铅暴露对人群骨代谢影响的Meta分析

Effect of lead exposure on bone metabolism in human populations:a meta-analysis

目的利用Meta分析的方法,研究铅暴露对人群骨代谢的影响。方法通过对中国期刊全文数据库、万方数据库、维普中文科技期刊数据库、PubMed、Web of science五个数据库,检索建库至2022年3月公开发表的铅暴露对人群骨代谢相关指标影响的文献,对文献进行筛选和资料提取。以AHRQ横断面研究评价标准对纳入文献进行质量评价。维生素D3、骨钙素、骨碱性磷酸酶作为骨代谢指标进行分析。采用Stata16、Review Manager 5.3软件进行森林图绘制、敏感性分析及发表偏倚检验,标准化均数差(SMD)及其95%可信区间(95%CI)作为效应指标。结果共纳入13篇文献(n=2029)。纳入的研究存在中高度异质性(I^(2)>50%),采取随机效应模型。相对于非铅接触人群,铅接触人群的钙磷代谢调节指标维生素D3的SMD为-1.11(95%CI:-2.20~-0.02),骨钙素的SMD为-0.50(95%CI:-0.91~-0.09),骨碱性磷酸酶的SMD为0.80(95%CI:0.42~1.19),差异均具有统计学意义(P<0.01)。结论Meta分析结果表明铅暴露影响人群的骨代谢,其中骨碱性磷酸酶水平升高,维生素D3、骨钙素水平下降。

Objective To investigate the effect of lead exposure on bone metabolism in human populations using a meta-analysis approach.Methods The Chinese Journal Full-text Database,Wanfang Database,VIP Database,PubMed,and Web of Science were searched for the literature regarding the effect of lead exposure on bone metabolism indicators in human populations published up to March 2022.The retrieved studies were screened,and the data were extracted.The quality of the included studies was assessed using the Agency for Healthcare Research and Quality(AHRQ)cross-sectional study evaluation criteria.The analytical indicators of bone metabolism included vitamin D3,osteocalcin,and bone alkaline phosphatase(BALP).Stata 16 and Review Manager 5.3 were used for forest mapping,sensitivity analysis,and publication bias testing,with the standardized mean difference(SMD)and its 95%confidence interval(CI)as the effect indicators.Results A total of 13 studies were included in this meta-analysis(n=2029).The included studies showed a moderate to high degree of heterogeneity(I^(2)>50%).Therefore,a random effects model was adopted.Compared with the population without lead exposure,the population with lead exposure showed significant differences(P<0.01)with SMDs of-1.11(95%CI:-2.20 to-0.02)for vitamin D3,-0.50(95%CI:-0.91 to-0.09)for osteocalcin,and 0.80(95%CI:0.42 to 1.19)for BALP.Conclusion The results of meta-analysis indicate that lead exposure has an effect on bone metabolism in human populations,characterized by increased levels of BALP and decreased levels of vitamin D3 and osteocalcin.