Effect of lead exposure on thyroid hormone levels in occupationally exposed populations: a Meta-analysis
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摘要:
目的 应用Meta分析探讨职业性铅暴露人群血铅水平与各类甲状腺激素(thyroid hormones, TH)水平的关系。 方法 通过计算机检索中英文数据库(中国知网、万方数据知识服务平台、维普中文科技期刊数据库、PubMed、Web of Science)，收集从建库至2022年10月国内外公开发表的有关铅暴露与TH水平的横断面研究，应用Stata 14.0软件进行Meta分析。 结果 共纳入14篇文献进行分析。Meta分析结果显示，与一般人群比较，职业性铅暴露人群中，血铅水平较高，促甲状腺激素(thyroid stimulating hormone, TSH)、甲状腺素(thyroxine, T4)、三碘甲状腺原氨酸(triiodothyronine, T3)、游离三碘甲状腺原氨酸(free triiodothyronine, FT3)、游离甲状腺素(free thyroxine, FT4)5种TH的平均浓度差异均无统计学意义(均P＞0.05)；暴露组血铅水平高于200 μg/L时，TSH水平升高，与对照组TSH的平均浓度差异有统计学意义(P＜0.05)。 结论 职业性铅暴露人群中高血铅水平与TSH水平升高相关。 Abstract:Objective Meta-analysis was used to explore the relationship between blood lead levels and thyroid hormone (TH) levels in people with occupational lead exposure. Methods Meta-analysis was performed using Stata14.0. Chinese and English databases, including CNKI, Wanfang Data Knowledge Service Platform, Chinese Science and Technology Journal Database, PubMed, Web of Science were searched. Cross-sectional studies on the relationship between lead exposure and thyroid hormone levels published from the databases establishment to October 2022 were collected. Results A total of 14 literatures were included for analysis. The results showed that compared with control population, the blood lead level was higher in people with occupational lead exposure. There was no statistical significance (all P > 0.05) in the average concentrations of thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free triiodothyronine (FT4) and free thyroxine (FT4) between the two groups. When the blood lead level in the exposed group was higher than 200 μg/L, the TSH level increased, and the difference between the exposed group and the control group was statistically significant (P < 0.05). Conclusions High blood lead level is associated with elevated TSH level in people with occupational lead exposure. -
图 2 铅暴露对工人游离甲状腺素水平影响的敏感性分析图
Figure 2. Sensitivity analysis of the effects of lesd exposure on free thyroxine levels in workers
图 3 铅暴露对工人促甲状腺激素水平影响的敏感性分析图
Figure 3. Sensitivity analysis of the effects of lead exposure on thyroid stimulating hormone levels in workers
图 4 血铅水平对工人促甲状腺激素水平影响的亚组Meta分析森林图
SMD: 标准加权均数差。
Figure 4. Subgroup Meta-analysis forest plot of the effects of blood lead levels on thyroid stimulating hormone levels in workers
SMD: standardized mean difference.
表 1 纳入文献基本信息
Table 1. Basic information of the included literatures
第一作者
First author发表年份
Year of publication国家或地区
Country or region暴露组
Exposed group对照组
Control group血清铅检测方法
Test method for serum lead血清激素检测方法
Methods for detection of serum hormones暴露组血铅水平/(μg·L-1)
Blood lead level in exposed group/(μg·L-1)结局指标
Outcome indicator例数
Number年龄/岁
Age/years例数
Number年龄/岁
Age/yearsGustafson Å[10] 1989 瑞典Sweden 25 36 25 36.8 AAS 实验室Laboratory 395.83±20.83 TSH，T4，T3 Gennart JP[11] 1992 比利时Belgium 98 37.7 85 38.8 ETAAS RIA 510.0±80.0 TSH，T4，T3 Schumacher C[12] 1998 加拿大Canada 22 40.4 36 42.1 ETAAS ELISA 455 TSH，FT4，T4 Dursun N[13] 1999 土耳其Turkey 27 41.11 30 42 ETAAS RIA 170.7±89.6 TSH，FT4，T4，T3 Singh B[14] 2000 印度India 50 31.3 35 28.9 AAS RIA 410~700 TSH，T4，T3 Lopez CM[15] 2000 阿根廷Argentina 75 41.1 62 - AAS ELISA 509±233 TSH，FT4，T4，T3 梁启荣[16] Liang QR[16] 2003 中国China 67 31.91 36 29.61 AAS RIA 737.5±85.42 TSH，FT4，FT3，T4，T3 Dundar B[17] 2006 土耳其Turkey 12 16.57 55 16.37 AAS CLIA 130.5±17.2 TSH，FT，T3 梁启荣[18] Liang QR[18] 2008 中国China 47 24~45 20 25~40 AAS RIA ＞600.00 TSH，FT4，FT3 Pekcici R[19] 2010 土耳其Turkey 16 34.3 60 32.9 AAS CLIA ＞800 TSH，FT4，FT3 Bledsoe ML[20] 2011 美国America 136 32.9 83 30.2 实验室Laboratory RIA 389±87 FT4，T4 Yılmaz H[21] 2012 土耳其Turkey 190 35.3 20 43.9 - - 440±169 TSH，FT4，T3 郭文峰[22] Guo WF[22] 2014 中国China 137 18~60 140 18~60 ETAAS RIA 243.98±78.62 TSH，T4，T3 Fahim YA[23] 2020 埃及Egypt 59 44.9 28 41.36 ICPMS ELISA 165±17.4 TSH，FT3 注：AAS，原子吸收光谱法；ETAAS，电热原子吸收光谱法；ICP-MS，电感耦合等离子体质谱法；ASV，阳极溶出伏安法；RIA，放射免疫分析法；ELISA，酶联免疫分析法；CLIA，化学发光免疫分析法；ECLIA电化学发光免疫分析法；TSH，促甲状腺激素；T4，甲状腺素；T3，三碘甲状腺原氨酸；FT4，游离甲状腺素；FT3，游离三碘甲状腺原氨酸；“-”无法获取。
Note：AAS, atomic absorption spectroscopy; ETAAS, electrothermal atomic absorption spectrometry; ICP-MS, inductively coupled plasma mass spectrometry; ASV, anodic stripping voltammetry; RIA, radio-immuni-assay; ELISA, enzyme-linked immunosorbent assay; CLIA, chemilumineseent immunoassay; ECLIA, electrochemical luminescence immunoassay; TSH, thyroid hormones; T4, thyroxine; T3, triiodothyronine; FT4, free thyroxine; FT3, free triiodothyronine; "-" unavailable.
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表 2 乔安娜·布里格斯研究所分析性横断面研究质量评价表
Table 2. Quality evaluation table for Joanna Briggs institute analytical cross-sectional studies
第一作者
Frist author发表年份
Year of publication1 2 3 4 5 6 7 8 9 Gustafson Å[10] 1989 是Yes 是Yes 是Yes 不适用Not applicable 是Yes 是Yes 是Yes 是Yes 是Yes Gennart JP[11] 1992 是Yes 不清楚Unclear 是Yes 不适用Not applicable 是Yes 是Yes 是Yes 是Yes 否No Schumacher C[12] 1998 是Yes 是Yes 否No 不适用Not applicable 是Yes 是Yes 是Yes 是Yes 是Yes Dursun N[13] 1999 是Yes 否No 是Yes 不适用Not applicable 否No 否No 是Yes 是Yes 否No Singh B[14] 2000 是Yes 是Yes 是Yes 不适用Not applicable 否No 否No 是Yes 是Yes 是Yes Lopez CM[15] 2000 是Yes 是No 是Yes 不适用Not applicable 否No 否No 是Yes 是Yes 是Yes 梁启荣[16] Liang QR[16] 2003 是Yes 是Yes 是Yes 不适用Not applicable 是Yes 是Yes 是Yes 否No 是Yes Dundar B[17] 2006 是Yes 是Yes 是Yes 不适用Not applicable 否No 否No 是Yes 是Yes 否No 梁启荣[18] Liang QR[18] 2008 是Yes 否No 是Yes 不适用Not applicable 否No 否No 是Yes 否No 是Yes Pekcici R[19] 2010 是Yes 否No 是Yes 是Yes 否No 否No 是Yes 是Yes 否No Bledsoe ML[20] 2011 是Yes 是Yes 是Yes 不适用Not applicable 是Yes 是Yes 是Yes 是Yes 是Yes Yılmaz H[21] 2012 是Yes 是Yes 不清楚Unclear 是Yes 是Yes 是Yes 不清楚Unclear 否No 是Yes 郭文峰[22] Guo WF[22] 2014 是Yes 是Yes 是Yes 不适用Not applicable 否No 否No 是Yes 否No 否Yes Fahim YA[23] 2020 是Yes 是Yes 是Yes 不适用Not applicable 是Yes 是Yes 是Yes 是Yes 否Yes 注：1，是否明确定义了纳入样本的标准；2，是否详细描述了研究对象和背景；3，暴露是否以有效且可靠的方式测量；4，是否客观标准的衡量状况；5，是否识别出混杂因素；6，是否制定了应对混杂因素的策略；7，是否以有效和可靠的方式测量结果；8，是否使用了适当的统计分析；9，数据或数据单位是否不存在质疑。
Note: 1, Were the criteria for inclusion in the sample clearly defined; 2, Were the study subjects and the setting described in detail; 3, Was the exposure measured in a valid and reliable way; 4, Were objective, standard criteria used for measurement of the condition; 5, Were confounding factors identified; 6, Were strategies to deal with confounding factors state; 7, Were the outcomes measured in a valid and reliable way; 8, Was appropriate statistical analysis used; 9, Was the data or unit of data unchallenged.
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表 3 铅暴露对工人5种甲状腺激素水平影响的Meta分析结果数据表
Table 3. Meta-analysis of the effects of lead exposure on the levels of five thyroid hormones in workers
甲状腺激素
Thyroid hormones例数
NumberSMD 95% CI Z值value P值value I2/% Q检验 χ2值value P值value TSH 13 0.23 -0.22~0.67 0.99 0.320 92.9 168.21 ＜0.001 FT4 10 0.59 -0.04~1.22 1.85 0.065 94.3 152.11 ＜0.001 FT3 6 0.03 -0.86~0.92 0.06 0.954 94.2 86.73 ＜0.001 T4 9 0.46 -0.16~1.08 1.46 0.144 95.9 192.97 ＜0.001 T3 7 0.01 -0.40~0.42 0.04 0.971 88.3 51.09 ＜0.001 注：SMD，标准加权均数差；TSH，促甲状腺激素；FT4，游离甲状腺素；FT3，游离三碘甲状腺原氨酸；T4，甲状腺素；T3，三碘甲状腺原氨酸。
Note: SMD, standardized mean difference; TSH, thyroid stimulating hormone; FT4, free thyroxine; FT3, free triiodothyronine; T4, thyroxine; T3, triiodothyronine.
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表 4 血铅水平分组的Meta亚组分析结果
Table 4. Meta-subgroup analysis results of blood lead level subgroups
甲状腺激素
Thyroid hormones血铅水平/(μg·L-1)
Blood lead level/(μg·L-1)SMD 95% CI χ2值
valueP值
valueTSH ＜200 -0.39 -1.46~0.68 22.80 ＜0.001 ≥200 0.40 -0.08~0.89 124.53 ＜0.001 FT4 ＜200 3.15 -0.02~6.33 104.87 ＜0.001 ≥200 0.02 -0.39~0.43 38.66 ＜0.001 FT3 ＜200 0.77 -0.32~1.85 7.51 ＜0.001 ≥200 -0.34 -1.52~0.83 62.09 ＜0.001 T4 ＜200 0.69 -2.18~3.55 66.56 ＜0.001 ≥200 0.41 -0.22~1.04 107.92 ＜0.001 T3 ＜200 0.03 -0.49~0.55 0 - ≥200 0.01 -0.46~0.47 50.27 ＜0.001 注：SMD，标准加权均数差；TSH，促甲状腺激素；FT4，游离甲状腺素；FT3，游离三碘甲状腺原氨酸；T4，甲状腺素；T3，三碘甲状腺原氨酸；-，无法获取。
Note: SMD, standardized mean difference; TSH, thyroid stimulating hormone; FT4, free thyroxine; FT3, free triiodothyronine; T4, thyroxine; T3, triiodothyronine; -, unavailable.
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表 5 样本量大小分组的Meta亚组分析结果
Table 5. Results of Meta-subgroup analysis of sample size groups
甲状腺激素
Thyroid hormones分组(样本量大小)
Subgroup (Sample siz)SMD 95% CI χ2值
valueP值
valueTSH ＜30 0.81 -0.24~1.86 62.45 ＜0.001 ≥30 -0.10 -0.58~0.38 91.27 ＜0.001 FT4 ＜30 2.27 0.13~4.40 110.46 ＜0.001 ≥30 0.02 -0.45~0.49 41.39 ＜0.001 FT3 ＜30 0.40 -0.02~0.81 0.73 0.390 ≥30 -0.16 -1.50~1.17 84.83 ＜0.001 T4 ＜30 1.45 -0.71~3.61 65.02 ＜0.001 ≥30 0.03 -0.55~0.60 96.02 ＜0.001 T3 ＜30 0.72 -0.65~2.10 11.34 ＜0.001 ≥30 -0.23 -0.58~0.12 22.20 ＜0.001 注：SMD，标准加权均数差；TSH，促甲状腺激素；FT4，游离甲状腺素；FT3，游离三碘甲状腺原氨酸；T4, 甲状腺素; T3, 三碘甲状腺原氨酸。
Note：SMD, standardized mean difference；TSH，thyroid stimulating hormone；FT4，free thyroxine；FT3，free triiodothyronine；T4, thyroxine; T3, triiodothyronine.
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