Institute of Environment and Health, Cranfield Health, Cranfield University, Cranfield, Bedfordshire MK43 0AL, United Kingdom.
Crit Rev Toxicol. 2013 Jul;43(6):515-34. doi: 10.3109/10408444.2013.798719.
Parkinson's disease (PD) is an idiopathic disease and its pathological feature is a loss of pigmented neurons in the substantia nigra. Some commonly used pesticides possess neurotoxicity, and exposure to such compounds may trigger mechanisms similar to those in the development of idiopathic PD. We conducted a systematic review of epidemiological studies, aiming at a critical evaluation of the association between the development of PD and pesticide exposure. Reported effect sizes (ES) in the relevant studies were pooled into the meta-analysis to derive summary ES. The summary ES suggested a significantly positive association between PD and overall pesticide use (non-occupational and/or occupational pesticide use) [1.42; 95% confidence interval (CI) 1.32 to 1.52, the fixed-effects model], as well as between PD and occupational pesticide exposure (1.49 with a 95% CI of 1.34-1.66). Both occupational herbicide and occupational insecticide exposure showed a significant association with PD. The results of the meta-analysis reported in this study suggest the existence of a statistically positive association between PD and pesticide exposure. The majority of the studies that were pooled in the meta-analysis were case-control design with very few cohort studies and most with poor exposure characterization thus, any further case-control studies using similar methodologies are unlikely to have a significant impact or understanding on the currently-reported association between pesticide exposure and the development of idiopathic PD. Therefore, we believe that if further epidemiological studies are going to be conducted in the area, they should be prospective cohort studies that will include accurate exposure assessment.
帕金森病（PD）是一种特发性疾病，其病理特征是黑质中色素性神经元的丧失。一些常用的农药具有神经毒性，接触此类化合物可能会引发类似于特发性 PD 发展的机制。我们对流行病学研究进行了系统评价，旨在对 PD 的发展与农药暴露之间的关联进行批判性评估。将相关研究中报告的效应大小（ES）汇总到荟萃分析中，得出综合 ES。汇总 ES 表明 PD 与总体农药使用（非职业性和/或职业性农药使用）之间存在显著正相关（1.42；95%置信区间[CI] 1.32 至 1.52，固定效应模型），以及 PD 与职业性农药暴露之间存在显著正相关（1.49，95%CI 为 1.34-1.66）。职业性除草剂和职业性杀虫剂暴露均与 PD 显著相关。本研究报告的荟萃分析结果表明，PD 与农药暴露之间存在统计学上的正相关。汇总荟萃分析的研究大多为病例对照设计，仅有少数队列研究，且大多数暴露特征描述较差，因此，任何进一步采用类似方法的病例对照研究都不太可能对目前报道的农药暴露与特发性 PD 发展之间的关联产生重大影响或理解。因此，我们认为，如果要在该领域进行进一步的流行病学研究，它们应该是包括准确暴露评估的前瞻性队列研究。
