Radiation Epidemiology Branch, National Cancer Institute, Executive Plaza South, Rockville, Maryland, USA.
Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1101-9. doi: 10.1016/j.ijrobp.2012.01.053. Epub 2012 Apr 10.
To assess the shape of the dose-response for various circulatory disease endpoints, and modifiers by age and time since exposure.
This was an analysis of the US peptic ulcer data testing for heterogeneity of radiogenic risk by circulatory disease endpoint (ischemic heart, cerebrovascular, other circulatory disease).
There were significant excess risks for all circulatory disease, with an excess relative risk Gy(-1) of 0.082 (95% CI 0.031-0.140), and ischemic heart disease, with an excess relative risk Gy(-1) of 0.102 (95% CI 0.039-0.174) (both p = 0.01), and indications of excess risk for stroke. There were no statistically significant (p > 0.2) differences between risks by endpoint, and few indications of curvature in the dose-response. There were significant (p < 0.001) modifications of relative risk by time since exposure, the magnitude of which did not vary between endpoints (p > 0.2). Risk modifications were similar if analysis was restricted to patients receiving radiation, although the relative risks were slightly larger and the risk of stroke failed to be significant. The slopes of the dose-response were generally consistent with those observed in the Japanese atomic bomb survivors and in occupationally and medically exposed groups.
There were excess risks for a variety of circulatory diseases in this dataset, with significant modification of risk by time since exposure. The consistency of the dose-response slopes with those observed in radiotherapeutically treated groups at much higher dose, as well as in lower dose-exposed cohorts such as the Japanese atomic bomb survivors and nuclear workers, implies that there may be little sparing effect of fractionation of dose or low-dose-rate exposure.
评估各种循环系统疾病终点和年龄及暴露后时间的剂量反应形状和修饰剂。
这是一项对美国消化性溃疡数据的分析，旨在通过循环系统疾病终点（缺血性心脏病、脑血管疾病、其他循环系统疾病）测试放射性风险的异质性。
所有循环系统疾病均存在显著的超额风险，Gy(-1)的超额相对风险为 0.082（95%置信区间为 0.031-0.140），缺血性心脏病的超额相对风险为 0.102（95%置信区间为 0.039-0.174）（均为 p = 0.01），且存在中风风险超额的迹象。各终点之间的风险无统计学差异（p > 0.2），且剂量反应曲线呈曲线的迹象较少。暴露后时间的相对风险存在显著（p < 0.001）修饰，其大小在终点之间没有差异（p > 0.2）。如果分析仅限于接受辐射的患者，则风险修饰相似，尽管相对风险略大，且中风风险未达到显著水平。剂量反应的斜率与在日本原子弹幸存者和职业性及医疗性暴露人群中观察到的斜率大致一致。
在该数据集，存在多种循环系统疾病的超额风险，且风险随暴露后时间显著修饰。剂量反应斜率与在高剂量放射治疗组以及低剂量暴露组（如日本原子弹幸存者和核工作者）中观察到的斜率一致，这表明分次剂量或低剂量率暴露的分割效应可能很小。
