饮用水源中大环内酯类抗生素的存在及其潜在健康风险

文献信息

中文摘要

背景： 大环内酯类抗生素（MLAs）广泛用于人类和兽医医学。其广泛使用已导致水生环境中的普遍污染，对公共卫生和生态系统构成重大风险。尽管其普遍存在，但对其环境归趋、多样暴露途径和潜在分子毒理学机制的综合分析仍不充分。方法：本研究系统回顾了2005年至2025年全球饮用水源中的MLAs及其潜在健康影响。使用VOSviewer进行文献计量分析，识别了关注生态风险、抗菌药物耐药性发展和健康结局的关键研究集群。结果：MLAs在地表水和地下水中频繁检出，特定区域浓度超过1000 ng/L，主要受季节变化和区域工业活动影响。此外，我们评估了MLAs如何通过食物链进入人类膳食来源，如海产品和乳制品。临床上，MLAs暴露与一系列不良健康结局相关，包括心脏毒性（QT间期延长）、听力损失、肥胖和发育缺陷。综述了五条代表性毒性通路：线粒体功能障碍和受损的线粒体自噬/凋亡、hERG钾通道阻断、胆汁酸稳态改变、烟碱型乙酰胆碱受体（nAChR）抑制和氧化应激。支持这些通路的证据因个别大环内酯类药物而异，其与饮用水暴露的相关性仍不确定。结论：通过识别现有研究空白，本综述为风险评估建立了坚实的科学基础，并呼吁加强监管以减轻MLAs相关的环境和健康风险。

英文摘要

Macrolide antibiotics (MLAs) are widely utilized in both human and veterinary medicine. Their extensive use has led to ubiquitous contamination in aquatic environments, posing significant risks to public health and ecosystems. Despite their prevalence, comprehensive analyses of their environmental fate, diverse exposure pathways, and potential molecular toxicological mechanisms remain insufficient. This study systematically reviewed MLAs in global drinking water sources from 2005 to 2025 and their potential impacts on health. Using VOSviewer for bibliometric analysis, key research clusters focusing on ecological risks, antimicrobial resistance development, and health outcomes were identified. MLAs are frequently detected in surface and groundwater, with concentrations exceeding 1000 ng/L in specific regions, primarily influenced by seasonal variations and regional industrial activities. Additionally, we assessed how MLAs through the food chain into human dietary sources such as seafood and dairy products. Clinically, MLAs exposure correlates with a range of adverse health outcomes including cardiotoxicity (QT interval prolongation), hearing loss, obesity, and developmental defects. Five representative toxicity pathways were reviewed: mitochondrial dysfunction and impaired mitophagy/apoptosis, hERG potassium channel blockade, altered bile acid homeostasis, nicotinic acetylcholine receptor (nAChR) inhibition, and oxidative stress. The evidence supporting these pathways varies across individual macrolides, and their relevance to exposure through drinking water remains uncertain. By identifying existing research gaps, this review establishes a robust scientific foundation for risk assessment and calls for enhanced oversight to mitigate the environmental and health risks associated with MLAs.