农村环境及农药暴露与肌萎缩侧索硬化风险相关性的荟萃分析  

Rural environment, pesticide exposure and the risk of amyotrophic lateral sclerosis： a meta analysis

作　　者：沈东超[1] 崔博[1] 方佳[1] 崔丽英 

机构地区：[1]中国医学科学院北京协和医院神经科,100730 [2]中国医学科学院神经科学中心

出　　处：《中华神经科杂志》2016年第1期54-63,共10页Chinese Journal of Neurology

摘　　要：目的探讨农村环境及农药暴露与肌萎缩侧索硬化（amyotrophic lateral sclerosis, ALS）风险的相关性。方法在英文数据库Embase、OvidMedline、Pubmed、CochraneLibrary及中文数据库万方数据库（Wanfang data）、中国生物医学文献数据库（CBM）、中国知网（CNKI）和维普数据库（V1P）中检索有关农药暴露、农民职业或农村居住与ALS风险相关性的研究，发表时间截至2015年5月。按照纽卡斯尔一渥太华量表（Newcastle-Ottawa Scale，NOS）对纳入的病例对照研究和队列研究进行质量评价。应用Revman5．3软件进行数据合并与发表偏倚检测。结果共纳入24篇病例对照研究和3篇队列研究，所有研究的NOS评分均≥6分。荟萃分析结果显示农药暴露（OR=1．41，95％CI1．28～1．56）和农民职业（OR=1．42，95％CI1．29～1．57）会显著增加ALS的罹患风险，但居住于农村并无此种关联（OR=1．21，95％CI0．97～1．51）。对农药暴露与ALS风险的相关性进行亚组分析显示，男性（OR=1．75，95％CI1．39～2．21）的罹患风险要高于女性（OR=1．53，95％C11．13～2．08），应用E1Escorial标准诊断ALS的研究其汇总风险（OR=1．68，95％CI1．45～1．95）要高于应用非E1Escorial标准的研究（OR=1．23，95％CI1．08～1．40）。研究存在轻度的发表偏倚。结论我们的发现支持农药暴露可增加ALS的罹患风险。因农民作业时经常有高水平的农药暴露，推荐应降低暴露水平或做好防护措施以降低ALS风险。Objective To explore the relationship between the risk of amyotrophic lateral sclerosis （ALS） and exposure to rural environments and pesticide. Methods Studies relevant to rural residence, farmer occupation, pesticide exposure and ALS were identified from the databases including Embase, Ovid Medline, Pubmed, Cochrane Library, Wanfang data, Chinese BioMedical Literature Database, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database up to March 2015. Quality of studies was assessed according to the Newcastle-Ottawa Scale （NOS）. Analysis of data and publication bias was performed with software Revman 5.3. Results A total of 24 case-control studies and 3 cohort studies were included into the analysis. The NOS scores of all studies were ≥6. The risk of ALS was associated with pesticide exposure （ OR = 1.41,95% CI 1.28 - 1.56） and farmer occupation （ OR = 1.42, 95% CI1.29 - 1.57）, but not associated with rural residence （OR = 1.21,95% CI0.97 - 1.51）. Subgroup analysis of pesticide exposure and ALS revealed that males （OR = 1.75,95% CI 1.39 -2. 21 ） had a higher risk than females （ OR = 1.53,95% CI 1.13 - 2. 08 ） , and the risk estimate was higher in studies using E1 Escorial standard （ OR = 1.68,95% CI 1.45 - 1.95） than studies not （ OR = 1.23,95% CI 1.08 - 1.40 ）. The meta analysis had a slight publication bias. Conclusions Our findings support pesticide exposure might increase the risk of ALS. Given thai farmers always have high levels of pesticide exposure in their work, they should decrease their exposure level or take proper precautions to lower the risk of ALS.

关 键 词：肌萎缩侧索硬化 农药残留 危险因素 环境暴露 荟萃分析 

分 类 号：R744.8[医药卫生—神经病学与精神病学]