Issaragrisil Surapol, Kaufman David W, Anderson Theresa, Chansung Kanchana, Leaverton Paul E, Shapiro Samuel, Young Neal S
Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Blood. 2006 Feb 15;107(4):1299-307. doi: 10.1182/blood-2005-01-0161. Epub 2005 Oct 27.
Aplastic anemia has been linked to environmental exposures, from chemicals and medical drugs to infectious agents. The disease occurs more frequently in Asia than in the West, with incidence rates 2- to 3-fold higher. We report updated results of an epidemiologic study conducted in Thailand from 1989 to 2002, in which 541 patients and 2261 controls were enrolled. Exposures were determined by in-person interview. We observed significantly elevated relative risk estimates for benzene (3.5) and other solvents (2.0) and for sulfonamides (5.6), thiazides (3.8), and mebendazole (3.0). Chloramphenicol use was infrequent, and no significant association was observed. Agricultural pesticides were implicated in Khonkaen (northeastern Thailand). There were significant associations with organophosphates (2.1), DDT (6.7), and carbamates (7.4). We found significant risks for farmers exposed to ducks and geese (3.7) and a borderline association with animal fertilizer (2.1). There was a significant association in Khonkaen with drinking other than bottled or distilled water (2.8). Nonmedical needle exposure was associated in Bangkok and Khonkaen combined (3.8). Most striking was the large etiologic fraction in a rural region accounted for by animal exposures and drinking of water from sources such as wells, rural taps, and rainwater, consistent with an infectious etiology for many cases of aplastic anemia in Thailand.
再生障碍性贫血与环境暴露有关,从化学物质、药物到感染因子。该疾病在亚洲的发病率高于西方,发病率高出2至3倍。我们报告了1989年至2002年在泰国进行的一项流行病学研究的最新结果,该研究纳入了541例患者和2261名对照。通过面对面访谈确定暴露情况。我们观察到苯(3.5)、其他溶剂(2.0)、磺胺类药物(5.6)、噻嗪类药物(3.8)和甲苯咪唑(3.0)的相对风险估计值显著升高。氯霉素的使用频率较低,未观察到显著关联。泰国东北部孔敬府发现农业杀虫剂与该病有关。有机磷(2.1)、滴滴涕(6.7)和氨基甲酸盐(7.4)与之有显著关联。我们发现接触鸭和鹅的农民有显著风险(3.7),与动物肥料有边缘关联(2.1)。孔敬府发现饮用非瓶装或蒸馏水与该病有显著关联(2.8)。曼谷和孔敬府合并地区非医疗用针头暴露与之有关联(3.8)。最引人注目的是,农村地区很大一部分病因是动物接触以及饮用井水、农村水龙头水和雨水等水源的水,这与泰国许多再生障碍性贫血病例的感染病因一致。