Martínez María Ángeles, Marquès Montse, Salas-Huetos Albert, Babio Nancy, Domingo José L, Salas-Salvadó Jordi
Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain; Centro de Investigación Biomédica en Red Fisiopatología de La Obesidad y La Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.
Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain; Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, Sant Llorenç 21, 43201, Reus, Catalonia, Spain.
Environ Res. 2023 Jan 15;217:114942. doi: 10.1016/j.envres.2022.114942. Epub 2022 Nov 24.
The incidence of infertility currently affects about 15% of the world's population. Male factors are estimated to be responsible for up to 40-50% of these cases. While the cause of these reproductive disorders is still unclear, the exposure to a family of ubiquitous compounds in our daily life, named endocrine disrupting chemicals (EDCs) could be involved. This paper was aimed at performing a systematic review and meta-analysis of population studies exploring whether human male exposure to EDCs affects male fertility. Clinical and observational studies assessing the exposure to EDCs along with sperm quality, the most common reproductive disorders, sperm DNA damage, sperm oxidative stress, fertilization rate, implantation rate, clinical pregnancy rate, live birth rate, and miscarriage rate were included. The quality assessment tool from the NHLBI-NIH was used to assure that studies met standardized quality criteria. Sensitivity analysis and heterogeneity among studies was assessed. Overall, the 32 selected articles, including 7825 individuals in the systematic review, explored 12 families of EDCs. The results revealed a high heterogeneity among studies in relation to the association between exposure to EDCs and the endpoints analyzed. Meta-analyses were performed with data from 7 articles including 479 individuals, 4 articles assessing the association between BPA in urine and sperm quality, and 3 articles evaluating PCB153 in serum and sperm quality. In the meta-analysis, we identified an unpredicted significant positive association between PCB153 exposure and sperm concentration. However, it would not be clinically relevant. No positive or inverse associations were found neither for BPA, nor for PCB153 and the rest of sperm parameters analyzed. The high disparity between studies made difficult to draw conclusions on the potential harmful effects of EDCs on male fertility. Consequently, to delineate the potential relationship that EDCs can have on male fertility, an important condition stressing the health system, further investigations are required.
目前，不孕症的发病率影响着全球约15%的人口。据估计，男性因素导致的此类病例占40%-50%。虽然这些生殖障碍的病因仍不明确，但日常生活中接触到的一类普遍存在的化合物——内分泌干扰化学物质（EDCs）可能与之有关。本文旨在对人群研究进行系统综述和荟萃分析，以探讨男性接触EDCs是否会影响男性生育能力。纳入了评估EDCs暴露以及精子质量、最常见的生殖障碍、精子DNA损伤、精子氧化应激、受精率、着床率、临床妊娠率、活产率和流产率的临床及观察性研究。使用了美国国立卫生研究院心肺血液研究所（NHLBI-NIH）的质量评估工具，以确保研究符合标准化质量标准。评估了研究之间的敏感性分析和异质性。总体而言，所选的32篇文章，包括系统综述中的7825名个体，探讨了12类EDCs。结果显示，在EDCs暴露与所分析的终点之间的关联方面，研究之间存在高度异质性。对7篇文章（包括479名个体）的数据进行了荟萃分析，4篇文章评估了尿液中双酚A（BPA）与精子质量之间的关联，3篇文章评估了血清中多氯联苯153（PCB153）与精子质量之间的关联。在荟萃分析中，我们发现PCB153暴露与精子浓度之间存在意外的显著正相关。然而，这在临床上并无相关性。对于BPA、PCB153以及所分析的其他精子参数，均未发现正相关或负相关。研究之间的巨大差异使得难以就EDCs对男性生育能力的潜在有害影响得出结论。因此，为了阐明EDCs与男性生育能力之间可能存在的关系，这是一个强调卫生系统的重要条件，还需要进一步研究。
