电离辐射对职业人群抗氧化酶活性和丙二醛含量影响的Meta分析
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摘要
系统评价电离辐射对职业人群抗氧化酶活性及脂质过氧化水平的影响。计算机检索中国知网、维普、万方、Cochrane Library、Web of Science、Pubmed、Embase数据库,搜索电离辐射对职业人群抗氧化酶活性和丙二醛(MDA)水平影响有关的文献,检索时限均为建库至2018年9月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,利用Stata12.0软件进行Meta分析。共纳入14篇文献,暴露组1 733例,非暴露组1 796例。Meta分析结果显示,与非暴露组相比,暴露组丙二醛含量和超氧化物歧化酶活性均升高(标准化均数差(SMD)=1.284,95%CI:0.74～1.828,p=0;SMD=0.681,95%CI:0.056～1.306,p=0.033),但谷胱甘肽过氧化物酶活性(SMD=-0.106,95%CI:-0.458～0.246,p=0.554)和过氧化氢酶活性(SMD=1.175,95%CI:-0.331～2.681,p=0.126)在两组间差异无统计学意义。放射工种亚组分析发现,与对照组相比,医疗、工业探伤和其他暴露组丙二醛含量显著升高,医疗暴露组超氧化物歧化酶活性显著升高,工业探伤暴露组超氧化物歧化酶活性显著降低。工龄亚组分析发现,与对照组相比,工龄≥12.56 a的暴露组丙二醛含量和超氧化物歧化酶活性显著升高。年有效剂量亚组分析发现,与对照组相比,剂量<1.19 mSv/a和剂量≥1.19 m Sv/a暴露组丙二醛含量均显著升高,剂量≥1.19 mSv/a暴露组超氧化物歧化酶活性显著降低。结果提示,电离辐射可引起职业人群脂质过氧化损伤,使丙二醛含量升高,对抗氧化酶活性的影响有待进一步研究。
In order to review the influence of ionizing radiation on antioxidant enzyme activity and malondialdehyde(MDA) levels, relevant literatures databases, such as the China National Knowledge Infrastructure(CNKI), VIP database, Wanfang database, The Cochrane Library, Web of Science, Pubmed, and EMbase, were searched until September 2018. Two reviewers independently screened these papers and evaluated the risk of bias.The extracted data were analyzed using Stata 12.0 software. A total of 14 literatures involving 1 733 radiation workers and 1 796 controls were included. The results of meta-analysis showed that the level of malondialdehyde and the activity of superoxide dismutase increased in the exposed than in the unexposed group(SMD=1.284, 95%CI: 0.74～1.828, p=0; SMD=0.681, 95% CI: 0.056～1.306, p=0.033), while there was no statistical significance observed in the activity of glutathione peroxidase and catalase, respectively(SMD=-0.106, 95% CI:-0.458～0.246, p=0.554; SMD=1.175, 95% CI:-0.331～2.681, p=0.126). The subgroup analysis stratified by work showed that compared with the unexposed group, the level of malondialdehyde was increased in themedical, industrial detecting and other groups, while the activity of superoxide dismutase was increased in medical group but decreased in industrial detecting group. The subgroup analysis stratified by work year showed that, compared with the unexposed group, the level of malondialdehyde and the activity of superoxide dismutase were increased in groups whose work age was higher than 12.56 a. While the subgroup analysis stratified by annual effective dose showed that, compared with the unexposed group, the level of malondialdehyde was increased in all groups and the activity of superoxide dismutase was decreased in groups whose dose was higher than 1.19 mSv/a. The results indicate that ionizing radiation can cause damage of lipid peroxidation with increased malondialdehyde; however its influence on antioxidant enzymes still needs further research.
In order to review the influence of ionizing radiation on antioxidant enzyme activity and malondialdehyde(MDA) levels, relevant literatures databases, such as the China National Knowledge Infrastructure(CNKI), VIP database, Wanfang database, The Cochrane Library, Web of Science, Pubmed, and EMbase, were searched until September 2018. Two reviewers independently screened these papers and evaluated the risk of bias.The extracted data were analyzed using Stata 12.0 software. A total of 14 literatures involving 1 733 radiation workers and 1 796 controls were included. The results of meta-analysis showed that the level of malondialdehyde and the activity of superoxide dismutase increased in the exposed than in the unexposed group(SMD=1.284, 95%CI: 0.74～1.828, p=0; SMD=0.681, 95% CI: 0.056～1.306, p=0.033), while there was no statistical significance observed in the activity of glutathione peroxidase and catalase, respectively(SMD=-0.106, 95% CI:-0.458～0.246, p=0.554; SMD=1.175, 95% CI:-0.331～2.681, p=0.126). The subgroup analysis stratified by work showed that compared with the unexposed group, the level of malondialdehyde was increased in themedical, industrial detecting and other groups, while the activity of superoxide dismutase was increased in medical group but decreased in industrial detecting group. The subgroup analysis stratified by work year showed that, compared with the unexposed group, the level of malondialdehyde and the activity of superoxide dismutase were increased in groups whose work age was higher than 12.56 a. While the subgroup analysis stratified by annual effective dose showed that, compared with the unexposed group, the level of malondialdehyde was increased in all groups and the activity of superoxide dismutase was decreased in groups whose dose was higher than 1.19 mSv/a. The results indicate that ionizing radiation can cause damage of lipid peroxidation with increased malondialdehyde; however its influence on antioxidant enzymes still needs further research.
引文
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4董雪梅,陈松根,何丽华,等.134名放射诊疗工作人员脂质过氧化水平调查[J].中国辐射卫生,2015,24(6):624-625.DOI:10.13491/j.cnki.issn.1004-714x.2015.06.020.DONG Xuemei,CHEN Songgen,HE Lihua,et al.The level of lipid peroxidation in radiology workers occupationally exposed ionizing radiation[J].Chinese Journal of Radiological Health,2015,24(6):624-625.DOI:10.13491/j.cnki.issn.1004-714x.2015.06.020.
5 Atang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analysis[J].European Journal of Epidemiology,2010,25(9):603-605.DOI:10.1007/s10654-010-9491-z.
6董小梅.低剂量电离辐射职业接触人群的遗传损伤和氧化-抗氧化效应研究[D].重庆:第三军医大学,2015.DONG Xiaomei.Genetoxic effects and oxidativeantioxidative status in radiation workers occupationally exposed low dose ionizing radiation[D].Chongqing:Army Medical University,2015.
7彭珊茁,张春生,马晓光,等.放射工作人员脂质过氧化和抗氧化能力的调查[J].中国自然医学杂志,2003,5(3):147-150.PENG Shanzhuo,ZHANG Chunsheng,MA Xiaoguang,et al.Lipid peroxidation and oxidative-antioxidative capacity in radiology workers occupationally exposed ionizing radiation[J].Chinese Journal of Natural Medicine,2003,5(3):147-150.
8宣志强,娄域峰,叶安方,等.介入放射工作人员血清中抗氧化能力的检测与分析[J].中华放射医学与防护杂志,2013,33(4):415-417.DOI:10.3760/cma.j.issn.0254-5098.2013.04.022.XUAN Zhiqiang,LOU Yufeng,YE Anfang,et al.Antioxidative capacity in serum of interventional radiology worker[J].Chinese Journal of Radiological Medicine and Protection,2013,33(4):415-417.DOI:10.3760/cma.j.issn.0254-5098.2013.04.022.
9刘剑英,钟进义.核接触人员机体相关指标变化的比较研究[J].实用医药杂志,2009,26(9):64-66.DOI:10.14172/j.cnki.issn1671-4008.2009.09.005.LIU Jianying,ZHONG Jinyi.Comparative study on the changes of the related organism-indexes of radiationexposed personnels[J].Practical Journal of Medicine&Pharmacy,2009,26(9):64-66.DOI:10.14172/j.cnki.issn1671-4008.2009.09.005.
10张元军,李志刚,杨宪普.放射工作人员血清中SOD、MDA含量分析[J].中国辐射卫生,2005,14(3):213.DOI:10.13491/j.cnki.issn.1004-714x.2005.03.039ZHANG Yuanjun,LI Zhigang,YANG Xianpu.The level of SOD and MDA in serum of radiology worker[J].Chinese Journal of Radiological Health,2005,14(3):213.DOI:10.13491/j.cnki.issn.1004-714x.2005.03.039.
11聂木海,张全新,梁晚芸,等.322名放射从业人员脂质过氧化调查[J].中国卫生检验杂志,2005,15(8):968-969.NIE Muhai,ZHANG Quanxin,LIANG Wanyun,et al.The level lipid peroxidation of 322 radiology worker[J].Chinese Journal of Health Laboratory Technology,2005,15(8):968-969.
12张冰洁,尚丽丽,王建昌,等.医用X射线工作者体内SOD、GSH-Px活性及MDA含量的分析[J].中国辐射卫生,1999,8(4):245-246.ZHANG Bingjie,SHANG Lili,WANG Jianchang,et al.The activity of SOD and GSH-Px and the content of MDA in workers occupationally exposed X-rays[J].Chinese Journal of Radiological Health,1999,8(4):245-246.
13 K?uciński P,Wójcik A,Grabowska-Bochenek R,et al.Erythrocyte antioxidant parameters in workers occupational exposed to low levels of ionizing radiation[J].Annals of Agricultural and Environmental Medicine,2008,15(1):9-12.
14 Kumar D,Kumari S,Salian S R,et al.Genetic instability in lymphocytes is associated with blood plasma antioxidant levels in health care workers occupationally exposed to ionizing radiation[J].International Journal of Toxicology,2016,35(3):327-335.DOI:10.1177/1091581815625593.
15 Serhatlioqlu S,Gursu M F,Gulcu F,et al.Levels of paraoxonase and arylesterase activities and malondialdehyde in workers exposed to ionizing radiation[J].Cell Biochemistry and Function,2003,21(4):371-375.DOI:10.1002/cbf.1042.
16 Hajer D,Ghada B S,Latifa H,et al.Oxidative stress and glutathione S-transferase genetic polymorphisms in medical staff professionally exposed to ionizing radiation[J].International Journal of Radiation Biology,2017,93(7):697-704.DOI:10.1080/09553002.2017.1305132.
17 Kumar D,Salian S R,Kalthur G,et al.Association between sperm DNA integrity and seminal plasma antioxidant levels in health workers occupationally exposed to ionizing radiation[J].Environmental Research,2014,132:297-304.DOI:10.1016/j.envres.2014.04.023.
18 Eken A,Aydin A,Erdem O,et al.Induced antioxidant activity in hospital staff occupationally exposed to ionizing radiation[J].International Journal of Radiation Biology,2012,88(9):648-53.DOI:10.3109/09553002.2012.702295.
19 Kayan M,Naziro?lu M,Celik O,et al.Vitamin C and Ecombination modulates oxidative stress induced by X-ray in blood of smoker and nonsmoker radiology technicians[J].Cell Biochemistry and Function,2009,27(7):424-429.DOI:10.1002/cbf.1589.
20旷满华,杨青廷,翦耀文,等.儿童缺铁性贫血与血铅水平关系的meta分析[J].中华疾病控制杂志,2016,20(1):79-83.DOI:10.16462/j.cnki.zhjbkz.2016.01.020.KUANG Manhua,YANG Qingting,JIAN Yaowen,et al.Association between iron deficiency anemia and blood lead level in children:a meta-analysis[J].Chinese Journal of Disease Control&Prevention,2016,20(1):79-83.DOI:10.16462/j.cnki.zhjbkz.2016.01.020.
21 Seonq K M,Kwon T,Seo S,et al.Perception of low dose radiation risks among radiation researchers in Korea[J].PLoS One,2017,12(2):e0171777.DOI:10.1371/journal.pone.0171777.
22 Katsarska O,Zaharieva E,Aneva N,et al.The soluble receptor ST2 is positively associated with occupational exposure to radiation[J].International Journal of Radiation Biology,2016,92(2):87-93.DOI:10.3109/09553002.2016.1115135.
23 Wei W,He J,Wanq J,et al.Serum microRNAs as early indicators for estimation of exposure degree in response to ionizing irradiation[J].Radiation Research,2017,188(3):342-354.DOI:10.1667/RR14702.1.
24 Doukali H,Ben Salah G,Hamdaoui L,et al.Oxidative stress and glutathione S-transferase genetic polymorphisms in medical staff professionally exposed to ionizing radiation[J].International Journal of Radiation Biology,2017,93(7):697-704.DOI:10.1080/09553002.2017.1305132.
25朱正错.介入治疗中X射线对先天性心脏病患儿过氧化损伤的研究[D].合肥:安徽医科大学第一附属医院,2012.ZHU Zhengcuo.Genetoxic effects and oxidativeantioxidative status in radiation workers occupationally exposed low dose ionizing radiation[D].Hefei:The First Affiliated Hospital of Anhui Medical University,2012.
26 Puthran S S,Sudha K,Rao G M,et al.Oxidative stress and low dose ionizing radiation[J].Indian Journal of Pharmacology,2009,53(2):181-184.
2 Seawright J W,Samman Y,Sridharan V,et al.Effects of low-dose rateγ-irradiation combined with simulated microgravity on markers of oxidative stress,DNAmethylation potential,and remodeling in the mouse heart[J].PLoS One,2017,12(7):e0180594.DOI:10.1371/journal.pone.0180594.
3 Ahmad I M,Temme J B,Abdalla M Y,et al.Redox status in workers occupationally exposed to long-term low levels of ionizing radiation:a pilot study[J].Redox Report,2016,21(3):139-45.DOI:10.1080/13510002.2015.1101891.
4董雪梅,陈松根,何丽华,等.134名放射诊疗工作人员脂质过氧化水平调查[J].中国辐射卫生,2015,24(6):624-625.DOI:10.13491/j.cnki.issn.1004-714x.2015.06.020.DONG Xuemei,CHEN Songgen,HE Lihua,et al.The level of lipid peroxidation in radiology workers occupationally exposed ionizing radiation[J].Chinese Journal of Radiological Health,2015,24(6):624-625.DOI:10.13491/j.cnki.issn.1004-714x.2015.06.020.
5 Atang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analysis[J].European Journal of Epidemiology,2010,25(9):603-605.DOI:10.1007/s10654-010-9491-z.
6董小梅.低剂量电离辐射职业接触人群的遗传损伤和氧化-抗氧化效应研究[D].重庆:第三军医大学,2015.DONG Xiaomei.Genetoxic effects and oxidativeantioxidative status in radiation workers occupationally exposed low dose ionizing radiation[D].Chongqing:Army Medical University,2015.
7彭珊茁,张春生,马晓光,等.放射工作人员脂质过氧化和抗氧化能力的调查[J].中国自然医学杂志,2003,5(3):147-150.PENG Shanzhuo,ZHANG Chunsheng,MA Xiaoguang,et al.Lipid peroxidation and oxidative-antioxidative capacity in radiology workers occupationally exposed ionizing radiation[J].Chinese Journal of Natural Medicine,2003,5(3):147-150.
8宣志强,娄域峰,叶安方,等.介入放射工作人员血清中抗氧化能力的检测与分析[J].中华放射医学与防护杂志,2013,33(4):415-417.DOI:10.3760/cma.j.issn.0254-5098.2013.04.022.XUAN Zhiqiang,LOU Yufeng,YE Anfang,et al.Antioxidative capacity in serum of interventional radiology worker[J].Chinese Journal of Radiological Medicine and Protection,2013,33(4):415-417.DOI:10.3760/cma.j.issn.0254-5098.2013.04.022.
9刘剑英,钟进义.核接触人员机体相关指标变化的比较研究[J].实用医药杂志,2009,26(9):64-66.DOI:10.14172/j.cnki.issn1671-4008.2009.09.005.LIU Jianying,ZHONG Jinyi.Comparative study on the changes of the related organism-indexes of radiationexposed personnels[J].Practical Journal of Medicine&Pharmacy,2009,26(9):64-66.DOI:10.14172/j.cnki.issn1671-4008.2009.09.005.
10张元军,李志刚,杨宪普.放射工作人员血清中SOD、MDA含量分析[J].中国辐射卫生,2005,14(3):213.DOI:10.13491/j.cnki.issn.1004-714x.2005.03.039ZHANG Yuanjun,LI Zhigang,YANG Xianpu.The level of SOD and MDA in serum of radiology worker[J].Chinese Journal of Radiological Health,2005,14(3):213.DOI:10.13491/j.cnki.issn.1004-714x.2005.03.039.
11聂木海,张全新,梁晚芸,等.322名放射从业人员脂质过氧化调查[J].中国卫生检验杂志,2005,15(8):968-969.NIE Muhai,ZHANG Quanxin,LIANG Wanyun,et al.The level lipid peroxidation of 322 radiology worker[J].Chinese Journal of Health Laboratory Technology,2005,15(8):968-969.
12张冰洁,尚丽丽,王建昌,等.医用X射线工作者体内SOD、GSH-Px活性及MDA含量的分析[J].中国辐射卫生,1999,8(4):245-246.ZHANG Bingjie,SHANG Lili,WANG Jianchang,et al.The activity of SOD and GSH-Px and the content of MDA in workers occupationally exposed X-rays[J].Chinese Journal of Radiological Health,1999,8(4):245-246.
13 K?uciński P,Wójcik A,Grabowska-Bochenek R,et al.Erythrocyte antioxidant parameters in workers occupational exposed to low levels of ionizing radiation[J].Annals of Agricultural and Environmental Medicine,2008,15(1):9-12.
14 Kumar D,Kumari S,Salian S R,et al.Genetic instability in lymphocytes is associated with blood plasma antioxidant levels in health care workers occupationally exposed to ionizing radiation[J].International Journal of Toxicology,2016,35(3):327-335.DOI:10.1177/1091581815625593.
15 Serhatlioqlu S,Gursu M F,Gulcu F,et al.Levels of paraoxonase and arylesterase activities and malondialdehyde in workers exposed to ionizing radiation[J].Cell Biochemistry and Function,2003,21(4):371-375.DOI:10.1002/cbf.1042.
16 Hajer D,Ghada B S,Latifa H,et al.Oxidative stress and glutathione S-transferase genetic polymorphisms in medical staff professionally exposed to ionizing radiation[J].International Journal of Radiation Biology,2017,93(7):697-704.DOI:10.1080/09553002.2017.1305132.
17 Kumar D,Salian S R,Kalthur G,et al.Association between sperm DNA integrity and seminal plasma antioxidant levels in health workers occupationally exposed to ionizing radiation[J].Environmental Research,2014,132:297-304.DOI:10.1016/j.envres.2014.04.023.
18 Eken A,Aydin A,Erdem O,et al.Induced antioxidant activity in hospital staff occupationally exposed to ionizing radiation[J].International Journal of Radiation Biology,2012,88(9):648-53.DOI:10.3109/09553002.2012.702295.
19 Kayan M,Naziro?lu M,Celik O,et al.Vitamin C and Ecombination modulates oxidative stress induced by X-ray in blood of smoker and nonsmoker radiology technicians[J].Cell Biochemistry and Function,2009,27(7):424-429.DOI:10.1002/cbf.1589.
20旷满华,杨青廷,翦耀文,等.儿童缺铁性贫血与血铅水平关系的meta分析[J].中华疾病控制杂志,2016,20(1):79-83.DOI:10.16462/j.cnki.zhjbkz.2016.01.020.KUANG Manhua,YANG Qingting,JIAN Yaowen,et al.Association between iron deficiency anemia and blood lead level in children:a meta-analysis[J].Chinese Journal of Disease Control&Prevention,2016,20(1):79-83.DOI:10.16462/j.cnki.zhjbkz.2016.01.020.
21 Seonq K M,Kwon T,Seo S,et al.Perception of low dose radiation risks among radiation researchers in Korea[J].PLoS One,2017,12(2):e0171777.DOI:10.1371/journal.pone.0171777.
22 Katsarska O,Zaharieva E,Aneva N,et al.The soluble receptor ST2 is positively associated with occupational exposure to radiation[J].International Journal of Radiation Biology,2016,92(2):87-93.DOI:10.3109/09553002.2016.1115135.
23 Wei W,He J,Wanq J,et al.Serum microRNAs as early indicators for estimation of exposure degree in response to ionizing irradiation[J].Radiation Research,2017,188(3):342-354.DOI:10.1667/RR14702.1.
24 Doukali H,Ben Salah G,Hamdaoui L,et al.Oxidative stress and glutathione S-transferase genetic polymorphisms in medical staff professionally exposed to ionizing radiation[J].International Journal of Radiation Biology,2017,93(7):697-704.DOI:10.1080/09553002.2017.1305132.
25朱正错.介入治疗中X射线对先天性心脏病患儿过氧化损伤的研究[D].合肥:安徽医科大学第一附属医院,2012.ZHU Zhengcuo.Genetoxic effects and oxidativeantioxidative status in radiation workers occupationally exposed low dose ionizing radiation[D].Hefei:The First Affiliated Hospital of Anhui Medical University,2012.
26 Puthran S S,Sudha K,Rao G M,et al.Oxidative stress and low dose ionizing radiation[J].Indian Journal of Pharmacology,2009,53(2):181-184.
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