目的 探讨抗生素暴露对人类生育力的影响,为不孕不育危险因素及防治的相关研究提供参考.方法 检索中国知网、万方数据知识服务平台、维普中文科技期刊数据库、PubMed、Embase和Web of Science数据库建库至2024年3月公开发表的关于抗生素暴露与人类生育力的研究文献.由双人独立进行文献筛选、资料提取和质量评价,定性分析抗生素暴露对人类生育力的影响.结果 共检索相关文献11 623篇,最终纳入31篇.类实验研究19篇,其中高质量4篇,中等质量15篇;观察性研究6篇,其中高质量5篇,中等质量1篇;随机对照试验6篇,在实施偏倚和测量偏倚维度上存在高风险.16项类实验研究和5项随机对照试验发现服用多西环素等敏感抗生素治疗生殖系统感染可提高女性妊娠率或男性精液质量;2项类实验和1项随机对照试验研究发现抗生素(西罗莫司/柳氮磺吡啶)治疗其他系统疾病时可能导致生殖系统方面的不良反应;4项观察性研究提示磺胺类、大环内酯类和四环素类等抗生素暴露会增加不孕症或前列腺癌风险;2项观察性研究发现抗生素对不孕症具有双重影响.结论 抗生素暴露对人类生育力可表现为有益或有害的双重影响,可能受抗生素种类、剂量及适应证影响.但这些研究存在样本量少、选择偏倚、无法做到随机和盲法等局限性,仍需优化研究设计进一步探究抗生素暴露与人类生育力的关系.
Effects of antibiotic exposure on human fertility:a systematic review
Objective To explore the impact of antibiotic exposure on human fertility,so as to provide the reference for related research on risk factors and prevention of infertility.Methods Publications pertaining to antibiotic exposure and human fertility were retrived in CNKI,Wanfang Data,VIP,PubMed,Embase and Web of Science from inception to March 2024.Two reviewers independently conducted literature screening,data extraction,and quality assessment.A qual-itative analysis was performed to investigate the effect of antibiotic exposure on human fertility.Results A total of 11 623 articles were retrieved,and 31 of them were finally included.Among them,19 were quasi-experimental studies(4 high-quality and 15 medium-quality),6 were observational studies(5 high-quality and 1 medium-quality),and 6 were randomized controlled trials(RCTs)with high risks of implementation bias and measurement bias.Sixteen quasi-ex-perimental studies and five RCTs found that the use of sensitive antibiotics such as doxycycline for the treatment of re-productive system infections improved female pregnancy rates or male semen quality.Two quasi-experimental studies and one RCT suggested that antibiotics(such as sirolimus or sulfasalazine)used to treat other systemic diseases might cause adverse effects on the reproductive system.Four observational studies indicated that exposure to antibiotics such as sulfonamides,macrolides,and tetracyclines increased the risk of infertility or prostate cancer.Two observational stud-ies found a dual effect of antibiotics on infertility.Conclusions Antibiotic exposure appears to have either beneficial or harmful effects on fertility,depending on the antibiotic types,doses,and indication.However,these studies have limi-tations such as small sample size,selection bias,and the inability to achieve randomization and blind methods.Further research with optimized designs is necessary to explore the relationship between antibiotic exposure and fertility.
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