Knapke Eric T, Magalhaes Danielly de P, Dalvie Mohamed Aqiel, Mandrioli Daniele, Perry Melissa J
Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.
Center for Environmental and Occupational Health Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
Toxicology. 2022 Jan 15;465:153017. doi: 10.1016/j.tox.2021.153017. Epub 2021 Oct 29.
Global sperm counts have declined in recent decades, coinciding with the proliferation of endocrine-disrupting chemicals, of which pesticides are some of the most common. Previous systematic reviews of epidemiologic studies published between 1991 through 2013 have reported associations between environmental and occupational pesticide exposure and reduced sperm quality, particularly associations with reduced sperm concentration. This systematic review used the Navigation Guide to critically evaluate the current body of evidence examining sperm quality and pesticide exposure in epidemiological studies. PubMed, Scopus, and Web of Science databases were searched for all English-language articles published after September 2012 until August 2021. Original observational studies that assessed human sperm quality parameters, defined as concentration, motility, morphology, and DNA integrity, and individual-level pesticide exposure were included. The risk of bias for each included study and the strength of evidence were evaluated using the Navigation Guide protocol. Nineteen studies assessing environmental or occupational pesticide exposure and sperm parameters were included. Eighteen studies were cross-sectional studies and one prospective cohort; sample sizes ranged from 42 to 2122 men from 14 different countries. Fifteen (79 %) studies found at least one significant association between pesticide exposure and reduced sperm quality. The overall risk of bias across studies was classified as low to moderate. The quality of evidence was determined to be moderate based on systematic evaluation criteria. There were consistent adverse associations between pesticide exposure and sperm motility (63 % of studies) and DNA integrity (80 % of studies). For sperm concentration and morphology, 42 % and 36 % of studies found significant negative associations, respectively. The strength of the body of evidence overall was rated as having sufficient evidence of toxicity. Regarding specific sperm endpoints, there was sufficient evidence that pesticides are toxic for sperm motility and DNA integrity; limited evidence of toxicity for sperm concentration; and inadequate evidence of toxicity for sperm morphology. The studies reviewed here showed consistent associations between pesticide exposure and diminished sperm parameters, particularly sperm motility and sperm DNA integrity. These findings are largely consistent with results of previous reviews, which have found significant negative associations between pesticide exposure and sperm quality in 13 of 20 (65 %) studies published between 1991 and 2008, and in 14 of 17 (82 %) studies published between 2008 and 2012. After thirty years of mounting evidence, actions are needed to reduce pesticide risks to testicular function and male fertility.
近几十年来，全球精子数量有所下降，与此同时，内分泌干扰化学物质不断扩散，其中农药是最常见的一些。此前对1991年至2013年间发表的流行病学研究进行的系统评价报告了环境和职业性接触农药与精子质量下降之间的关联，特别是与精子浓度降低的关联。本系统评价使用《导航指南》对当前有关流行病学研究中精子质量和农药接触的证据进行严格评估。在PubMed、Scopus和科学网数据库中检索了2012年9月之后至2021年8月发表的所有英文文章。纳入了评估人类精子质量参数（定义为浓度、活力、形态和DNA完整性）以及个体水平农药接触情况的原始观察性研究。使用《导航指南》方案评估每项纳入研究的偏倚风险和证据强度。纳入了19项评估环境或职业性农药接触与精子参数的研究。18项研究为横断面研究，1项为前瞻性队列研究；样本量从来自14个不同国家的42名至2122名男性不等。15项（79%）研究发现农药接触与精子质量下降之间至少存在一种显著关联。各研究的总体偏倚风险被分类为低至中度。根据系统评价标准，证据质量被判定为中等。农药接触与精子活力（63%的研究）和DNA完整性（80%的研究）之间存在一致的不良关联。对于精子浓度和形态，分别有42%和36%的研究发现显著的负相关。总体证据强度被评定为有足够的毒性证据。关于特定的精子终点，有足够的证据表明农药对精子活力和DNA完整性有毒性；对精子浓度有毒性的证据有限；对精子形态有毒性的证据不足。此处综述的研究表明农药接触与精子参数降低之间存在一致的关联，特别是精子活力和精子DNA完整性。这些发现与之前综述的结果基本一致，之前的综述发现在1991年至2008年发表得20项研究中的13项（65%）以及2008年至2012年发表的17项研究中的14项（82%）中，农药接触与精子质量之间存在显著的负相关。在有了三十年越来越多的证据之后，需要采取行动降低农药对睾丸功能和男性生育能力的风险。
