Osame M, Janssen R, Kubota H, Nishitani H, Igata A, Nagataki S, Mori M, Goto I, Shimabukuro H, Khabbaz R
Third Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
Ann Neurol. 1990 Jul;28(1):50-6. doi: 10.1002/ana.410280110.
To study the epidemiology of human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Japan, we conducted two nationwide surveys between October 1986 and March 1989. A total of 710 patients with HAM (definite HAM, 589; probable HAM, 121) were reported. Of the 589 patients with definite HAM, 69% were residents of the areas with the highest prevalence HTLV-I in Japan. To determine the importance of blood transfusion in the pathogenesis of HAM/TSP, we performed a case-control study in the Kagoshima district in southern Japan. Significantly more patients with HAM reported a history of blood transfusion (26/129, or 20%) than did subjects in a health survey of the general population (41/1,290, or 3%; odds ratio = 7.7, p less than 0.001) or than did hospitalized neurological patients (6/119, or 5%; odds ratio = 4.8, p less than 0.001). Furthermore, the cumulative percentages of the intervals between blood transfusion and the onset of the symptoms of HAM fit a lognormal curve, suggesting that transfusion was an important common exposure. Blood transfusion probably transmitted HTLV-I to the patients with transfusion-associated HAM because there was a significant decrease in the number of patients with the transfusion-associated HAM who received blood after implementation of nationwide screening of blood donors in 1986 (p = 0.004). In the first 2 years, screening the blood supply in Japan appears to have decreased the number of reported patients with HAM by 16%.
为研究日本I型人类嗜T细胞病毒（HTLV-I）相关脊髓病/热带痉挛性截瘫（HAM/TSP）的流行病学，我们于1986年10月至1989年3月期间开展了两项全国性调查。共报告了710例HAM患者（确诊HAM 589例；疑似HAM 121例）。在589例确诊HAM患者中，69%是日本HTLV-I患病率最高地区的居民。为确定输血在HAM/TSP发病机制中的重要性，我们在日本南部的鹿儿岛地区进行了一项病例对照研究。报告有输血史的HAM患者（26/129，即20%）显著多于一般人群健康调查中的受试者（41/1290，即3%；优势比 = 7.7，p < 0.001）或住院神经科患者（6/119，即5%；优势比 = 4.8，p < 0.001）。此外，输血与HAM症状发作之间间隔时间的累积百分比符合对数正态曲线，表明输血是一个重要的共同暴露因素。输血可能将HTLV-I传播给了输血相关HAM患者，因为在1986年实施全国献血者筛查后，输血相关HAM患者接受输血后的数量显著减少（p = 0.004）。在最初的2年里，日本筛查供血似乎使报告的HAM患者数量减少了16%。
