Kang Hyun, Cha Eun Shil, Choi Geun Joo, Lee Won Jin
Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2014 Dec;29(12):1610-7. doi: 10.3346/jkms.2014.29.12.1610. Epub 2014 Nov 21.
The aim of this study was to examine the relationship between the risk of amyotrophic lateral sclerosis (ALS) and exposure to rural environments. Studies were identified through OVID MEDLINE and EMBASE search up to September 2013 using as keywords rural residence, farmers, and pesticide exposure. Twenty-two studies were included for this meta-analysis. Summary odds ratios (ORs) were calculated using random effect model by type of exposure index, and subgroup analyses were conducted according to study design, gender, region, case ascertainment, and exposure assessment. The risk of ALS was significantly increased with pesticide exposure (OR, 1.44; 95% CI, 1.22-1.70) and with farmers (OR, 1.42; 95% CI, 1.17-1.73), but was not significant with rural residence (OR, 1.25; 95% CI, 0.84-1.87). The risk estimates for subgroup analysis between pesticide exposure and ALS indicated a significant positive association with men (OR, 1.96), and in studies using El Escorial criteria for ALS definition (OR, 1.63) and expert judgment for pesticide exposure (OR, 2.04) as well. No significant publication bias was observed. Our findings support the association of pesticide exposure and an increased risk for ALS, stressing that the use of more specific exposure information resulted in more significant associations.
本研究旨在探讨肌萎缩侧索硬化症（ALS）风险与农村环境暴露之间的关系。通过检索截至2013年9月的OVID MEDLINE和EMBASE数据库来确定相关研究，使用农村居住、农民和农药暴露作为关键词。本荟萃分析纳入了22项研究。根据暴露指数类型，采用随机效应模型计算汇总比值比（OR），并根据研究设计、性别、地区、病例确定和暴露评估进行亚组分析。接触农药（OR，1.44；95%CI，1.22 - 1.70）和农民身份（OR，1.42；95%CI，1.17 - 1.73）会使ALS风险显著增加，但农村居住情况（OR，1.25；95%CI，0.84 - 1.87）与之无关。农药暴露与ALS亚组分析的风险估计表明，男性（OR，1.96）以及在使用El Escorial标准定义ALS（OR，1.63）和专家判断农药暴露情况（OR，2.04）的研究中也存在显著正相关。未观察到明显的发表偏倚。我们的研究结果支持农药暴露与ALS风险增加之间的关联，强调使用更具体的暴露信息会导致更显著的关联。
