Kłodowska-Duda Gabriela, Jasińska-Myga Barbara, Safranow Krzysztof, Boczarska-Jedynak Magdalena, Opala Grzegorz
Klinika Neurologii Wieku Podeszłego, Slaska Akademia Medyczna, ul. Medyków 14, 40-752 Katowice Ligota.
Neurol Neurochir Pol. 2005 Nov-Dec;39(6):445-50.
Various factors are suspected to participate in PD onset and include environment-related factors and workplace exposure to pesticides, metals and hydrocarbons. Nevertheless, results of epidemiological research are inconsistent. Some authors emphasize hydrocarbons exposure to younger patients. Our aim was to compare PD risk factors to onset age.
Of 174 patients with idiopathic PD, without dementia, two subgroups were isolated: 65 patients with early onset PD (EOPD) below 50 (n=65, age 52.8+/-7.6 years, onset 42.8+/-5.3 years) and 109 patients with late onset (LOPD) above 50 (n=109, age 67.8+/-7.0, onset 60.8+/-6.7 years). Various environmental factors reported in literature were analyzed.
The univariate analysis showed that factors significantly predisposing to EOPD are vocational education (OR 3.24, 95%CI 1.50-7.00, p<0.003), smoking (OR 1.94, 95%CI 1.02-3.69, p<0.05), well water consumption at 20-40 (OR 2.77, 95%CI 1.31-5.86, p<0.008), and after 40 (OR 4.84, 95%CI 1.95-11.99, p<0.0007), side-effects following exposure to paints (OR 2.26, 95%CI 1.10-4.66, p<0.03) and exposure to solvents (OR 1.98, 95%CI 0.96-4.07, p<0.07) on borderline significance. Drinking well water both between 20-40 and after 40 involved a substantial increase in EOPD (OR 6.57, 95%CI 2.43-17.75, p<0.0002). Education only at a primary level proved to be protective against EOPD (OR 0.20, 95%CI 0.07-0.55, p<0.002). The multivariate logistic regression model demonstrated that independent EOPD risk factors are smoking (OR 2.20, 95%CI 1.07-4.53, p<0.04) and well water consumption both between 20-40 and after 40 (OR 8.29, 95%CI 2.73-25.23, p<0.0002), whilst the independent protective factor is education only at a primary level (OR 0.17, 95%CI 0.05-0.53, p<0.003).
Our research demonstrated that a number of independent environmental factors significantly affect the risk of PD onset at younger ages. Presumably, some of the observed differences in the results of research of various authors into PD risk factors may be caused by ignoring onset age within the researched patients.
多种因素被怀疑参与帕金森病（PD）的发病过程，包括与环境相关的因素以及工作场所接触杀虫剂、金属和碳氢化合物。然而，流行病学研究结果并不一致。一些作者强调碳氢化合物暴露与年轻患者发病有关。我们的目的是比较帕金森病的危险因素与发病年龄。
在174例无痴呆的特发性帕金森病患者中，分离出两个亚组：65例发病年龄在50岁以下的早发性帕金森病（EOPD）患者（n = 65，年龄52.8±7.6岁，发病年龄42.8±5.3岁）和109例发病年龄在50岁以上的晚发性帕金森病（LOPD）患者（n = 109，年龄67.8±7.0岁，发病年龄60.8±6.7岁）。对文献中报道的各种环境因素进行了分析。
单因素分析显示，显著易患早发性帕金森病的因素包括职业教育（比值比[OR] 3.24，95%置信区间[CI] 1.50 - 7.00，p < 0.003）、吸烟（OR 1.94，95%CI 1.02 - 3.69，p < 0.05）、20 - 40岁期间饮用井水（OR 2.77，95%CI 1.31 - 5.86，p < 0.008）以及40岁以后饮用井水（OR 4.84，95%CI 1.95 - 11.99，p < 0.0007）、接触油漆后的副作用（OR 2.26，95%CI 1.10 - 4.66，p < 0.03）和接触溶剂（OR 1.98，95%CI 0.96 - 4.07，p < 0.07，接近显著性水平）。20 - 40岁期间和40岁以后都饮用井水会使早发性帕金森病的发病风险大幅增加（OR 6.57，95%CI 2.43 - 17.75，p < 0.0002）。仅接受小学教育被证明对早发性帕金森病有保护作用（OR 0.20，95%CI 0.07 - 0.55，p < 0.002）。多因素逻辑回归模型表明，早发性帕金森病的独立危险因素是吸烟（OR 2.20，95%CI 1.07 - 4.53，p < 0.04）以及20 - 40岁期间和40岁以后饮用井水（OR 8.29，95%CI 2.73 - 25.23，p < 0.0002），而独立保护因素是仅接受小学教育（OR 0.17，95%CI 0.05 - 0.53，p < 0.003）。
我们的研究表明，一些独立的环境因素显著影响年轻时帕金森病的发病风险。据推测，不同作者对帕金森病危险因素研究结果中观察到的一些差异可能是由于在研究患者时忽略了发病年龄所致。
