地方性砷中毒与心电图异常的Meta分析  

Association of endemic arsenic poisoning and abnormal electrocardiogram: Meta-analysis

作　　者：肖呈琦 杨乾磊 张恬 郭相东 周雨桦 丁锐[1] 安艳[1] Xiao Chengqi;Yang Qianlei;Zhang Tian;Guo Xiangdong;Zhou Yuhua;Ding Rui;An Yan(Department of Toxicology,School of Public Health,Medical College of Soochow University,Suzhou 215123,China)

机构地区：[1]苏州大学苏州医学院公共卫生学院卫生毒理学系,苏州215123

出　　处：《中华地方病学杂志》2022年第1期75-80,共6页Chinese Journal of Endemiology

基　　金：国家自然科学基金(81872646、81573173);国家级大学生创新创业训练计划(201910285058);江苏省大学生创新创业训练计划(201910285053Z)。

摘　　要：目的系统评价地方性砷中毒与心电图异常的相关性。方法通过Pubmed、Web of Science、Embase、中国知网(CNKI)、万方数据库(WanFang Data)、维普网等数据库进行文献检索,将国内外发表的地方性砷中毒与心电图异常有关的流行病学文献纳入研究,时限为建库至2020年12月1日。采用RevMan 5.3软件进行二分类变量的Meta分析,根据异质性结果选用随机效应模型,以比值比(OR)作为效应指标;通过亚组分析寻找特征性变化;使用漏斗图评价发表偏倚。结果最终纳入6篇中文文献及3篇英文文献,共计9篇文献。心电图异常包括QTc延长、ST-T段改变、电轴左偏、心律失常;最终纳入暴露组1975例,包含心电图异常575例;对照组750例,包含心电图异常145例。通过Meta分析,心电图异常合并OR值[95%置信区间(CI)]为4.41(2.83~6.87),两组之间差异有统计学意义(Z=6.56,P<0.05);亚组分析结果,QTc延长、ST-T段改变、电轴左偏、心律失常的合并OR值(95%CI)分别为12.30(5.91~25.59)、2.74(1.39~5.41)、2.93(0.89~9.62)、4.13(2.38~7.17)。结论地方性砷中毒可能会引起心电图异常;砷暴露造成的QTc延长可能是砷暴露造成心电图异常的特征改变。Objective To evaluate the correlation between endemic arsenic poisoning and abnormal electrocardiogram(ECG).Methods PubMed,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),Wanfang data,VIP and other databases were used for literature retrieval,and epidemiological literatures related to abnormal ECG of endemic arsenic poisoning published in domestic and abroad were included in the study.The time limit was from the establishment of the database to December 1,2020.RevMan 5.3 was used for Meta-analysis of binary variables.Random effect model was selected according to the results of heterogeneity,and odds ratio(OR)was used as the effect index.Characteristic changes were found by subgroup analysis.Bias was published by funnel plot.Results Nine articles were included in this Meta-analysis,with 6 articles in Chinese and 3 articles in English,respectively.The abnormal ECG changes included QTc prolongation,ST-T segment change,left axis deviation and arrhythmia.Finally,1975 cases were included in the exposure group,including 575 cases of abnormal ECG;750 cases of control group,including 145 cases of abnormal ECG.Meta-analysis showed that the combined OR value[95%confidence interval(CI)]of abnormal ECG changes was 4.41(2.83-6.87),with statistical significance between the two groups(Z=6.56,P<0.05);the results of subgroup analysis showed that the combined OR values(95%CI)of QTc prolongation,ST-T segment change,left axis deviation and arrhythmia were 12.30(5.91-25.59),2.74(1.39-5.41),2.93(0.89-9.62)and 4.13(2.38-7.17),respectively.Conclusions Endemic arsenic poisoning may cause abnormal ECG.Prolongation of QTc caused by arsenic exposure may be the characteristic change of abnormal ECG.

关 键 词：砷中毒 心电图异常 META分析 QTC延长 

分 类 号：R599.1[医药卫生—内科学]