母体砷暴露与新生儿死亡率及婴儿死亡率关系的Meta分析  

Relationship between maternal arsenic exposure and neonatal mortality and infant mortality:A meta-analysis

作　　者：史书迪 吴雨欣 吴昊[1] 冯喆 王梦涵 景楠 杨乾磊 安艳[1] Shi Shudi;Wu Yuxin;Wu Hao;Feng Zhe;Wang Menghan;Jing Nan;Yang Qianlei;An Yan(Department of Toxicology,School of Public Health,Suzhou Medical College,Soochow University,Suzhou 215021,China;China-Japan Joint Laboratory on Environmental Health,School of Public Health,Suzhou Medical College,Soochow University,Suzhou 215021,China)

机构地区：[1]苏州大学苏州医学院公共卫生学院毒理学系,苏州215021 [2]苏州大学苏州医学院公共卫生学院中日环境与健康联合实验室,苏州215021

出　　处：《中华地方病学杂志》2024年第12期1021-1026,共6页Chinese Journal of Endemiology

基　　金：国家自然科学基金(81872646、81811540034、81573173、82381240027);国家级大学生创新创业训练计划项目、江苏省大学生创新创业训练计划项目(202210285067Z、202210285069Z)

摘　　要：目的系统评价母体砷暴露与新生儿死亡率(neonatal mortality,NM)、婴儿死亡率(infant mortality,IM)的关系。方法通过PubMed、Web of Science、Embase、Cochrane Library、中国知网数据库、万方数据知识服务平台、维普中文期刊服务平台、中国生物医学文献数据库进行文献检索,纳入国内外发表的母体砷暴露与NM、IM关系的病例-对照、队列、横断面研究,检索时间为数据库建库至2023年6月4日。采用Stata MP 16.0软件进行数据分析,用I^(2)统计量和Q检验进行异质性检验,根据各研究结果间异质性选用固定效应模型(不存在显著的异质性,I^(2)≤50%,P≥0.100)或者随机效应模型(存在显著的异质性,I^(2)>50%,P<0.100)进行Meta分析。以OR值(95%CI)作为效应值,并根据不同暴露指标、饮水砷暴露水平及研究类型进行亚组分析。同时,采用广义最小二乘法对母体砷暴露与NM、IM的剂量-反应关系进行分析。结果最终纳入9篇英文文献(包含3053名女性和74172对母婴),其中NM结局的有6篇、IM结局的有8篇。经异质性检验,各研究间NM(I^(2)=75.20%,P=0.001)、IM(I^(2)=62.50%,P=0.009)均存在显著的异质性。采用随机效应模型进行Meta分析,NM、IM的合并OR值(95%CI)分别为1.38(1.11~1.73)、1.51(1.21~1.89)。根据暴露指标分组,NM结局中,全部研究均以饮水砷为暴露指标,饮水砷的合并OR值(95%CI)为1.38(1.11~1.73);IM结局中,尿砷、饮水砷的合并OR值(95%CI)分别为3.42(1.38~8.47)、1.44(1.16~1.79)。根据饮水砷暴露水平分组,NM、IM结局中,高、低暴露水平(>50、>10~50μg/L)的合并OR值(95%CI)分别为1.18(0.97~1.44)、1.54(1.41~1.67),1.22(1.03~1.43)、1.55(1.18~2.03)。根据研究类型分组,NM、IM结局中,回顾性队列、前瞻性队列、横断面研究的合并OR值(95%CI)分别为1.54(1.41~1.67)、1.11(0.96~1.28)、1.90(1.01~3.55),1.55(1.18~2.03)、2.01(0.82~4.94)、1.58(0.87~2.88)。剂量-反应关系分析显示,母体砷暴露与IM的剂量-反Objective To systematically evaluate the relationship between maternal arsenic exposure and neonatal mortality(NM)and infant mortality(IM).Methods Literature searches were conducted through PubMed,Web of Science,Embase,Cochrane Library,CNKI database,Wanfang Data Knowledge Service Platform,VIP Chinese Journal Service Platform,and the Chinese Biomedical Literature Database to include case-control,cohort,and cross-sectional studies on the relationship between maternal arsenic exposure and NM,IM published domestically and internationally.The search period was from database establishment to June 4,2023.Data analysis was conducted using Stata MP 16.0 software,and heterogeneity tests were performed using I^(2) statistics and Q-test.Fixed effect model(no significant heterogeneity,I^(2)≤50%,P≥0.100)or random effect model(significant heterogeneity,I^(2)>50%,P<0.100)was selected according to heterogeneity among study results for meta-analysis.The OR value(95%CI)was used as the effect value,and subgroup analysis was performed based on different exposure index,arsenic exposure levels in drinking water and study types.At the same time,the dose-response relationship between maternal arsenic exposure and NM,IM was analyzed using generalized least square method.Results Finally,9 English literature articles(including 3053 women and 74172 maternal and infant pairs)were included,including 6 articles on NM outcomes and 8 articles on IM outcomes.After heterogeneity testing,there was significant heterogeneity in NM(I^(2)=75.20%,P=0.001)and IM(I^(2)=62.50%,P=0.009)among all studies.Random effect model was used for meta-analysis,and the combined OR values(95%CI)of NM and IM were 1.38(1.11-1.73)and 1.51(1.21-1.89),respectively.According to the exposure index grouping,in the NM outcome,all studies used drinking water arsenic as the exposure index,and the combined OR value(95%CI)of drinking water arsenic was 1.38(1.11-1.73).In the IM outcome,the combined OR values(95%CI)for urinary arsenic and drinking water arsenic were 3.42(1.38-8.47)

关 键 词：砷 新生儿死亡率 婴儿死亡率 META分析 

分 类 号：R174[医药卫生—妇幼卫生保健]