Université catholique de Louvain, SSS/IREC/LTAP, Louvain Center for Toxicology and Applied Pharmacology, Avenue E. Mounier 52, bte B1.52.12, B-1200 Brussels, Belgium.
Environ Int. 2012 Oct 1;46:30-43. doi: 10.1016/j.envint.2012.05.004. Epub 2012 Jun 13.
To systematically review available cohort studies and estimate quantitatively the association between occupational exposure to pesticides and Parkinson's disease (PD).
Studies were identified from a MEDLINE search through 30 November 2011 and from the reference lists of identified publications. Relative risk (RR) estimates were extracted from 12 studies published between 1985 and 2011. Meta-rate ratio estimates (mRR) were calculated according to fixed and random-effect meta-analysis models. Meta-analyses were performed on the whole set of data and separate analyses were conducted after stratification for gender, exposure characterisation, PD cases identification, geographic location, reported risk estimator and cohort study design.
A statistically significant increased risk of PD was observed when all studies were combined (mRR=1.28; 95% confidence interval [CI]: 1.03-1.59) but there was a high heterogeneity and inconsistency among studies. The highest increased risks were observed for studies with the best design, i.e. reporting PD diagnosis confirmed by a neurologist (mRR=2.56; CI: 1.46-4.48; n=4), for cohort studies reporting incidence of PD (mRR=1.95; CI: 1.29-2.97; n=3) as well as for prospective cohorts (mRR=1.39; CI: 1.09-1.78; n=6). A significant increased risk was also seen for banana, sugarcane and pineapple plantation workers (mRR=2.05; CI: 1.23-3.42; n=2).
The present study provides some support for the hypothesis that occupational exposure to pesticides increases the risk of PD.
系统回顾现有的队列研究，定量估计职业性暴露于农药与帕金森病（PD）之间的关联性。
通过 2011 年 11 月 30 日之前的 MEDLINE 检索和已确定出版物的参考文献列表，确定研究。从 1985 年至 2011 年发表的 12 项研究中提取相对风险（RR）估计值。根据固定和随机效应荟萃分析模型计算荟萃率比（mRR）估计值。对整套数据进行荟萃分析，并按性别、暴露特征、PD 病例鉴定、地理位置、报告风险估计器和队列研究设计进行分层后进行单独分析。
当综合所有研究时，观察到 PD 的风险显著增加（mRR=1.28；95%置信区间[CI]：1.03-1.59），但研究之间存在高度异质性和不一致性。具有最佳设计的研究观察到的风险增加最高，即报告由神经病学家确诊的 PD 诊断（mRR=2.56；CI：1.46-4.48；n=4），报告 PD 发病率的队列研究（mRR=1.95；CI：1.29-2.97；n=3）以及前瞻性队列研究（mRR=1.39；CI：1.09-1.78；n=6）。香蕉、甘蔗和菠萝种植园工人的风险也显著增加（mRR=2.05；CI：1.23-3.42；n=2）。
本研究为职业性暴露于农药会增加 PD 风险的假说提供了一些支持。
