母体砷暴露与早产关系的Meta分析

Meta-analysis of the relationship between maternal arsenic exposure and preterm birth

目的系统评价母体砷暴露与早产的相关性。方法通过Pubmed、Web of Science、Embase、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,收集国内外发表的母体砷暴露与早产有关的流行病学研究,时限为建库开始至2022年11月。采用Stata MP15软件进行二分类变量的Meta分析,将符合纳入标准的文献进行异质性检验,根据异质性检验结果,采用随机效应模型或固定效应模型进行综合的定量分析,以比值比(OR)作为效应指标;通过亚组分析寻找其异质性来源;利用漏斗图定性评价发表偏倚。结果最终纳入15篇文献(n=9892256279),其中前瞻性队列研究10篇、回顾性队列研究3篇和横断面研究2篇。通过Meta分析,早产合并OR值(95%CI)为1.06(1.03~1.09)。依据砷暴露标志进行亚组分析,头发砷、血液砷、尿液砷、饮水砷、胎盘砷的合并OR值(95%CI)分别为0.97(0.56~1.69)、1.40(1.22~1.60)、1.04(0.93~1.17)、1.14(1.04~1.24)和0.69(0.07~6.38);依据地区进行亚组分析,亚洲、美洲、欧洲和非洲的合并OR值(95%CI)分别为1.17(1.04~1.31)、1.10(1.05~1.14)、0.69(0.07~6.38)和1.17(1.01~1.36);依据研究类型进行亚组分析,前瞻性队列研究、回顾性队列研究和横断面研究的合并OR值(95%CI)分别为1.16(1.05~1.28)、1.01(1.01~1.02)和1.65(0.73~3.74)。结论母体砷暴露可能会导致早产的发生,饮水砷含量可能是评估人体砷暴露及致早产风险的重要指标。

OBJECTIVE To systematic evaluate the association between maternal arsenic exposure and preterm birth.METHODS A literature search was conducted through Pubmed,Web of Science,Embase,China Knowledge Network(CNKI),WanFang Data,Vip Chinese Journal Service Platform(VIP)with a time frame of November 2022 from the beginning of database construction.Meta-analysis of dichotomous variables was performed using Stata MP15 software,and a random or fixed effects model was chosen for the meta-analysis based on the heterogeneity result,with the ratio of ratios(OR)as the effect indicator;subgroup analysis was used to find characteristic changes;funnel plots were used to evaluate publication bias.RESULTS A total of 15 papers with a sample size of(n=9892256279),10 prospective cohort studies,3 retrospective cohort studies,and 2 cross-sectional studies,were included in 6 Chinese and 9 English papers.By Meta-analysis,the combined OR of preterm birth outcome was 1.06(95%CI 1.03-1.09);the result of subgroup analysis by exposure factors and region,the combined OR(95%CI)of hair,blood,urine,drinking water,and placenta were 0.97(0.56-1.69),1.40(1.22-1.60),1.04(0.93-1.17),1.14(1.04-1.24)and 0.69(0.07-6.38).The combined OR(95%CI)were 1.17(1.04-1.31),1.10(1.05-1.14),0.69(0.07-6.38)and 1.17(1.01-1.36)for Asia,Americas,Europe and Africa,respectively.For subgroup analysis based on study type,the combined OR(95%CI)was 1.16(1.05-1.28),1.01(1.01-1.02)and 1.65(0.73-3.74)for prospective cohort studies,retrospective cohort studies,and cross-sectional studies,respectively.CONCLUSION Maternal arsenic exposure may contribute to the occurrence of preterm birth,and drinking water arsenic levels may be an important indicator for assessing human arsenic exposure and risk of causing preterm birth.