金属雌激素暴露与妊娠糖尿病风险:来自系统评价和荟萃分析的证据

Metalloestrogens exposure and risk of gestational diabetes mellitus: Evidence emerging from the systematic review and meta-analysis

作者：Wanxin Wu , Junjie Ren , Juan Wang , Jiamei Wang , Deshui Yu , Yan Zhang , Fa Zeng  ,Binbin Huang

来源：https://doi.org/10.1016/j.envres.2024.118321

摘要：

Background  Metalloestrogens are metals and metalloid elements with estrogenic activity found everywhere. Their impact on human health is becoming more apparent as human activities increase.

Objective   Our aim is to conduct a comprehensive systematic review and meta-analysis of observational studies exploring the correlation between metalloestrogens (specifically As, Sb, Cr, Cd, Cu, Se, Hg) and Gestational Diabetes Mellitus (GDM).

Methods  PubMed, Web of Science, and Embase were searched to examine the link between metalloestrogens (As, Sb, Cr, Cd, Cu, Se, and Hg) and GDM until December 2023. Risk estimates were derived using random effects models. Subgroup analyses were conducted based on study countries, exposure sample, exposure assessment method, and detection methods. Sensitivity analyses and adjustments for publication bias were carried out to assess the strength of the findings.

Results  Out of the 389 articles identified initially, 350 met our criteria and 33 were included in the meta-analysis, involving 141,175 subjects (9450 cases, 131,725 controls). Arsenic, antimony, and copper exposure exhibited a potential increase in GDM risk to some extent (As: OR = 1.28, 95 % CI [1.08, 1.52]; Sb: OR = 1.73, 95 % CI [1.13, 2.65]; Cu: OR = 1.29, 95 % CI [1.02, 1.63]), although there is a high degree of heterogeneity (As: Q = 52.93, p < 0.05, I2= 64.1 %; Sb: Q = 31.40, p < 0.05, I2= 80.9 %; Cu: Q = 21.14, p < 0.05, I2= 71.6 %). Conversely, selenium, cadmium, chromium, and mercury exposure did not exhibit any association with the risk of GDM in our study.

Discussion  Our research indicates that the existence of harmful metalloestrogens in the surroundings has a notable effect on the likelihood of GDM. Hence, we stress the significance of environmental elements in the development of GDM and the pressing need for relevant policies and measures.

Keywords  Antimony; Arsenic; Copper; Gestational diabetes mellitus; Metalloestrogens.

背景  金属雌激素是随处可见的具有雌激素活性的金属和类金属元素。随着人类活动的增加，金属雌激素对人类健康的影响日益明显。

目的  我们的目的是对探索金属雌激素（特别是砷、锑、铬、镉、铜、硒、汞）与妊娠糖尿病（GDM）之间相关性的观察性研究进行全面的系统回顾和荟萃分析。

方法  检索PubMed、Web of Science和Embase，研究金属雌激素（As、Sb、Cr、Cd、Cu、Se和Hg）与妊娠糖尿病（GDM）之间的联系，直至2023年12月。采用随机效应模型得出风险估计值。根据研究国家、暴露样本、暴露评估方法和检测方法进行了分组分析。为评估研究结果的强度，还进行了敏感性分析和发表偏倚调整。

结果  初步确定的 389 篇文章中，350 篇符合我们的标准，33 篇被纳入荟萃分析，涉及 141 175 名受试者（9450 例病例，131 725 例对照）。砷、锑和铜暴露在一定程度上可能会增加患 GDM 的风险（砷、锑和铜的 OR = 1.28，95 %）： OR=1.28，95 % CI [1.08，1.52]；Sb： OR=1.73，95 % CI [1.13，2.65]；Cu： OR=1.29，95 % CI [1.02，1.63]），尽管存在高度异质性（As： Q=52.93，P<0.05，I2=64.1%；Sb： Q = 31.40，p < 0.05，I2= 80.9 %；Cu： Q = 21.14，p < 0.05，I2= 71.6 %）。相反，在我们的研究中，硒、镉、铬和汞的暴露与 GDM 的风险没有任何关联。

讨论  我们的研究表明，周围环境中存在的有害金属雌激素对 GDM 的发生有显著影响。因此，我们强调环境因素在 GDM 发病中的重要性，以及制定相关政策和措施的迫切性。