Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis.
Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis.
复制标题
成人血铅水平与肾损害关系的Meta分析
DOI：
10.3390/ijerph18084174
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发表时间：
2021-04-15
影响因子：
--
通讯作者：
Kotepui M
中科院分区：
文献类型：
--
作者：
Kuraeiad S;Kotepui M
背景：从事铅相关职业或环境铅暴露的成年人可能存在肾功能损害和铅肾病的风险。本荟萃分析旨在确定血铅水平（BLL）对中年参与者肾功能的影响。方法：从PubMed、Scopus和ISI Web of Science检索报道成年受试者BLL和肾功能测试的横断面、纵向或队列研究。纳入相关研究，并使用纽卡斯尔-渥太华量表（NOS）对质量进行评估。使用随机效应模型估计高BLL（≥30µg/dL）、中等BLL（20 - 30µg/dL）和低BLL（<20µg/dL）参与者的汇总平均BLL。使用随机效应模型估计暴露和未暴露参与者之间BLL、血尿素氮（BUN）、肌酐、尿酸和肌酐清除率的汇总平均差异。进行meta回归以证明合并平均BLL的效应大小（ES）与肾功能之间的关联。采用Cochrane Q和I2统计评估纳入研究的异质性。Cochrane Q < 0.05, I2 > 50%表明纳入的研究存在显著的异质性。采用效应量与效应量标准误差之间的漏斗图评估发表偏倚。结果：1657篇文章中，43篇被纳入meta分析。荟萃分析显示，高BLL、中度BLL和低BLL参与者的汇总平均BLL分别为42.41µg/dL（95%置信区间（CI）： 42.14-42.67, I2: 99.1%）、22.18µg/dL （95% CI: 21.68-22.68, I2: 60.4%）和2.9µg/dL （95% CI: 2.9 - 2.9, I2: 100%）。暴露者的平均BLL高于未暴露者（加权平均差值（WMD）： 25.5, p < 0.0001, 95% CI: 18.59 ~ 32.45, I2: 99.8%， 17项研究）。暴露者的平均BUN （WMD: 1.66, p < 0.0001, 95% CI: 0.76-2.55, I2: 76%， 10项研究）和平均肌酐（WMD: 0.05, p = 0.007, 95% CI: 0.01-0.08, I2: 76.8%， 15项研究）高于未暴露者。暴露者的平均肌酐清除率低于未暴露者（标准平均差（SMD）： - 0.544, p = 0.03, 95% CI: - 1.035 - (- 0.054), I2: 96.2%）。meta回归显示，BLL对BUN有显著的正影响（p = 0.022，系数：0.75，常数：−3.7,10项研究）。结论：BLL与高BUN、高肌酐、低肌酐清除率等肾功能指标异常有关。此外，BUN似乎是铅致肾功能损害最有价值的预后指标。因此，定期检查铅接触工人的肾功能应该是一个优先事项，并公开推广。
Background: The adult population in lead-related occupations or environmentally exposed to lead may be at risk for renal impairment and lead nephropathy. This meta-analysis aims to determine the impact of blood lead level (BLL) on renal function among middle-aged participants. Methods: Cross-sectional, longitudinal, or cohort studies that reported BLL and renal function tests among adult participants were retrieved from PubMed, Scopus, and ISI Web of Science. Relevant studies were included and assessed for quality using the Newcastle–Ottawa Scale (NOS). The pooled mean BLL of participants with a high BLL (≥30 µg/dL), moderate BLL (20–30 µg/dL), and low BLL (<20 µg/dL) was estimated using the random effects model. The pooled mean differences in BLL, blood urea nitrogen (BUN), creatinine, uric acid, and creatinine clearance between the exposed and non-exposed participants were estimated using the random effects model. Meta-regression was performed to demonstrate the association between the effect size (ES) of the pooled mean BLL and renal function. Heterogeneity among the included studies was assessed using the Cochrane Q and I2 statistics. Cochrane Q with a p value less than 0.05 and I2 more than 50% demonstrated substantial heterogeneity among the studies included. Publication bias was assessed using the funnel plot between the effect size and standard error of the effect size. Results: Out of 1657 articles, 43 were included in the meta-analysis. The meta-analysis demonstrated that the pooled mean BLL in the participants with a high BLL, moderate BLL, and low BLL was 42.41 µg/dL (95% confidence interval (CI): 42.14–42.67, I2: 99.1%), 22.18 µg/dL (95% CI: 21.68–22.68, I2: 60.4%), and 2.9 µg/dL (95% CI: 2.9–2.9, I2: 100%), respectively. The mean BLL of the exposed participants was higher than that of the non-exposed participants (weighted mean difference (WMD): 25.5, p < 0.0001, 95% CI: 18.59–32.45, I2: 99.8%, 17 studies). The mean BUN (WMD: 1.66, p < 0.0001, 95% CI: 0.76–2.55, I2: 76%, 10 studies) and mean creatinine (WMD: 0.05, p = 0.007, 95% CI: 0.01–0.08, I2: 76.8%, 15 studies) in the exposed participants were higher than those in the non-exposed participants. The mean creatinine clearance in the exposed participants was lower than that in the non-exposed participants (standard mean difference (SMD): −0.544, p = 0.03, 95% CI: −1.035–(−0.054), I2: 96.2%). The meta-regression demonstrated a significant positive effect of BLL on BUN (p = 0.022, coefficient: 0.75, constant: −3.7, 10 studies). Conclusions: BLL was observed to be associated with abnormal renal function test parameters, including high BUN, high creatinine, and low creatinine clearance. Moreover, BUN seemed to be the most valuable prognostic marker for lead-induced renal impairment. Therefore, regular checks for renal function among lead-exposed workers should be a priority and publicly promoted.
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作者：
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