中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2015年
1期
11-19
,共9页
云妙英%阿德娜依·阿力肯%秦颖%赵智慧%刘琪%徐刚
雲妙英%阿德娜依·阿力肯%秦穎%趙智慧%劉琪%徐剛
운묘영%아덕나의·아력긍%진영%조지혜%류기%서강
尿道下裂%雌激素类%meta分析
尿道下裂%雌激素類%meta分析
뇨도하렬%자격소류%meta분석
Hypospadias%Estrogens%Meta-analysis
目的 评价外源性雌激素与尿道下裂发病的关系. 方法 计算机联机检索Medline、Web of Science(ISI)、EMBASE、Cochrane图书馆、EBSCO Host、Elsevier Science Direct以及中国生物医学文献数据库和中国知网等数据库,辅以手工查阅北京大学医学部和国家图书馆相关书籍、期刊等资源,收集1990年1月至2011年7月关于外源性雌激素与尿道下裂发病关系的流行病学研究文献.纳入有母亲妊娠前或妊娠期是否暴露于外源性雌激素,有OR值或RR值及其95％CI的外源性雌激素与尿道下裂相关性的病例对照和队列研究.根据非随机对照研究评价量表筛选和评价文献,提取原始数据.采用Review Manager 5.2软件进行meta分析. 结果 共18篇文献最终纳入本研究,包括病例对照研究文献16篇与队列研究文献(均为己烯雌酚)2篇.纳入的16篇病例对照研究文献的组间异质性有统计学意义(P=0.002),采用随机效应模型计算合并OR值及其95％CI,总效应值为1.35(1.08～1.70).关于妊娠期暴露于己烯雌酚的病例对照研究共3篇,采用固定效应模型(异质性检验P=0.250)合并OR值及其95％CI为2.12 (1.18～3.80);3篇口服避孕药研究和3篇双对氯苯基三氯乙烷及其衍生物暴露研究采用固定效应模型(异质性检验P值分别为0.450和0.980)进行合并分析,OR值及其95％CI分别为1.01 (0.81～1.27)和1.04(0.61～1.74).植物雌激素和邻苯二甲酸酯的研究各有2篇,随机效应模型(异质性检验P值均为0.020)合并效应OR值及其95％CI分别为1.88(0.52～6.79)和1.68 (0.47～5.94).按欧洲和北美等2个地区划分,5篇北美文献固定效应模型(异质性检验P=0.110)总OR值及其95％CI为1.13(0.86～1.53),欧洲地区11篇文献随机效应模型(异质性检验P=0.002)总OR值及其95％CI为1.51(1.13～2.03),其中3篇荷兰文献的固定效应模型(异质性检验,P=0.400)总OR值及其95％CI为1.47(0.90～2.38),3篇英国文献的随机效应模型(异质性检验,P=0.000)总OR值及其95％CI为2.14(0.74～6.18).2篇队列研究文献合并随机效应模型(异质性检验P=0.002)总RR值及其95％CI为6.19(0.39～99.55).采用漏斗图对纳入文献进行发表偏倚分析,发现阴性研究文献发表少,已发表文献偏向于阳性结果. 结论 尿道下裂与外源性雌激素总效应有关,且显示出地理相关性.母亲妊娠期暴露于己烯雌酚可能增加其子代患尿道下裂的风险.
目的 評價外源性雌激素與尿道下裂髮病的關繫. 方法 計算機聯機檢索Medline、Web of Science(ISI)、EMBASE、Cochrane圖書館、EBSCO Host、Elsevier Science Direct以及中國生物醫學文獻數據庫和中國知網等數據庫,輔以手工查閱北京大學醫學部和國傢圖書館相關書籍、期刊等資源,收集1990年1月至2011年7月關于外源性雌激素與尿道下裂髮病關繫的流行病學研究文獻.納入有母親妊娠前或妊娠期是否暴露于外源性雌激素,有OR值或RR值及其95％CI的外源性雌激素與尿道下裂相關性的病例對照和隊列研究.根據非隨機對照研究評價量錶篩選和評價文獻,提取原始數據.採用Review Manager 5.2軟件進行meta分析. 結果 共18篇文獻最終納入本研究,包括病例對照研究文獻16篇與隊列研究文獻(均為己烯雌酚)2篇.納入的16篇病例對照研究文獻的組間異質性有統計學意義(P=0.002),採用隨機效應模型計算閤併OR值及其95％CI,總效應值為1.35(1.08～1.70).關于妊娠期暴露于己烯雌酚的病例對照研究共3篇,採用固定效應模型(異質性檢驗P=0.250)閤併OR值及其95％CI為2.12 (1.18～3.80);3篇口服避孕藥研究和3篇雙對氯苯基三氯乙烷及其衍生物暴露研究採用固定效應模型(異質性檢驗P值分彆為0.450和0.980)進行閤併分析,OR值及其95％CI分彆為1.01 (0.81～1.27)和1.04(0.61～1.74).植物雌激素和鄰苯二甲痠酯的研究各有2篇,隨機效應模型(異質性檢驗P值均為0.020)閤併效應OR值及其95％CI分彆為1.88(0.52～6.79)和1.68 (0.47～5.94).按歐洲和北美等2箇地區劃分,5篇北美文獻固定效應模型(異質性檢驗P=0.110)總OR值及其95％CI為1.13(0.86～1.53),歐洲地區11篇文獻隨機效應模型(異質性檢驗P=0.002)總OR值及其95％CI為1.51(1.13～2.03),其中3篇荷蘭文獻的固定效應模型(異質性檢驗,P=0.400)總OR值及其95％CI為1.47(0.90～2.38),3篇英國文獻的隨機效應模型(異質性檢驗,P=0.000)總OR值及其95％CI為2.14(0.74～6.18).2篇隊列研究文獻閤併隨機效應模型(異質性檢驗P=0.002)總RR值及其95％CI為6.19(0.39～99.55).採用漏鬥圖對納入文獻進行髮錶偏倚分析,髮現陰性研究文獻髮錶少,已髮錶文獻偏嚮于暘性結果. 結論 尿道下裂與外源性雌激素總效應有關,且顯示齣地理相關性.母親妊娠期暴露于己烯雌酚可能增加其子代患尿道下裂的風險.
목적 평개외원성자격소여뇨도하렬발병적관계. 방법 계산궤련궤검색Medline、Web of Science(ISI)、EMBASE、Cochrane도서관、EBSCO Host、Elsevier Science Direct이급중국생물의학문헌수거고화중국지망등수거고,보이수공사열북경대학의학부화국가도서관상관서적、기간등자원,수집1990년1월지2011년7월관우외원성자격소여뇨도하렬발병관계적류행병학연구문헌.납입유모친임신전혹임신기시부폭로우외원성자격소,유OR치혹RR치급기95％CI적외원성자격소여뇨도하렬상관성적병례대조화대렬연구.근거비수궤대조연구평개량표사선화평개문헌,제취원시수거.채용Review Manager 5.2연건진행meta분석. 결과 공18편문헌최종납입본연구,포괄병례대조연구문헌16편여대렬연구문헌(균위기희자분)2편.납입적16편병례대조연구문헌적조간이질성유통계학의의(P=0.002),채용수궤효응모형계산합병OR치급기95％CI,총효응치위1.35(1.08～1.70).관우임신기폭로우기희자분적병례대조연구공3편,채용고정효응모형(이질성검험P=0.250)합병OR치급기95％CI위2.12 (1.18～3.80);3편구복피잉약연구화3편쌍대록분기삼록을완급기연생물폭로연구채용고정효응모형(이질성검험P치분별위0.450화0.980)진행합병분석,OR치급기95％CI분별위1.01 (0.81～1.27)화1.04(0.61～1.74).식물자격소화린분이갑산지적연구각유2편,수궤효응모형(이질성검험P치균위0.020)합병효응OR치급기95％CI분별위1.88(0.52～6.79)화1.68 (0.47～5.94).안구주화북미등2개지구화분,5편북미문헌고정효응모형(이질성검험P=0.110)총OR치급기95％CI위1.13(0.86～1.53),구주지구11편문헌수궤효응모형(이질성검험P=0.002)총OR치급기95％CI위1.51(1.13～2.03),기중3편하란문헌적고정효응모형(이질성검험,P=0.400)총OR치급기95％CI위1.47(0.90～2.38),3편영국문헌적수궤효응모형(이질성검험,P=0.000)총OR치급기95％CI위2.14(0.74～6.18).2편대렬연구문헌합병수궤효응모형(이질성검험P=0.002)총RR치급기95％CI위6.19(0.39～99.55).채용루두도대납입문헌진행발표편의분석,발현음성연구문헌발표소,이발표문헌편향우양성결과. 결론 뇨도하렬여외원성자격소총효응유관,차현시출지리상관성.모친임신기폭로우기희자분가능증가기자대환뇨도하렬적풍험.
Objective To evaluate the correlation between environmental estrogen and incidence of hypospadias.Methods Medline,Web of Science (ISI),EMBASE,the Cochrane Library,EBSCO Host,Elsevier Science Direct,Chinese Biomedicine (CBMdisc),and China National Knowledge Infrastructure(CNKI) databases,had been searched and secondary manual search for library was also conducted.Case-control and cohort studies,reporting odds ratio (OR) or relative risk (RR) of environmental estrogen exposure before or during pregnancy and their 95％ confidence interval (CI) for the occurrence of hypospadias and published from January 1990 to July 2011,were included.Review Manager 5.2 software were used for data analysis.Results Altogether,18 studies were finally recruited including two cohort studies (only diethylstilbestrol was involved) and 16 case-control studies.While the 16 case-control studies showed significant heterogeneity (P=0.002),and the pooled OR (95％CI) calculated by random effect model was 1.35(1.08-1.70).For the three case-control studies on diethylstilbestrol exposured during pregnancy,no heterogeneity was found (P=0.250) and the pooled OR (95％CI) with fixed effect model was 2.12(1.18-3.80).For the three case-control studies on oral contraceptives and the other three on exposure to dichlorodiphenyltrichloroethane (DDT) or DDT-derived materials,the pooled OR (95％CI) were 1.01 (0.81-1.27) and 1.04 (0.61-1.74) respectively with fixed effect model as no heterogeneity was found (P=0.450 and 0.980).There were two case-control studies on phytoestrogens and two on phthalates,and both showed significant heterogeneity (both P=0.020).The pooled OR (95％CI) with random effect model were 1.88 (0.52-6.79) and 1.68 (0.47-5.94),respectively.The pooled OR (95％CI) of case-control studies in Europe (11 studies) and North America(five studies) were 1.51 (1.13-2.03) and 1.13(0.86 1.53) with the random and fixed effect model,separately (heterogeneity test P values were 0.002 and 0.110,respectively).Among those 11 studies in Europe,there were three from Holland and three from England with the pooled OR (95％CI) of 1.47(0.90-2.38) and 2.14(0.74-6.18) with fixed and random effect model (heterogeneity test P values were 0.400 and 0.000),respectively.For the two cohort studies,the pooled RR (95％CI) was 6.19 (0.39-99.55) (heterogeneity test P value was 0.002).Analysis of sensitivity and bias of publication found that publications with positive results were more than those with negative results.Conclusions Environmental estrogens may have effect on hypospadias with geographical differences.Maternal exposure to diethylstilbestrol during pregnancy increases the risk of hypospadias in the offspring.
