From the Harvard Center for Population and Development Studies (E.L.S.), Cambridge, MA; INSERM U1061 (L.-A.G., C.B.), Neuropsychiatrie: recherche épidemiologique et clinique, Université Montpellier I, Hôpital La Colombière, France; Department of Society, Human Development, and Health (C.A.O.), Harvard School of Public Health, Boston, MA; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, AP-HP; University of Bordeaux (H.A.), ISPED, Centre INSERM U897-Epidemiologie-Biostatistique; University of Bordeaux (H.A.), Department of Psychology, Bordeaux; Population-based Cohort Platform (M.G., M.Z.), Epidemiology and Public Health Research Center, UMRS INSERM 1018, Villejuif; Université Versailles Saint-Quentin UMRS 1018 (M.G., M.Z.); CMRR Languedoc Roussillon (C.B.), CHU Montpellier, France.
Neurology. 2014 May 13;82(19):1716-23. doi: 10.1212/WNL.0000000000000413.
To test the effects of lifetime occupational solvent exposure, as measured by dose and timing, on performance on multiple cognitive tests among retired French utility workers.
A total of 2,143 retirees in the GAZEL cohort underwent cognitive testing in 2010. Lifetime exposure to chlorinated solvents, petroleum solvents, and benzene was assessed using a job exposure matrix. We modeled effects of lifetime solvent dose, timing of last exposure, and a combination of these metrics on risk for cognitive impairment.
Thirty-three percent of participants were exposed to chlorinated solvents, 26% to benzene, and 25% to petroleum solvents. High exposure to solvents was significantly associated with poor cognition; for example, those highly exposed to chlorinated solvents were at risk of impairment on the Mini-Mental State Examination (risk ratio 1.18; 95% confidence interval 1.06, 1.31), the Digit Symbol Substitution Test (1.54; 1.31, 1.82), semantic fluency test (1.33; 1.14, 1.55), and the Trail Making Test B (1.49; 1.25, 1.77). Retirees at greatest risk for deficits had both high lifetime exposure to solvents and were last exposed 12 to 30 years before testing. Risk was somewhat elevated among those with high lifetime exposure who were last exposed 31 to 50 years before testing. Those with high, recent exposure exhibited impairment in almost all domains, including those not typically associated with solvent exposure.
While risk of cognitive impairment among moderately exposed workers may attenuate with time, this may not be fully true for those with higher exposure. This has implications for physicians working with formerly solvent-exposed patients as well as for workplace exposure limit policies.
测试一生中职业性溶剂暴露（通过剂量和时间来衡量）对已退休法国公用事业工人多项认知测试表现的影响。
GAZEL 队列中共有 2143 名退休人员于 2010 年接受了认知测试。使用职业暴露矩阵评估了氯代溶剂、石油溶剂和苯的终生暴露情况。我们对终生溶剂剂量、末次暴露时间以及这些指标的组合对认知障碍风险的影响进行了建模。
33%的参与者接触过氯代溶剂，26%接触过苯，25%接触过石油溶剂。高暴露于溶剂与认知能力下降显著相关；例如，高度接触氯代溶剂的人在简易精神状态检查（风险比 1.18；95%置信区间 1.06，1.31）、数字符号替代测试（1.54；1.31，1.82）、语义流畅性测试（1.33；1.14，1.55）和连线测试 B（1.49；1.25，1.77）上存在认知障碍风险。暴露时间长且终生接触量最高的退休人员风险最大，他们在测试前 12 至 30 年最后一次接触溶剂。在终生接触量高但在测试前 31 至 50 年最后一次接触溶剂的人群中，风险也略有升高。终生接触量高且近期接触量高的人群几乎在所有领域都存在认知障碍，包括那些通常与溶剂接触无关的领域。
虽然中度暴露工人的认知障碍风险可能会随时间减弱，但对于那些高暴露的工人来说，这种情况可能并不完全正确。这对那些与以前暴露于溶剂的患者一起工作的医生以及工作场所暴露限制政策都有影响。
