苯系物暴露致月经异常的meta分析  

A meta-analysis of menstrual abnormalities in workers exposed to benzene series

作　　者：徐茗[1] 李宗昂 许志珍 付朝晖 于常艳[1] 李雪霏 张美辨 XU Ming;LI Zong’ang;XU Zhizhen;FU Zhaohui;YU Changyan;LI Xuefei;ZHANG Meibian(National Institute of Occupational Health and Poison Control,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Beijing City University,Beijing 100094,China;Institute of Urban Safety and Environmental Science,Beijing Academy of Science and Technology,Beijing 100054,China)

机构地区：[1]中国疾病预防控制中心职业卫生与中毒控制所,北京100050 [2]北京城市学院,北京100094 [3]北京市科学技术研究院城市安全与环境科学研究所,北京100054

出　　处：《环境与职业医学》2024年第10期1156-1161,共6页Journal of Environmental and Occupational Medicine

基　　金：中国疾控中心职业卫生所项目(102393220020090000017)。

摘　　要：[背景]大量横断面研究表明,苯系物暴露与女工月经异常率升高存在相关性,但这些研究报告作为预防医学领域的证据仍显混乱。[目的]通过系统地深入分析多项独立研究文献,为生殖功能损害的早期预防提供更为严谨的科学依据。[方法]检索医学文献数据库Pubmed、Medline、Cochrane Library、中国知网、万方数据、维普资讯中1987年1月至2022年7月公开发表的相关文献,按照病例对照研究要求采集定义明确且一致的暴露组和对照组资料。meta分析计算暴露致月经异常的合并比值比(OR),再分别按照不同因素分组分析,观察苯系物化学成分、暴露剂量、累积暴露剂量、年龄等因素的影响。计算频数、归因危险度百分比(AR),观察苯系物暴露致月经异常的症状特征。[结果]符合纳入标准的文献共计53篇。其中包括苯系物暴露女工27068人和对照女工22857人。吸入暴露于苯系物时,苯系物中含有的苯、甲苯、二甲苯增加了女工月经异常的风险(OR=3.46,95%CI:2.79~4.30,AR=29.37%)且OR值随联合暴露浓度增大而增大(OR=2.57~4.33),累积暴露量低组的OR值低于高组(OR=2.81 vs 3.86,P<0.01),年龄18~36岁且联合暴露浓度低组的OR值高于18~45岁且联合暴露浓度高组(OR=5.83 vs 2.93,P<0.01)。苯、甲苯、二甲苯单一成分或多种成分不同暴露浓度的月经异常OR值显示出较大差异(OR=2.39~6.42,95%CI:1.26~9.06)。AR较高的症状维度是经量异常(AR=47.12%)、周期异常(AR=38.68%)。症状受暴露因素影响较大的有:周期不规律(OR=3.33,95%CI:2.94~3.79,AR=51.25%,n=1103)、经量过多(OR=3.02,95%CI:2.76~3.30,AR=46.73%,n=2262)、痛经(OR=3.22,95%CI:2.69~3.84,AR=44.18%,n=3183)、经期过长(OR=2.20,95%CI:1.99~2.43,AR=37.02%,n=1452)。[结论]吸入暴露于苯系物时,苯系物中含有的苯、甲苯、二甲苯的联合浓度增加可增加育龄女工月经异常的风险。苯系物的化学成分、暴露剂量、累积暴露量、年[Background]A large body of cross-sectional studies have indicated a correlation between exposure to benzene series and increased rates of menstrual abnormalities in female workers,but these findings are confusing as evidence in the field of preventive medicine.[Objective]To provide a more rigorous scientific basis for early prevention of reproductive function impairment through systematic review of independent studies.[Methods]A comprehensive search was conducted for scientific articles published between January 1987 and July 2022,encompassing databases such as PubMed,Medline,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Data,and CQVIP.A meta-analysis was conducted on literature that met the stringent criteria for case-control studies,featuring well-defined and consistent datasets.A meticulous investigation was executed to ascertain the collective odds ratio(OR)linked to menstrual abnormalities,encompassing diverse categories such as component,dosage,cumulative exposure dosage,and age groups.The prevalence and corresponding risk fractions were estimated by calculating frequency distributions and attributing risk percentages(AR).[Results]A total of 53 papers of case-control studies were included in the meta-analysis,involving 27068 benzene series-exposed female workers and 22857 control female workers.During inhalation exposure to benzene series,benzene,toluene,and xylene all increased the risk of female menstrual abnormalities(OR=3.46,95%CI:2.79,4.30,AR=29.37%).The OR value elevated with the increase of joint exposure concentration(OR=2.57-4.33),the OR value of the low cumulative exposure group was lower than that of the high cumulative exposure group(OR=2.81 vs 3.86,P<0.01),and the OR value of the group aged 18 to 36 years old was higher than that of the group aged 18 to 45 years old(OR=5.83 vs 2.93,P<0.01).The OR value discrepancy was apparent among the groups with single and multi-components of benzene,toluene,and xylene at different concentrations(OR=2.39-6.42,95%CI:1.26,9.06).The sy

关 键 词：苯系物 苯 甲苯 二甲苯 职业暴露 月经异常 META分析 

分 类 号：R13[医药卫生—劳动卫生]