Richardson S, Zittoun R, Bastuji-Garin S, Lasserre V, Guihenneuc C, Cadiou M, Viguie F, Laffont-Faust I
INSERM U 170, Villejuif, France.
Int J Epidemiol. 1992 Dec;21(6):1063-73. doi: 10.1093/ije/21.6.1063.
A case-control study has been performed for occupational risk factors of acute leukaemia, based on 185 cases more than 30 years old and 513 matched controls. There was a significant excess of polyvalent farming and electronic engineers among professions of cases, and, in addition of metal workers when considering the professions pursued for more than 5 years. The corresponding exposures were analysed through a detailed questionnaire, and assessed by an industrial hygienist after blinding the case-control status. The odds ratios (OR) were computed after adjustment on matching variables and prior chemo- or radiotherapy treatment, and after stratification for the level and total duration of exposure. There was no excess of professional exposure to ionizing radiation among cases. A significant relationship was observed between acute leukaemia and high or medium exposure to benzene, as well as over 10 years high or medium exposure to exhaust gas. In addition a significant relationship was observed with exposure to pesticides--insecticides and/or weed killers--and to electric and magnetic fields (EMF). The relationship with pesticides was significant when considering high or medium exposure to weed killers and more than 10 years exposure to both subtypes of pesticides. The relationship with pesticides and EMF remained significant when confounding factors were taken into consideration and after adjustment on co-exposure to benzene. The cytological studies showed that acute leukaemias following exposure to benzene (high or medium) and to EMF were only of myelogenous subtypes, whereas those following exposure to pesticides were divided between lymphoblastic and myeloblastic subtypes. Cytogenetic studies failed to show increased frequency of chromosomal abnormalities, as described in acute leukaemias secondary to anti-cancer treatments. Our study adds credence to the hypothesis that pesticides and EMF are leukaemogenic agents, together with benzene.
基于185例30岁以上的急性白血病病例和513例匹配对照，开展了一项关于急性白血病职业危险因素的病例对照研究。病例职业中多元务农者和电子工程师显著过多，此外，若考虑从事超过5年的职业，则金属工人也显著过多。通过详细问卷分析相应暴露情况，并在对病例对照状态进行盲法处理后由一名工业卫生学家进行评估。在对匹配变量以及先前的化疗或放疗治疗进行调整后，以及在按暴露水平和总暴露时长进行分层后，计算优势比（OR）。病例中职业性接触电离辐射并无过多情况。观察到急性白血病与高或中度苯暴露以及超过10年的高或中度废气暴露之间存在显著关联。此外，还观察到与杀虫剂和/或除草剂等农药以及与电场和磁场（EMF）的暴露存在显著关联。当考虑高或中度除草剂暴露以及超过10年的两种农药亚型暴露时，与农药的关联显著。在考虑混杂因素并对同时接触苯进行调整后，与农药和EMF的关联仍然显著。细胞学研究表明，接触苯（高或中度）和EMF后的急性白血病仅为髓细胞亚型，而接触农药后的急性白血病则分为淋巴细胞性和髓细胞性亚型。细胞遗传学研究未能显示出染色体异常频率增加，这与抗癌治疗继发的急性白血病情况不同。我们的研究为农药和EMF与苯一起是白血病致病因素这一假说提供了证据。
