农药暴露与儿童急性白血病关系的病例-对照研究  

A case-control study on correlation of pesticide exposure with childhood acute leukemia

作　　者：张妍[1] 朱莎[3] 高宇[1] 王筱金 陈涛[3] 杨友[3] 汪国权[4] 胡国华[4] 施蓉[1] 金萍[1] 田英[1] 

机构地区：[1]上海交通大学公共卫生学院环境卫生学教研室,200025 [2]基础医学院生物统计教研室 [3]上海交通大学医学院附属新华医院上海市环境与儿童健康重点实验室 [4]上海市疾病预防控制中心卫生检测实验室

出　　处：《中华预防医学杂志》2011年第1期41-46,共6页Chinese Journal of Preventive Medicine

基　　金：基金项目：国家自然科学基金（30571542,30901171）;上海市自然科学基金（09ZR1416500）;上海交通大学医学院科技基金（09XJ21054）;上海市卫生局青年科研项目（2008Y119）

摘　　要：目的 探讨农药暴露与儿童急性白血病发病之间的关系.方法 选取2006年1月1日至2008年12月31日就诊于上海儿童医学中心,年龄小于15周岁的80例初发急性白血病患儿作为病例组.以在病例所在医院进行健康检查、在发育行为儿科就诊、骨科门诊就诊和人院治疗的（排除血液系统疾病、肿瘤性疾病等）与病例组匹配的96例儿童作为对照组.对两组儿童进行相关环境因素的问卷调查,并每人收取30～40 ml随机尿样,采用气相色谱-火焰分光光度法检测5种有机磷农药尿代谢产物.结果 问卷调查显示,55.0%（44/80）的病例组家庭使用灭蚊剂,对照组家庭占33.3%（32/96）,灭蚊剂的使用可增加儿童急性白血病的发病风险（OR=2.444;95%CI：1.326～4.506）.有机磷农药尿代谢产物检测显示,病例组磷酸二乙酯、磷酸二甲酯、二甲基硫代磷酸酯、二乙基硫代磷酸酯和二乙基二硫代磷酸酯浓度中位数分别为0.0682、0.0082、0.0183、0.0233、0.4259 μg/g肌酐;对照组浓度中位数分别为0.0865、0.0025、0.0112、0.0123、0.1207μg/g肌酐.两组比较,除DEP（Z=-1.081,P=0.279）外,其余代谢产物浓度差异均有统计学意义（Z值分别为-5.752、-2.800、-3.316、-8.120,P值均〈0.05）.结论 农药暴露可能是儿童急性白血病发病的危险因素之一.Objective To evaluate the correlation of pesticide exposure with childhood acute leukemia. Methods An exploratory case-control study was conducted among childhood acute leukemia patients under 15 years old in Shanghai, China. From January 1st,2006 to December 31st,2008, a total of 80 newly diagnosed acute leukemia patients were recruited from Shanghai Children＇s Medical Center for the case group. Another 96 age-matched patients who visited the hospital for health examination, pediatric treatment or osteological therapy excluding hematological system diseases and neoplastic disease, were recruited for the control group. A questionnaire survey was conducted in both groups; and a 30-40 ml random urine sample was collected from each participant. Five types of organophosphorus pesticide metabolites was then detected among the samples, using Gas Chromatography with Flame Spectrophotometry. Results According to result of the questionnaire survey, more participants （55.0% （44/80）） in case group than in the control group （33.3% （32/96）） reported using mosquitocide, which might increase the risk of childhood acute leukemia （OR = 2.444;95% CI：1. 326-4. 506）. At the same time, the detection showed that the concentration （median） of organophosphate metabolites diethyl phosphrate,dimethyl phophrate,dimethyl thiophosphrate,diethyl thiophosphrate and diethyl dithiophosphrate in case group were 0. 0682,0. 0082,0. 0183,0. 0233,0. 4259 μg/g Cr, which were all significantly higher than in control group （0. 0865,0. 0025,0. 0112,0. 0123,0. 1207 μg/g Cr） except the concentration of diethyl phosphrate （Z =-1.081, P = 0. 279）. The difference showed statistical significance （Z =-5. 752,-2. 800,-3.316,-8. 120, P 〈 0. 05）. Conclusion Pesticide exposure may be one of the risk factors for childhood acute leukemia.

关 键 词：农药 儿童 急性白血病 病例对照研究 

分 类 号：R733.71[医药卫生—肿瘤]