Fransman Wouter, Roeleveld Nel, Peelen Susan, de Kort Wim, Kromhout Hans, Heederik Dick
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Epidemiology. 2007 Jan;18(1):112-9. doi: 10.1097/01.ede.0000246827.44093.c1.
Nurses and other hospital workers are exposed to antineoplastic drugs during daily activities. Previous studies suggest that antineoplastic drugs at occupational exposure levels may be toxic to reproduction, but these studies are not consistent or conclusive.
Self-administered questionnaires were completed by 4393 exposed and nonexposed nurses employed between 1990 and 1997 (79% response). Questions were asked about pregnancy outcome, work-related exposures, and lifestyle. Exposure to antineoplastic drugs was estimated using task-based dermal exposure measurements and self-reported task frequencies. Time to pregnancy was modeled using survival analysis, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for other reproductive outcomes using multiple logistic regression analysis. Associations were further explored by nonparametric regression modeling.
Nurses highly exposed to antineoplastic drugs took longer to conceive than referent nurses (adjusted hazard ratio = 0.8; CI = 0.6-0.9). Exposure to antineoplastic drugs was associated with premature delivery (OR per unit increase in ln[exposure] = 1.08; CI = 1.00-1.17) and low birth weight (OR per unit increase in ln[exposure] = 1.11; 1.01-1.21). Penalized smoothed spline plots corroborated these log-linear relations. Spontaneous abortion, stillbirth, congenital anomalies, and sex of offspring appeared not to be related to exposure to antineoplastic drugs.
Antineoplastic drugs may reduce fertility and increase poor neonatal outcomes among occupationally exposed oncology nurses.
护士和其他医院工作人员在日常工作中会接触到抗肿瘤药物。先前的研究表明，职业暴露水平的抗肿瘤药物可能对生殖有毒性，但这些研究并不一致或具有决定性。
对1990年至1997年受雇的4393名接触和未接触抗肿瘤药物的护士进行了自填式问卷调查（回复率为79%）。问题涉及妊娠结局、工作相关暴露和生活方式。使用基于任务的皮肤暴露测量和自我报告的任务频率来估计抗肿瘤药物的暴露情况。使用生存分析对受孕时间进行建模，并使用多元逻辑回归分析计算其他生殖结局的比值比（OR）及其95%置信区间（CI）。通过非参数回归建模进一步探讨关联。
与对照护士相比，高度接触抗肿瘤药物的护士受孕时间更长（调整后的风险比=0.8；CI=0.6-0.9）。接触抗肿瘤药物与早产（ln[暴露]每增加一个单位，OR=1.08；CI=1.00-1.17）和低出生体重（ln[暴露]每增加一个单位，OR=1.11；1.01-1.21）相关。惩罚平滑样条图证实了这些对数线性关系。自然流产、死产、先天性异常和后代性别似乎与接触抗肿瘤药物无关。
抗肿瘤药物可能会降低职业接触的肿瘤护士的生育能力，并增加不良新生儿结局的发生。
