选用固定效应模型或随机效应模型进行综合定量分析,通过亚组分析探讨其异质性来源;使用Stata SE 15软件进行漏斗图绘制和Egger′s回归法检验,评价发表偏倚。结果最终纳入10篇文献,均为英文。Meta分析结果显示,砷暴露可使人群肺功能指标呼气第一秒的用力呼气量(FEV1)、用力肺活量(FVC)明显降低,MD及其95%可信区间(CI)分别为-23.82(-39.93^-7.72)ml和-47.47(-73.97^-20.98)ml,差异有统计学意义(Ζ=2.90、3.51,P均<0.01);共3篇文献报告了一秒率(FEV1/FVC),MD(95%CI)为-4.72(-13.10~3.67),砷暴露与FEV1/FVC之间未见关联(Z=1.10,P>0.05)。亚组分析结果显示,地区亚组间FEV1、FVC比较,差异具有统计学意义(χ2=6.80、30.06,P均<0.01)。结论砷暴露与肺活量测量指标FEV1和FVC呈负相关,但与FEV1/FVC无关联,提示砷暴露可能主要导致限制性肺通气功能异常。

Objective To systematically evaluate the relationship between arsenic exposure and pulmonary ventilation dysfunction,so as to provide a basis for clarifying the mechanism of lung function injury caused by arsenic exposure and identifying at-risk populations of arsenic exposure.Methods Pertinent studies were identified by searching PubMed,Embase,Web of Science,China Biology Medicine Disc(CBM),China National Knowledge Infrastructure(CNKI),Wanfang Data and VIP Database through March 2020.The studies that reported arsenic exposure and lung function dysfunction published at home and abroad were collected comprehensively.According to the inclusion and exclusion criteria,two reviewers independently screened and extracted the literatures.All of the Meta-analysis were performed by using Review Manager 5.3 software,the mean difference value(MD)was used as the effect index,the fixed effect model or the random effect model were performed for comprehensive quantitative analysis according to the heterogeneity results,and subgroup analysis was conducted to explore the source of heterogeneity.Stata SE 15 software for funnel mapping and Egger's regression test were used to evaluate publication bias.Results Totally 10 documents were included,all in English.The Meta-analysis showed that arsenic exposure could significantly reduce forced expiratory volume in one second(FEV1)and forced vital capacity(FVC),and the MD(95%CI)was-23.82(-39.93--7.72)ml and-47.47(-73.97--20.98)ml,respectively.The differences were statistically significant(Ζ=2.90,3.51,P<0.01).FEV1/FVC was reported in three documents,and MD(95%CI)was-4.72(-13.10-3.67).There was no evidence of an association between arsenic exposure and FEV1/FVC(Ζ=1.10,P>0.05).The results of subgroup analysis showed that there were significant differences in FEV1 and FVC among subgroups by region(χ2=6.80,30.06,P<0.01).Conclusion Arsenic exposure is negatively correlated with vital capacity measurement indexes FEV1 and FVC,but not with FEV1/FVC,indicating that arsenic exposure may mainly lead to restrictive pulmonary ventilation dysfunction.