刘思雨, 张明. 有机溶剂与噪声联合暴露对听力损伤影响的meta分析[J]. 环境与职业医学, 2021, 38(6): 631-636. DOI: 10.13213/j.cnki.jeom.2021.20487
引用本文: 刘思雨, 张明. 有机溶剂与噪声联合暴露对听力损伤影响的meta分析[J]. 环境与职业医学, 2021, 38(6): 631-636. DOI: 10.13213/j.cnki.jeom.2021.20487
LIU Siyu, ZHANG Ming. Effects of combined exposure to organic solvents and noise on hearing loss: A meta-analysis[J]. Journal of Environmental and Occupational Medicine, 2021, 38(6): 631-636. DOI: 10.13213/j.cnki.jeom.2021.20487
Citation: LIU Siyu, ZHANG Ming. Effects of combined exposure to organic solvents and noise on hearing loss: A meta-analysis[J]. Journal of Environmental and Occupational Medicine, 2021, 38(6): 631-636. DOI: 10.13213/j.cnki.jeom.2021.20487

有机溶剂与噪声联合暴露对听力损伤影响的meta分析

Effects of combined exposure to organic solvents and noise on hearing loss: A meta-analysis

  • 摘要: 背景

    噪声性听力损伤已经成为目前世界上最普遍的职业病之一,引起职业人群听力损伤的机制复杂。有机溶剂作为一种耳毒性毒物,已被证实可联合噪声暴露,增强对职业人群听力的损害。

    目的

    使用meta分析的方法探讨与单纯暴露于噪声相比,职业人群联合暴露于有机溶剂以及噪声对听力损伤增加的风险。

    方法

    通过检索中国知网、中国生物医学文献、万方、维普、Medline及Pubmed等数据库,获取国内外2020年1月前公开发表的所有研究联合暴露于有机溶剂和职业性噪声对听力损伤影响的中英文文献。横断面研究采用美国卫生保健研究和质量机构推荐量表(AHRQ),病例对照研究和队列研究应用纽卡斯尔-渥太华量表(NOS)对纳入的文献进行质量评价;纳入文献的数据以及效应量采用STATA 16.0进行统计分析。经异质性分析后,采用随机效应模型对纳入文献的效应量进行合并。对纳入的文献进行敏感性分析以及发表偏倚的分析,对纳入文献中存在的混杂因素进行meta回归分析和累积meta分析。

    结果

    本研究经AHRQ评价工具及NOS量表评价后共纳入19篇文献,且文献质量均较高,总共提供了9 039个研究对象的信息。纳入的原始研究文献存在异质性(Q=110.11,P < 0.005,I2=84.16%),应用随机效应模型对纳入的效应量OR值进行合并,得到合并OR值为2.32(95%CI:1.75~3.07)。异质性检验结果显示,有机溶剂暴露浓度、暴露时间、发表时间、年龄以及噪声强度等自变量的meta回归分析显示均无统计学意义,样本量为造成异质性的主要因素(P=0.01)。经累积meta分析,这种异质性不会随发表时间的累积而改变。效应量OR经敏感性分析后结果稳定,纳入文献经Egger和Begg检验后不存在发表偏倚(Z=0.10,P=0.92;t=0.05,P=0.97)。

    结论

    经现有数据meta分析认为,与单纯暴露于噪声相比,职业人群联合暴露于噪声与有机溶剂患听力损伤的风险增加。

     

    Abstract: Background

    Noise-induced hearing loss has become one of the most common occupational diseases in the world. However, the mechanism of hearing loss is very complex. Organic solvents as one of the ototoxic poisons have been confirmed to combine noise exposure to enhance hearing damage in working populations.

    Objective

    The meta-analysis investigates the effects of combined exposure to organic solvents and occupational noise and individual exposure to occupational noise on hearing loss and the increased risks.

    Methods

    By searching China National Knowledge Network (CNKI), Chinese Biomedical Literature (CBM), Wanfang, VIP, Medline, and Pubmed databases, domestic and foreign literature on the effects of combined exposure to organic solvents and occupational noise on hearing loss before January 2020 were retrieved. Cross-sectional studies were evaluated using the Agency for Healthcare Research and Quality (AHRQ) evaluation tool, and case-control studies and cohort studies using the Newcastle-Ottawa Scale. Effect values and supplement data included in the literature were analyzed using STATA 16.0. After heterogeneity analysis, a random effect model was used to merge the effect values. Sensitivity analysis and publication bias analysis were conducted for the included literatures, and meta-regression analysis and cumulative meta-analysis were conducted for the confounding factors in the included literatures.

    Results

    A total of 19 high-quality papers were included in this study after the evaluation by AHRQ and NOS scales, and a total of 9 389 subjects were provided with information. There was heterogeneity (Q=110.11, P < 0.005, I2=84.16%). After adjustment, the odds ratio of hearing loss due to combined exposure to organic solvents and noise to noise exposure alone was 2.32 (95% CI: 1.75-3.07). The results of meta-regression analysis showed that independent variables such as organic solvent exposure concentration, exposure time, publication year, age, and noise intensity showed no statistical significance and sample size was the only contributor. Based on the results of cumulative meta-analysis, this heterogeneity did not change with the accumulation of publication time. The effect size OR was stable after sensitivity analysis, and there was no publication bias in the included literatures tested by Egger and Begg (Z=0.10, P=0.92; t=0.05, P=0.97).

    Conclusion

    Based on the meta-analysis results of existing data, it is believed that combined exposure to noise and organic solvents increases the risk of hearing loss compared with exposure to noise alone.

     

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