中国循证医学杂志

中国循证医学杂志

镉暴露与高血压发病风险相关性的 Meta 分析

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目的 系统评价镉暴露与高血压的发病风险的相关性。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、VIP 和 CNKI 数据库,搜集镉暴露和高血压相关性的病例对照研究,检索时限均从建库至 2018 年 3 月。由两位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 12.0 软件进行 Meta 分析。 结果 共纳入了 9 个研究,其中高血压患者 19 841 例,非高血压对照人群 27 578 例。Meta 分析结果显示,血镉水平上升会增加高血压的发病风险[OR=1.23,95%CI(1.17,1.30),P<0.001];但是尿镉水平上升与高血压的发病风险无相关性[OR=0.77,95%CI(0.55,1.07),P=0.61]。亚组分析结果显示,血镉水平上升与高血压的发病风险,在从不吸烟人群[OR=1.19,95%CI(1.09,1.31),P<0.001]、男性[OR=1.19,95%CI(1.11,1.28),P<0.001]、女性[OR=1.28,95%CI(1.18,1.40),P<0.001]、黄种人[OR=1.26,95%CI(1.19,1.34),P<0.001]和发表于 2010 年之后的文章[OR=1.24,95%CI(1.17,1.31),P<0.001]方面,差异均有统计学意义。尿镉水平与高血压的发病风险在当前吸烟人群[OR=0.72,95%CI(0.56,0.93),P=0.013]、黄种人[OR=0.65,95%CI(0.50,0.83),P=0.001]和发表于 2010 年之前的文章[OR=0.61,95%CI(0.50,0.75),P<0.001]方面,差异均有统计学意义。 结论 血镉水平与高血压发病风险具有相关性,高水平血镉是高血压的危险因素之一。男性、女性、非吸烟人群和黄种人的血镉水平与高血压发病风险具有相关性。尿镉水平与高血压发病风险不相关。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objectives To systematically review the relationship between cadmium exposure and the risk of hypertension. Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were searched online to collect studies of cadmium exposure and hypertension from inception to March 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by Stata 12.0 software. Results A total of 9 studies were included, of which 19 841 cases were patients of hypertension, and 27 578 cases were in the control group. The results of meta-analysis showed that blood cadmium was associated with risk of hypertension (OR=1.23, 95%CI 1.17 to 1.30, P<0.001). However, no significant association was found between urinary cadmium and the risk of hypertension (OR=0.77, 95%CI 0.55 to 1.07,P=0.61). The results of subgroup analysis showed non-smokers (OR=1.19, 95%CI 1.09 to 1.31, P<0.001), males (OR=1.19, 95%CI 1.11 to 1.28,P<0.001), females (OR=1.28, 95%CI 1.18 to 1.40,P<0.001), yellow race (OR=1.26, 95%CI 1.19 to 1.34,P<0.001), and the literatures published after 2010 (OR=1.24, 95%CI 1.17 to 1.31,P<0.001) were associated with risk of hypertension in blood cadmium. The current smokers (OR=0.72, 95%CI 0.56 to 0.93,P=0.013), yellow race (OR=0.65, 95%CI 0.50 to 0.83, P=0.001), and the literatures published before 2010(OR=0.61, 95%CI 0.50 to 0.75, P<0.001) were associated with risk of hypertension in urinary cadmium. Conclusions Blood cadmium is associated with risk of hypertension and high level of blood cadmium is a risk factor for hypertension. The levels of blood cadmium of non-smokers, males, females, yellow race are associated with risk of hypertension in blood cadmium. Urinary cadmium was not significantly associated with the risk of hypertension. The above conclusions are required to be verified by more high quality studies.

关键词: 镉暴露; 血镉; 尿镉; 高血压; 病例对照研究; Meta 分析

Key words: Cadmium exposure; Blood cadmium; Urinary cadmium; Hypertension; Case control study; Meta-analysis

引用本文: 张斯蒙, 田沛茹, 辛芳冉, 魏婷婷, 何俏, 艾聪, 倪萍, 时景璞. 镉暴露与高血压发病风险相关性的 Meta 分析. 中国循证医学杂志, 2018, 18(10): 1062-1069. doi: 10.7507/1672-2531.201804004 复制

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