Liu Yan,Han Rong,Wu Shengde.Clinical trials of associations between environmental particulate matter and hypospadias: a scoping review[J].Journal of Clinical Pediatric Surgery,2026,(01):43-48.[doi:10.3760/cma.j.cn101785-202312064]
环境颗粒物和尿道下裂相关性的临床研究:范围性综述
- Title:
- Clinical trials of associations between environmental particulate matter and hypospadias: a scoping review
- Keywords:
- Particular Matter; Hypospadias; Surgical Procedures; Operative; Child
- 摘要:
- 目的 总结分析环境颗粒物和尿道下裂关系的相关研究,发现当前领域的不足,为进一步研究提供参考。方法 通过检索中国知网、万方医学网、中文科技期刊数据库、PubMed、Web of Science、Embase、Cochrane Library数据库,检索时间自1930年1月1日至2023年11月3日。筛选针对“环境颗粒物和尿道下裂相关性”开展的临床研究类文献并下载。采用范围性综述的研究方法,运用Microsoft Excel对文献的发表国家、发表时间、研究类型、颗粒物特征、颗粒物和尿道下裂的关系等信息进行整合分析。结果 本研究共检索到3 582篇文献,经过初筛和复筛后,最终纳入19篇文献(中国知网4篇,万方医学网3篇,PubMed 3篇,Web of Science 9篇,中文科技期刊数据库0篇,Embase 0篇,Cochrane Library数据库0篇),其中发文量最多的国家是中国(n=11);2021年发文量最多(6篇),占总文献量的31.6%(6/19);共包括9项回顾性队列研究、9项病例对照研究(其中包含1项病例交叉研究)、1项横断面调查;19项研究中纳入的协变量包括产母资料(年龄、文化程度、种族、产次等)、孕期情况(受孕季节、孕期是否使用叶酸、孕期是否吸烟或饮酒等)、婴儿情况(出生缺陷类型)、社会经济指数、污染物、气象因素等。主要应用的统计学方法为Logistic回归,有4项研究利用了时间序列分析的方法。在纳入的19项研究中,可吸入颗粒物(particulate matter,PM)暴露窗口期多样,主要通过固定监测点收集数据,部分研究采用模型校正暴露物浓度;多地颗粒物浓度数据被报道,且多超出国家空气质量标准;部分研究分析发现季节和人类活动对PM浓度具有影响。4项研究报道了气象因素与大气污染物之间具有相关性。10项研究(包括6项回顾性队列研究、3项病例对照研究、1项横断面调查)关注空气污染和出生缺陷的相关性,仅将尿道下裂作为结局指标的一部分。9项研究(包括3项回顾性队列研究、6项病例对照研究)对环境颗粒物与尿道下裂的相关性进行了探讨,其中4项报告指出孕期PM2.5的暴露和尿道下裂的发生有关,2项报告二者呈无意义正相关,2项报告二者呈零关联,1项报告二者呈无意义负相关。对不同研究中报道的PM浓度和尿道下裂发病率进行对比,发现PM浓度越高的地区尿道下裂的发病率越高。结论 孕期颗粒物暴露会增加尿道下裂的发生风险,尤其在孕早期。即使在未对二者相关性进行探讨的研究中也可发现,颗粒物浓度越高,尿道下裂的发病率越高。未来还需进行更大样本的队列研究,纳入气象因素、尿道下裂分型、生物学指标等相关因素。
- Abstract:
- Objective To conduct a scoping review of the relationship between environmental particulate matter and hypospadias,identify gaps in the current field and provide references for further researches. Methods Seven major literature databases,including CNKI (China National Knowledge Infrastructure),Wanfang Medical Database,VIP (Chinese Science & Technology Periodical Database),PubMed,Web of Science,Embase and Cochrane Library,were searched for identifying and downloading clinical studies examining the correlation between environmental particulate matter and hypospadias.A scoping review methodology was employed,utilizing Microsoft Excel software for collating such research profiles as country of origin,publication year,study type,characteristics of particulate matter and the relationship between particulate matter and hypospadias.The search period spanned from January 1,1930 to November 3,2023. Results A total of 3,582 articles were retrieved.After initial and secondary screening,19 articles were ultimately included (4 from CNKI,3 from Wanfang Medical Database,3 from PubMed and 9 from Web of Science,0 from VIP, 0 from Embase and 0 from Cochrane Library) with China contributing the largest number of publications (n=11).The year 2021 saw the highest publication volume with 6 articles accounting for 31.6%(6/19) of total.These studies comprised 9 retrospective cohort studies,9 case-control studies (including one case-crossover study) and 1 cross-sectional survey.The covariates of 19 studies encompassed maternal profiles (age,education level,ethnicity & parity,etc.),pregnancy status (season of conception,gestational folate dosing,smoking/alcohol consumption during pregnancy,etc.),infant status (types of birth defects),socioeconomic indices,other pollutants and meteorological factors,etc.The primary statistical method was Logistic regression with 4 studies utilizing time-series analysis.Among 19 included studies,PM exposure windows were diverse and data primarily collected through fixed monitoring stations,with some studies using models for adjusting exposure concentrations.Particulate matter concentrations reported from multiple locations were often higher than national air quality standards.Some studies revealed that seasons and human activities influenced PM concentrations.Four studies focused upon the correlations between meteorological factors and air pollutants.10 studies (including 6 retrospective cohort studies,3 case-control studies,and 1 cross-sectional survey) explored the association between air pollution and birth defects,with hypospadias included as part of the outcome indicators.A total of 9 studies (including 3 retrospective cohort studies and 6 case-control studies) explored the correlation between environmental particulate matter and hypospadias with 4 studies hinting at an association between exposure to PM2.5 during pregnancy and the occurrence of hypospadias.The remaining studies addressed a non-significant positive correlation,no correlation and a non-significant negative correlation,respectively.Furthermore,a comparison of PM concentrations and hypospadias incidence rates in different studies indicated that areas with higher PM concentrations tended to have higher incidence rates of hypospadias. Conclusions Exposure to particulate matter during pregnancy,especially in the first trimester,may elevate the risk of hypospadias.Even in studies not explicitly exploring this correlation,a trend was observed where higher particulate matter concentration was associated with a higher incidence of hypospadias.Future researches should include larger cohort studies,incorporating such the relevant factors as meteorological factors,hypospadias subtypes and biological parameters.
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备注/Memo
收稿日期:2023-12-28。
基金项目:国家自然科学基金(82071632)
通讯作者:吴盛德,Email:shengdewu@hospital.cqmu.edu.cn