产前滴滴涕或多氯联苯暴露与出生缺陷风险相关性的 Meta 分析


目的 系统评价孕妇产前暴露于滴滴涕(DDT)或多氯联苯(PCBs)与新生儿出生缺陷风险之间的关系。 方法 计算机检索 PubMed、EMbase、WanFang Data、VIP 和 CNKI 数据库,搜集有关产前 DDT 或 PCBs 暴露与出生缺陷关系的病例-对照研究,检索时限均从建库至 2017 年 2 月。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 Stata 13.0 软件进行 Meta 分析。 结果 共纳入 14 个研究,包括 2 238 例出生缺陷新生儿和 2 355 例对照新生儿。Meta 分析结果显示:产前暴露于高水平的 DDT 会导致新生儿隐睾发生率增加[OR=1.12,95%CI(1.09,1.15),P<0.001]。而 DDT 暴露与尿道下裂和神经管畸形发生没有相关性。产前暴露于高水平的 PCBs 与隐睾、尿道下裂、神经管畸形发生也没有相关性。 结论 孕妇产前暴露于高水平的 DDT 可能是隐睾发生的危险因素。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the association between prenatal exposure to dichlorodiphenyltrichloroethane (DDT) or polychlorinated biphenyls (PCBs) and the risk of congenital anomalies. Methods PubMed, EMbase, WanFang Data, VIP and CNKI databases were electronically searched to collect case-control studies on the relationship between prenatal exposure to DDT or PCBs and congenital anomalies from inception to February 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 13.0 software. Results A total of 14 studies involving 2 238 infants with defect and 2 335 infants without defect were included. The results of meta-analysis showed that: the prenatal exposure to high level of DDT increased the incidence of cryptorchidism (OR=1.12, 95% CI 1.09 to 1.15, P<0.001). However, DDT exposure had no correlation to hypospadias and neural tube defects. The associations between prenatal exposure to PCBs and cryptorchidism, hypospadias, neural tube defects were not discovered. Conclusion Prenatal exposure to high levels of DDT may be a risk factor for cryptorchidism. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.

关键词: 滴滴涕; 多氯联苯; 产前暴露; 出生缺陷; 系统评价; Meta 分析; 病例-对照研究

Key words: Dichlorodiphenyltrichloroethane; Polychlorinated biphenyls; Prenatal exposure; Congenital anomalies; Systematic review; Meta-analysis; Case-control study

引用本文: 林瑜, 张小芬, 何洁, 赵本华, 赖圳宾, 赵泽宇, 于晓姗, 陈江慧, 林修羽, 苏艳华, 刘刚. 产前滴滴涕或多氯联苯暴露与出生缺陷风险相关性的 Meta 分析. 中国循证医学杂志, 2018, 18(4): 365-372. doi: 10.7507/1672-2531.201707129 复制

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