儿童时期遭受原子弹辐射的幸存者中，辐射剂量与甲状腺结节患病率的关系（2007-2011 年）。

Association of radiation dose with prevalence of thyroid nodules among atomic bomb survivors exposed in childhood (2007-2011).

机构信息

Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan2First Department of Internal Medicine, Graduate School of Biochemical Sciences, Nagasaki University, Nagasaki, Japan.

Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan.

出版信息

JAMA Intern Med. 2015 Feb;175(2):228-36. doi: 10.1001/jamainternmed.2014.6692.

DOI:10.1001/jamainternmed.2014.6692

PMID:25545696

Abstract

IMPORTANCE

Few studies have evaluated the association of radiation dose with thyroid nodules among adults exposed to radiation in childhood.

OBJECTIVE

To evaluate radiation dose responses on the prevalence of thyroid nodules in atomic bomb survivors exposed in childhood.

DESIGN, SETTING, AND PARTICIPANTS: This survey study investigated 3087 Hiroshima and Nagasaki atomic bomb survivors who were younger than 10 years at exposure and participated in the thyroid study of the Adult Health Study at the Radiation Effects Research Foundation. Thyroid examinations including thyroid ultrasonography were conducted between October 2007 and October 2011, and solid nodules underwent fine-needle aspiration biopsy. Data from 2668 participants (86.4% of the total participants; mean age, 68.2 years; 1213 men; and 1455 women) with known atomic bomb thyroid radiation doses (mean dose, 0.182 Gy; median dose, 0.018 Gy; dose range, 0-4.040 Gy) were analyzed.

MAIN OUTCOMES AND MEASURES

The prevalence of all thyroid nodules having a diameter of 10 mm or more (consisting of solid nodules [malignant and benign] and cysts), prevalence of small thyroid nodules that were less than 10 mm in diameter detected by ultrasonography, and atomic bomb radiation dose-responses.

RESULTS

Thyroid nodules with a diameter of 10 mm or more were identified in 470 participants (17.6%): solid nodules (427 cases [16.0%]), malignant tumors (47 cases [1.8%]), benign nodules (186 cases [7.0%]), and cysts (49 cases [1.8%]), and all were significantly associated with thyroid radiation dose. Excess odds ratios per gray unit were 1.65 (95% CI, 0.89-2.64) for all nodules, 1.72 (95% CI, 0.93-2.75) for solid nodules, 4.40 (95% CI, 1.75-9.97) for malignant tumors, 2.07 (95% CI, 1.16-3.39) for benign nodules, and 1.11 (95% CI, 0.15-3.12) for cysts. The interaction between age at exposure and the dose was significant for the prevalence of all nodules (P = .003) and solid nodules (P < .001), indicating that dose effects were significantly higher with earlier childhood exposure. No interactions were seen for sex, family history of thyroid disease, antithyroid antibodies, or seaweed intake. No dose-response relationships were observed for small (<10-mm diameter) thyroid nodules.

CONCLUSIONS AND RELEVANCE

Radiation effects on thyroid nodules exist in atomic bomb survivors 62 to 66 years after their exposure in childhood. However, radiation exposure is not associated with small thyroid nodules.

摘要

重要性

很少有研究评估儿童期暴露于辐射的成年人的辐射剂量与甲状腺结节之间的关联。

目的

评估广岛和长崎原子弹幸存者中，儿童期暴露于辐射后的甲状腺结节患病率的辐射剂量反应。

设计、设置和参与者：本调查研究调查了 3087 名广岛和长崎原子弹幸存者，他们在暴露时年龄均小于 10 岁，并参加了辐射影响研究所成人健康研究中的甲状腺研究。在 2007 年 10 月至 2011 年 10 月期间进行了甲状腺检查，包括甲状腺超声检查，对实性结节进行了细针抽吸活检。对已知原子弹甲状腺辐射剂量（平均剂量 0.182Gy；中位数剂量 0.018Gy；剂量范围 0-4.040Gy）的 2668 名参与者（总参与者的 86.4%；平均年龄 68.2 岁；1213 名男性；1455 名女性）的数据进行了分析。

主要结果和测量

所有直径为 10mm 或更大的甲状腺结节（包括实性结节[恶性和良性]和囊肿）的患病率、超声检查发现的直径小于 10mm 的小甲状腺结节的患病率，以及原子弹辐射剂量反应。

结果

470 名参与者（17.6%）有直径为 10mm 或更大的甲状腺结节：实性结节（427 例[16.0%]）、恶性肿瘤（47 例[1.8%]）、良性结节（186 例[7.0%]）和囊肿（49 例[1.8%]），所有这些均与甲状腺辐射剂量显著相关。每戈瑞单位的超额优势比为 1.65（95%CI，0.89-2.64），所有结节；1.72（95%CI，0.93-2.75），实性结节；4.40（95%CI，1.75-9.97），恶性肿瘤；2.07（95%CI，1.16-3.39），良性结节；1.11（95%CI，0.15-3.12），囊肿。暴露年龄与剂量之间的交互作用对于所有结节（P=0.003）和实性结节（P<0.001）的患病率均有统计学意义，表明儿童期早期暴露的剂量效应明显更高。在性别、甲状腺疾病家族史、抗甲状腺抗体或海藻摄入量方面未观察到交互作用。对于小（直径<10mm）甲状腺结节未观察到剂量反应关系。