Engel L S, Checkoway H, Keifer M C, Seixas N S, Longstreth W T, Scott K C, Hudnell K, Anger W K, Camicioli R
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Occup Environ Med. 2001 Sep;58(9):582-9. doi: 10.1136/oem.58.9.582.
To examine the risk of parkinsonism related to lifetime occupational exposure to pesticides among a cohort of men, mostly orchardists, in Washington State.
All 310 subjects in this study had previously participated in a cohort study of men occupationally exposed to pesticides. Subjects were given a structured neurological examination and completed a self administered questionnaire which elicited detailed information on pesticide (insecticide, herbicide, and fungicide) use throughout their working careers. Demographic characteristics were also sought. Subjects had a mean age of 69.6 years (range 49-96, SD 8.1). There were 238 (76.8%) subjects who reported some occupational exposure to pesticides, whereas 72 (23.2%) reported none. Parkinsonism was defined by the presence of two or more of rest tremor, rigidity, bradykinesia, and impairment of postural reflexes in subjects not on antiparkinsonian medication, or the presence of at least one sign if they were on such medication. Parkinson's disease was not studied explicitly because of the difficulty in distinguishing it from other parkinsonian syndromes. A generalised linear model was used to estimate prevalence ratios (PRs) for parkinsonism relative to history of farming, pesticide use, and use of well water.
A PR of 2.0 (95% confidence interval (95% CI) 1.0 to 4.2) was found for subjects in the highest tertile of years of exposure to pesticides; a similarly increased, non-significant, PR was found for the middle tertile (1.9 (95% CI 0.9 to 4.0)), although a trend test did not show a significant exposure-response relation. No increased risks were found associated with specific pesticides or pesticide classes, nor with a history of farming or use of well water.
Parkinsonism may be associated with long term occupational exposure to pesticides, although no associations with specific pesticides could be detected. This finding is consistent with most of the publications on this topic.
在华盛顿州的一组男性（大多为果园工人）中，研究终生职业性接触杀虫剂与帕金森症风险之间的关系。
本研究中的310名受试者此前均参与了一项针对职业性接触杀虫剂男性的队列研究。受试者接受了结构化的神经学检查，并完成了一份自我管理的问卷，该问卷收集了他们整个职业生涯中使用杀虫剂（包括杀虫剂、除草剂和杀菌剂）的详细信息。同时还收集了人口统计学特征。受试者的平均年龄为69.6岁（范围49 - 96岁，标准差8.1）。有238名（76.8%）受试者报告有职业性接触杀虫剂的情况，而72名（23.2%）报告无接触。帕金森症的定义为：未服用抗帕金森药物的受试者出现静止性震颤、肌强直、运动迟缓及姿势反射障碍中的两项或更多项；或正在服用此类药物的受试者出现至少一项体征。由于难以将帕金森病与其他帕金森综合征区分开来，故未对其进行明确研究。使用广义线性模型来估计帕金森症相对于务农史、杀虫剂使用情况和井水使用情况的患病率比（PR）。
接触杀虫剂年限处于最高三分位数的受试者的PR为2.0（95%置信区间（95%CI）1.0至4.2）；处于中间三分位数的受试者的PR同样有所升高但无统计学意义（1.9（95%CI 0.9至4.0）），尽管趋势检验未显示出显著的暴露 - 反应关系。未发现与特定杀虫剂或杀虫剂类别、务农史或井水使用相关的风险增加。
帕金森症可能与长期职业性接触杀虫剂有关，尽管未检测到与特定杀虫剂的关联。这一发现与该主题的大多数出版物一致。
