出生后镉暴露对儿童体格和青春发育影响的系统评价及Meta分析

黄添文婧; 彭泽钦; 刘琴

doi:10.16835/j.cnki.1000-9817.2025088

出生后镉暴露对儿童体格和青春发育影响的系统评价及Meta分析

doi: 10.16835/j.cnki.1000-9817.2025088

重庆医科大学公共卫生学院/环境与人群健康研究中心/医学与社会发展研究中心，重庆 401331

基金项目:

重庆医科大学未来医学青年创新团队发展支持计划项目 W0054

详细信息

作者简介:
黄添文婧(1997-)，女，四川省人，在读硕士，主要研究方向为儿童青少年发育与健康

通讯作者:
刘琴，E-mail：liuqin@cqmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R339.3⁺⁵ N945.1
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- 被引次数: 0
出版历程
- 收稿日期: 2024-09-26
- 修回日期: 2025-02-05
- 网络出版日期: 2025-04-03
- 刊出日期: 2025-03-25

Effects of postnatal cadmium exposure on physical and pubertal development in children: a systematic review and Meta-analysis

School of Public Health, Chongqing Medical University/Research Center for Environment and Human Health/Research Center for Medicine and Social Development, Chongqing (401331), China

摘要

摘要: 目的系统评价出生后镉暴露对儿童青春发育和体格发育的影响，为后期开展镉暴露相关研究提供参考依据。方法检索PubMed、EBSCO、Web of Science、OVID、中国知网、万方、维普、中国生物医学文献数据库搜集相关研究，检索时间为建库至2024年2月27日。由2名研究者独立筛选文献、提取资料，评价纳入研究的偏倚风险，并使用定量系统评价证据分级工具(GRADE)分级标准评估每个结局指标的证据质量。使用Stata 17.0软件对发生月经初潮的风险比(HR)进行Meta分析，对其他指标采用定性方法归纳总结。结果共纳入6项队列研究，包含4项青春发育和2项体格发育研究，共计2 899名儿童。镉暴露与女童月经初潮的研究均发现尿镉质量体积浓度高的儿童月经初潮到来的更迟(HR=0.86，95%CI=0.74~0.99，P < 0.05；3项研究；中等质量证据)，其中1项研究发现镉暴露对儿童乳房和阴毛发育的影响无统计学意义(aOR=0.90，95%CI=0.72~1.14；aOR=0.85，95%CI=0.64~1.13，P值均＞0.05，低质量证据)；仅1项关于男童睾丸体积、外生殖器和阴毛发育的研究发现尿镉与青春发育的关联无统计学意义(aOR=0.76，95%CI=0.50~1.15；aOR=1.07，95%CI=0.79~1.45；aOR=0.79，95%CI=0.51~1.23，P值均＞0.05，低质量证据)。关于镉暴露对儿童身高、体重的影响(2项研究；低质量证据)，其中1项研究结果显示，镉暴露与儿童体格生长发育呈负相关(身高和体重的多变量调整归因差异分别为-1.60 cm，95%CI=-2.40~-0.77 cm；-0.57 kg，95%CI=-0.88~-0.26 kg，P值均 < 0.05)，另1项研究表明镉暴露对儿童的身高和体重无影响(F值分别为1.35，1.76，P值均＞0.05)，但对头围和胸围产生负向影响(F值分别为3.43，4.50，P值均 < 0.05；低质量证据)。结论儿童时期镉暴露会导致女童月经初潮延迟，在一定程度上影响儿童的体格发育。
- 镉 /
- 体格生长 /
- 青春期发育 /
- Meta分析 /
- 儿童
Abstract: Objective To systematically evaluate the effects of postnatal cadmium exposure on children's pubertal and physical development, so as to provide reference for the latter research on cadmium exposure. Methods A computer search of PubMed, EBSCO, Web of Science, OVID, CNKI, WanFang, VIP and CBM database were conducted to collect relevant studies, and the search period was from the time of database construction to 27 February 2024. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies, and used GRADE to assess the certainty of the evidence for each outcome. Meta-analysis of the risk ratio (HR) for the occurrence of menarche was performed using Stata 17.0 software, and the results were summarized qualitatively for other indicators. Results A total of 6 cohort studies were included, comprising four pubertal development and two physical development studies with a total of 2 899 children. Studies of cadmium exposure and menarche in girls all found that late menarche in children with higher urinary cadmium concentrations (HR=0.86, 95%CI=0.74-0.99, P < 0.05; 3 studies; moderate-certainty evidence), and one of these studies found no statistically significant effect of cadmium exposure on breast and pubic hair development in children (aOR=0.90, 95%CI=0.72-1.14; aOR=0.85, 95%CI=0.64-1.13, P>0.05; low-quality evidence); the only study testicular volume, external genitalia and pubic hair development in boys found on effects of urinary cadmium exposure on pubertal development (aOR=0.76, 95%CI=0.50-1.15; aOR=1.07, 95%CI=0.79-1.45; aOR=0.79, 95%CI=0.51-1.23, P>0.05; low-certainty evidence). Regarding the effects of cadmium exposure on children's height and weight (2 studies, low-certainty evidence), the results of one study showed that cadmium exposure was negatively associated with children's physical growth (multivariable-adjusted attributable differences in height and weight study, being -1.60 cm, 95%CI=-2.40 to -0.77 cm; and -0.57 kg, 95%CI=-0.88 to -0.26 kg, P < 0.05), while the other showed no effect of cadmium exposure on children's height and weight (F=1.35, 1.76, P>0.05), but a negative effect on head and chest circumference (F=3.43, 4.50, P < 0.05; low-certainty evidence). Conclusion Cadmium exposure in childhood causes delayed menarche in girls and affects physical growth to some extent.
- Cadmium /
- Physical growth /
- Adolescent development /
- Meta-analysis /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 出生后镉暴露对儿童青春发育和体格发育影响文献筛选流程

Figure 1. Literature screening process for the effects of postnatal cadmium exposure on children's pubertal and physical development

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图 2 不同质量体积浓度镉暴露对女童月经初潮影响的亚组分析

Figure 2. Subgroup analysis for the effect of different mass volume concentrations of cadmium exposure on menarche in girls

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表 1 出生后镉暴露对儿童青春发育和体格发育影响纳入文献的基本特征

Table 1. Basic characteristics of the included literature on the effects of postnatal cadmium exposure on children's pubertal and physical development

第一作者与年份	国家地区	样本来源	基线样本量	分组情况	生物样本	镉暴露检测年龄/岁	结局指标	结局指标随访时间
Reynolds(2020)^[10]	美国	社区、学校	女：211	按照尿镉质量体积浓度(μg/L)分为4组：1组(< 0.2)；2组(0.2~0.3)；3组(0.3~0.4)；4组(≥0.4)	尿	10~13	月经初潮时间	每月1次，共随访2年
Ashrap(2019)^[11]	墨西哥	医院	女：132	未分组	尿	8~13	月经初潮时间，阴毛发育期、乳房发育Tanner分期	14~18岁
Ashrap(2020)^[12]	墨西哥	医院	男：118	未分组	尿	8~14	外生殖器发育期、阴毛发育Tanner分期，睾丸体积	10~18岁
Malin Igra (2023)^[13]	孟加拉国	社区	女：750	按照尿镉质量体积浓度(μg/L)四分位数分为4组：Q1(0.12~0.16)、Q2(0.16~0.23)、Q3(0.23~0.36)、Q4(0.36~3.80)	尿	5	月经初潮时间	每6个月随访1次，12~15岁
				按照尿镉质量体积浓度(μg/L)四分位数分为4组：Q1(0.02~0.17)、Q2(0.17~0.25)、Q3(0.26~0.39)、Q4(0.39~2.90)	尿	10
Gardner(2013)^[14]	孟加拉国	社区	总：1 505(男：794，女：711)	5岁时：(1)尿镉质量体积浓度高(≥P₉₅)、尿镉质量体积浓度低(≤P₅)；(2)<0.16，0.16~<0.27，≥0.27 μg/L	尿	1.5；5	身高、体重	(1)出生后第1年每月1次；(2)出生后第2年每3个月1次；(3)第5年
姜帅(2014)^[15]	中国	医院	横：461(男：236、女：225) 纵：184	(1)根据尿镉质量体积浓度的P₂₅、P₇₅分为低、中、高3组；尿镉极高值≥P₉₅，尿镉极低值≤P₂₅。(2)未分组：尿镉质量体积浓度对数值	尿	1；2；3	身高、体重、头围、胸围	(1)2岁；(2)3岁

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表 2 出生后镉暴露对儿童青春发育和体格发育影响纳入研究的偏倚风险评分

Table 2. Evaluation of bias risk of included studies on the effect of postnatal cadmium exposure on children's pubertal and physical development

第一作者与年份	研究对象的代表性	研究对象的选择	暴露因素的测量方法	感兴趣的结局在干预前是否发生	是否考虑混杂因素	研究组和对照组是否相似	对研究对象的结局进行准确无偏倚的评估	结果的随访时间是否足够长	随访质量是否高	总分
Reynolds(2020)^[10]	1	1	1	1	1	1	1	0	1	8
Ashrap(2019)^[11]	1	0	1	1	1	0	1	1	0	6
Ashrap(2020)^[12]	1	0	1	1	1	0	1	1	1	7
Malin Igra(2023)^[13]	1	1	1	1	1	1	0	1	0	7
Gardner(2013)^[14]	1	1	1	1	1	1	1	1	1	9
姜帅(2014)^[15]	1	1	1	1	1	1	1	1	0	8

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