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有机溶剂暴露与慢性肾衰竭风险之间不存在关联:一项基于全国人口的病例对照研究。

Absence of association between organic solvent exposure and risk of chronic renal failure: a nationwide population-based case-control study.

作者信息

Fored C Michael, Nise Gun, Ejerblad Elisabeth, Fryzek Jon P, Lindblad Per, McLaughlin Joseph K, Elinder Carl-Gustaf, Nyrén Olof

机构信息

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

出版信息

J Am Soc Nephrol. 2004 Jan;15(1):180-6. doi: 10.1097/01.asn.0000103872.60993.06.

Abstract

Exposure to organic solvents has been suggested to cause or exacerbate renal disease, but methodologic concerns regarding previous studies preclude firm conclusions. We examined the role of organic solvents in a population-based case-control study of early-stage chronic renal failure (CRF). All native Swedish residents aged 18 to 74 yr, living in Sweden between May 1996 and May 1998, formed the source population. Incident cases of CRF in a pre-uremic stage (n = 926) and control subjects (n = 998), randomly selected from the study base, underwent personal interviews that included a detailed occupational history. Expert rating by a certified occupational hygienist was used to assess organic solvent exposure intensity and duration. Relative risks were estimated by odds ratios (OR) in logistic regression models, with adjustment for potentially important covariates. The overall risk for CRF among subjects ever exposed to organic solvents was virtually identical to that among never-exposed (OR, 1.01; 95% confidence interval [CI], 0.81 to 1.25). No dose-response relationships were observed for lifetime cumulative solvent exposure, average dose, or exposure frequency or duration. The absence of association pertained to all subgroups of CRF: glomerulonephritis (OR, 0.96; 95% CI, 0.68 to 1.34), diabetic nephropathy (OR, 1.02; 95% CI, 0.74 to 1.41), renal vascular disease (OR, 1.16; 95% CI, 0.76 to 1.75), and other renal CRF (OR, 0.92; 95% CI, 0.66 to 1.27). The results from a nationwide, population-based study do not support the hypothesis of an adverse effect of organic solvents on CRF development, in general. Detrimental effects from subclasses of solvents or on specific renal diseases cannot be ruled out.

摘要

有机溶剂暴露被认为会导致或加重肾脏疾病,但先前研究的方法学问题使得无法得出确凿结论。我们在一项基于人群的早期慢性肾衰竭(CRF)病例对照研究中,考察了有机溶剂的作用。所有1996年5月至1998年5月居住在瑞典、年龄在18至74岁的瑞典本土居民构成了源人群。从研究对象中随机选取的处于尿毒症前期的CRF新发病例(n = 926)和对照对象(n = 998)接受了个人访谈,其中包括详细的职业史。由认证职业卫生学家进行专家评级,以评估有机溶剂暴露强度和持续时间。在逻辑回归模型中通过比值比(OR)估计相对风险,并对潜在重要协变量进行调整。曾接触有机溶剂的受试者中CRF的总体风险与未接触者几乎相同(OR,1.01;95%置信区间[CI],0.81至1.25)。未观察到终生累积溶剂暴露、平均剂量、暴露频率或持续时间与剂量反应关系。这种无关联适用于CRF的所有亚组:肾小球肾炎(OR,0.96;95% CI,0.68至1.34)、糖尿病肾病(OR,1.02;95% CI,0.74至1.41)、肾血管疾病(OR,1.16;95% CI,0.76至1.75)以及其他肾性CRF(OR,0.92;95% CI,0.66至1.27)。总体而言,一项基于全国人群的研究结果不支持有机溶剂对CRF发生有不良影响这一假设。不能排除溶剂亚类或对特定肾脏疾病的有害影响。

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