A Meta-analysis of Arsenic Exposure and Lung Function: Is There Evidence of Restrictive or Obstructive Lung Disease?
A Meta-analysis of Arsenic Exposure and Lung Function: Is There Evidence of Restrictive or Obstructive Lung Disease?
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DOI：
10.1007/s40572-018-0192-1
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发表时间：
2018-06
影响因子：
7.9
通讯作者：
Navas-Acien A
中科院分区：
文献类型：
--
作者：
Sanchez TR;Powers M;Perzanowski M;George CM;Graziano JH;Navas-Acien A
全世界有数亿人通过受污染的水接触到砷。本研究的目的是确定砷相关的肺功能缺陷是否类似于阻塞性或限制性肺疾病，以帮助阐明机制途径并确定高危人群。我们最近发表了一篇定性系统综述，概述了砷和非恶性呼吸结果的研究。来自不同生命阶段和不同暴露水平的几个人群的证据表明，砷暴露与慢性肺病死亡率、呼吸系统症状和肺功能水平低下有一致的关联。然而，已发表的综述仅对已发表的研究进行了广泛的定性描述，没有考虑特定的肺活量测定模式，没有进行荟萃分析，也没有评估剂量-反应关系。我们检索了PubMed和Embase关于环境砷暴露和肺功能的研究。我们使用反方差加权随机效应模型进行了荟萃分析，总结了砷与一秒钟用力呼气量（FEV1）、用力肺活量（FVC）和FEV1/FVC比值的调整后效应估计。在9项研究中，水中砷的中位数为23至860 μg/L。每项研究中，FEV1的最高砷暴露类别（范围从11至800 μg/L）与最低砷暴露类别（范围从<10至<100 μg/L）的综合估计平均差异（MD）为- 42(95%置信区间（CI）： - 70至- 16)mL， FVC为- 50 (95%CI: - 63至- 37)mL。三项研究报告了FEV1/FVC的效应估计，但没有证据表明两者之间存在关联；合并估计MD为0.01 （95%CI: - 0.005, 0.024）。本综述支持砷与限制性损伤相关，基于砷与FEV1和FVC之间的负相关关系，但与FEV1/FVC无关。未来的研究应该确认低水平砷暴露是否是一个限制性肺部疾病风险因素，以便在美国确定高危人群。
Hundreds of millions of people worldwide are exposed to arsenic via contaminated water. The goal of this study was to identify whether arsenic-associated lung function deficits resemble obstructive- or restrictive-like lung disease, in order to help illuminate a mechanistic pathway and identify at-risk populations. We recently published a qualitative systematic review outlining the body of research on arsenic and non-malignant respiratory outcomes. Evidence from several populations, at different life stages, and at different levels of exposure showed consistent associations of arsenic exposure with chronic lung disease mortality, respiratory symptoms, and lower lung function levels. The published review, however, only conducted a broad qualitative description of the published studies without considering specific spirometry patterns, without conducting a meta-analysis, and without evaluating the dose-response relationship. We searched PubMed and Embase for studies on environmental arsenic exposure and lung function. We performed a meta-analysis using inverse-variance weighted random-effects models to summarize adjusted effect estimates for arsenic and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Across nine studies, median water arsenic levels ranged from 23 to 860 μg/L. The pooled estimated mean difference (MD) comparing the highest category of arsenic exposure (ranging from >11 to >800 μg/L) versus the lowest (ranging from <10 to <100 μg/L) for each study for FEV1 was −42 (95% confidence interval (CI): −70, −16) mL and for FVC was −50 (95%CI: −63, −37) mL. Three studies reported effect estimates for FEV1/FVC, for which there was no evidence of an association; the pooled estimated MD was 0.01 (95%CI: −0.005, 0.024). This review supports that arsenic is associated with restrictive impairments based on inverse associations between arsenic and FEV1 and FVC, but not with FEV1/FVC. Future studies should confirm whether low-level arsenic exposure is a restrictive lung disease risk factor in order to identify at-risk populations in the US.
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