Sanborn M, Kerr K J, Sanin L H, Cole D C, Bassil K L, Vakil C
Chesley Medical Clinic, Box 459, Chesley, ON.
Can Fam Physician. 2007 Oct;53(10):1712-20.
To investigate whether there are associations between exposure to pesticides and 4 chronic non-cancer health effects: dermatologic, neurologic, reproductive, and genotoxic effects.
We searched PreMedline, MEDLINE, and LILACS using the key word pesticide combined with the term for the specific health effect being searched. Reviewers scanned the references of all articles for additional relevant studies.
Studies since 1992 were assessed using structured inclusion and quality-of-methods criteria. Studies scoring <4 on a 7-point global methodologic quality scale were excluded. In total, 124 studies were included. These studies had a mean quality score of 4.88 out of 7.
Strong evidence of association with pesticide exposure was found for all neurologic outcomes, genotoxicity, and 4 of 6 reproductive effects: birth defects, fetal death, altered growth, and other outcomes. Exposure to pesticides generally doubled the level of genetic damage as measured by chromosome aberrations in lymphocytes. Only a few high-quality studies focused on the dermatologic effects of pesticides. In some of these studies, rates of dermatitis were higher among those who had had high exposure to pesticides on the job.
Evidence from research on humans consistently points to positive associations between pesticide exposure and 3 of the 4 non-cancer health outcomes studied. Physicians have a dual role in educating individual patients about the risks of exposure and in reducing exposure in the community by advocating for restrictions on use of pesticides.
调查接触农药与4种慢性非癌症健康影响之间是否存在关联，这4种影响分别为皮肤病学影响、神经学影响、生殖影响和遗传毒性影响。
我们使用关键词“农药”并结合所搜索的特定健康影响术语，检索了预医学数据库、医学文献数据库和拉丁美洲及加勒比地区卫生科学数据库。评审人员查阅了所有文章的参考文献以寻找其他相关研究。
采用结构化纳入标准和方法学质量标准对1992年以来的研究进行评估。在7分的整体方法学质量量表上得分低于4分的研究被排除。总共纳入了124项研究。这些研究的平均质量得分在7分制中为4.88分。
对于所有神经学结果、遗传毒性以及6种生殖影响中的4种（出生缺陷、胎儿死亡、生长改变和其他结果），均发现了与接触农药相关的有力证据。通过淋巴细胞染色体畸变测量，接触农药通常会使遗传损伤水平加倍。只有少数高质量研究关注农药的皮肤病学影响。在其中一些研究中，工作中高剂量接触农药的人群中皮炎发生率更高。
来自人体研究的证据一致表明，在所研究的4种非癌症健康结果中，有3种与接触农药存在正相关。医生在向个体患者宣传接触农药的风险以及通过倡导限制农药使用来减少社区接触方面具有双重作用。
