妊娠窗口期大气颗粒物暴露对早产影响的meta分析

目的综合以往发表的相关文献,分析不同妊娠窗口期大气颗粒物(PM_(2.5)、PM_(10))暴露对早产的影响。方法检索国内外2000年1月1日—2015年10月1日公开发表的关于大气颗粒物暴露对早产影响的研究文献,根据纳入及排除标准筛选出符合要求的文献26篇,采用R 3.1.1软件的metafor统计包对入选文献进行异质性检验和相应的效应值合并,并对结果进行敏感性分析、发表偏倚检验和校正,评价妊娠窗口期颗粒物暴露对早产的影响。结果通过建立各妊娠窗口期大气颗粒物与早产的暴露-反应关系,发现大气PM_(2.5)浓度每升高10μg/m~3,妊娠早、中、晚期及整个妊娠期早产发生的合并OR(95%CI)分别为1.10(1.01~1.21),1.07(0.79~1.45),1.04(0.97~1.10),1.05(0.97~1.13);大气PM10浓度每升高10μg/m~3,妊娠早、中、晚期及整个妊娠期早产发生的合并OR(95%CI)分别为0.98(0.97~1.00),0.99(0.98~1.01),1.01(0.99~1.04)和1.00(1.00~1.00)。结论不同妊娠窗口期的大气颗粒物暴露所致早产发生风险存在差异,妊娠早期大气PM_(2.5)的暴露可明显增加早产风险。

Impact of atmospheric particulate matter at different period of gestation on preterm birth: a meta-analysis

Objective To synthesize the relevant researches and analyze the influence of atmospheric particulate matter (PMz5,PM10) on preterm birth at different periods of gestation.Methods Literatures on atmospheric particulate matter and preterm birth published in the journals from January 1st 2000 to October 1 st 2015 were collected by the search engines Pubmed,CNKI,etc.Literatures selected by the strict standards which were made before the study and 26 pieces of the papers were adopted.In the present study,the meta for package of the R 3.1.1 software was used to check the heterogeneity and merge the effect value of the selected literatures.The sensitivity analysis and publication bias of the results were detected and adjusted.Results Each 10 μg/m3 increase in PMz5 was associated with combined OR values of the 1st trimester,the 2nd trimester,the 3rd trimester and entire gestation at 1.10 (1.01-1.21),1.07 (0.79-1.45),1.04 (0.97-1.10) and 1.05 (0.97-1.13),respectively;and 10 μg/m3 increase in PM10 was associated with combined OR values of the 1st trimester,the 2nd trimester,the 3rd trimester and entire gestation at 0.98(0.97-1.00),0.99(0.98-1.01),1.01(0.99-1.04) and 1.00(1.00-1.00),respectively.Conclusion The preterm birth risk due to maternal exposure to air particulate matter is different in different gestation window phase,the exposure of PM2.5 in the 1st trimester can significantly increase the risk of premature birth.