职业性接触农药会增加 AD 发病风险：Cache 县研究。
Occupational exposure to pesticides increases the risk of incident AD: the Cache County study.
机构信息
Duke University Medical Center, Durham, NC, USA.
出版信息
Neurology. 2010 May 11;74(19):1524-30. doi: 10.1212/WNL.0b013e3181dd4423.
BACKGROUND
Commonly used organophosphate and organochlorine pesticides inhibit acetylcholinesterase at synapses in the somatic, autonomic, and central nervous systems and may therefore have lasting effects on the nervous system. Few studies have examined the relationship of pesticide exposure and risk of dementia or Alzheimer disease (AD). We sought to examine the association of occupational pesticide exposure and the risk of incident dementia and AD in later life.
METHODS
Residents of the agricultural community of Cache County, UT, who were aged 65 years and older as of January 1995, were invited to participate in the study. At baseline, participants completed detailed occupational history questionnaires that included information about exposures to various types of pesticides. Cognitive status was assessed at baseline and after 3, 7, and 10 years. Standardized methods were used for detection and diagnosis of dementia and AD. Cox proportional hazards survival analyses were used to evaluate the risk of incident dementia and AD associated with pesticide exposure.
RESULTS
Among 3,084 enrollees without dementia, more men than women reported pesticide exposure (p < 0.0001). Exposed individuals (n = 572) had more years of education (p < 0.01) but did not differ from others in age. Some 500 individuals developed incident dementia, 344 with AD. After adjustment for baseline age, sex, education, APOE epsilon4 status, and baseline Modified Mini-Mental State Examination scores, Cox proportional hazards models showed increased risks among pesticide-exposed individuals for all-cause dementia, with hazard ratio (HR) 1.38 and 95% confidence interval (CI) 1.09-1.76, and for AD (HR 1.42, 95% CI 1.06-1.91). The risk of AD associated with organophosphate exposure (HR 1.53, 95% CI 1.05-2.23) was slightly higher than the risk associated with organochlorines (HR 1.49, 95% CI 0.99-2.24), which was nearly significant.
CONCLUSIONS
Pesticide exposure may increase the risk of dementia and Alzheimer disease in late life.
背景
常用的有机磷和有机氯农药会抑制躯体、自主和中枢神经系统中的乙酰胆碱酯酶，因此可能对神经系统产生持久影响。很少有研究检查过农药接触与痴呆症或阿尔茨海默病（AD）风险之间的关系。我们试图研究职业性农药接触与晚年发生痴呆症和 AD 的风险之间的关联。
方法
邀请犹他州 Cache 县农业社区的年龄在 1995 年 1 月年满 65 岁及以上的居民参加研究。在基线时，参与者完成了详细的职业史调查问卷，其中包括有关接触各种类型农药的信息。在基线以及 3 年、7 年和 10 年后评估认知状态。使用标准化方法进行痴呆症和 AD 的检测和诊断。Cox 比例风险生存分析用于评估与农药接触相关的新发痴呆症和 AD 的风险。
结果
在 3084 名没有痴呆症的登记参与者中，报告农药接触的男性多于女性（p < 0.0001）。接触者（n = 572）受教育年限更多（p < 0.01），但与其他人在年龄上没有差异。约有 500 人发生了新发痴呆症，其中 344 人患有 AD。在校正基线年龄、性别、教育程度、APOE ε4 状态和基线改良迷你精神状态检查评分后，Cox 比例风险模型显示，农药接触者发生所有原因痴呆症的风险增加，风险比（HR）为 1.38，95%置信区间（CI）为 1.09-1.76，AD 的风险增加（HR 1.42，95%CI 1.06-1.91）。与有机磷接触相关的 AD 风险（HR 1.53，95%CI 1.05-2.23）略高于与有机氯相关的风险（HR 1.49，95%CI 0.99-2.24），接近显著。
结论
农药接触可能会增加晚年痴呆症和阿尔茨海默病的风险。
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