Crane M M, Keating M J, Trujillo J M, Labarthe D R, Frankowski R F
Epidemiology Discipline, University of Texas School of Public Health, Houston 77225.
JAMA. 1989 Aug 4;262(5):634-9.
Three previous investigations have reported a relationship between clonal chromosome abnormalities in marrow of patients with acute nonlymphocytic leukemia and employment in occupations involving mutagenic chemicals, but the effects of other exposures were not described. Environmental exposure profiles, gathered by questionnaire, were therefore compared using a case-control study design in 235 newly diagnosed patients with acute nonlymphocytic leukemia: 126 with abnormal and 109 with normal karyotypes. The univariate odds ratio for occupation at diagnosis was 4.6, which, when adjusted for demographic and other exposures by logistic regression, was reduced to 2.5 (95% confidence interval, 0.5 to 12.8). Adjusted point estimates for other exposures were 4.3 (1.4 to 13.3) for prior cytotoxic therapy, 1.7 (0.9 to 3.1) for cigarette smoking, and 1.9 (1.0 to 3.4) for alcohol use. Dose-response relationships were present for both tobacco and alcohol consumption. Associations between specific abnormalities (+8, -7I-7q, [corrected] inv16, t[8;21]) and certain exposures were also present. These results suggest that life-style exposures may be associated with cytogenetic lesions in persons with acute nonlymphocytic leukemia.
此前已有三项研究报告称，急性非淋巴细胞白血病患者骨髓中的克隆性染色体异常与从事涉及诱变化学物质的职业有关，但未描述其他暴露因素的影响。因此，采用病例对照研究设计，对235例新诊断的急性非淋巴细胞白血病患者通过问卷调查收集的环境暴露情况进行了比较：126例核型异常，109例核型正常。诊断时职业的单因素优势比为4.6，经逻辑回归对人口统计学和其他暴露因素进行调整后，降至2.5（95%置信区间，0.5至12.8）。其他暴露因素的调整点估计值分别为：既往细胞毒性治疗为4.3（1.4至13.3），吸烟为1.7（0.9至3.1），饮酒为1.9（1.0至3.4）。烟草和酒精消费均存在剂量反应关系。特定异常（+8、-7/7q、inv16、t[8;21]）与某些暴露因素之间也存在关联。这些结果表明，生活方式暴露可能与急性非淋巴细胞白血病患者的细胞遗传学损伤有关。
