一项采用“同一健康”方法的试点病例对照研究，以评估斯里兰卡病因不明的慢性肾脏病的行为、环境和职业风险因素。
A pilot case-control study using a one health approach to evaluate behavioral, environmental, and occupational risk factors for chronic kidney disease of unknown etiology in Sri Lanka.
作者信息
M Pry Jake, Jackson Wendi, Rupasinghe Ruwini, Lishanthe Guneratne, Badurdeen Zied, Abeysekara Tilak, Chandrajith Rohana, Smith Woutrina, Wickramasinghe Saumya
机构信息
Implementation Science Unit, Centre for Infectious Disease Research Zambia (CIDRZ), 10101 Lusaka, Zambia.
School of Medicine, Washington University, St. Louis, MO USA.
出版信息
One Health Outlook. 2021 Feb 23;3:4. doi: 10.1186/s42522-020-00034-3. eCollection 2021.
BACKGROUND
Chronic kidney disease of unknown etiology (CKDu) was first recognized in Sri Lanka in the early 1990s, and since then it has reached epidemic levels in the North Central Province of the country. The prevalence of CKDu is reportedly highest among communities that engage in chena and paddy farming, which is most often practiced in the dry zone including the North Central and East Central Provinces of Sri Lanka. Previous studies have suggested varied hypotheses for the etiology of CKDu; however, there is not yet a consensus on the primary risk factors, possibly due to disparate study designs, sample populations, and methodologies.
METHODS
The goal of this pilot case-control study was to evaluate the relationships between key demographic, cultural, and occupational variables as risk factors for CKDu, with a primary interest in pesticide exposure both occupationally and through its potential use as an ingredient in brewed kasippu alcohol. An extensive one health focused survey was developed with in cooperation with the Centre for Research, Education, and Training on Kidney Diseases of Sri Lanka.
RESULTS
A total of 56 CKDu cases and 54 control individuals were surveyed using a proctored, self-reported questionnaire. Occupational pesticide exposure and alcohol consumption were not found to be significant risk factors for CKDu. However, a statistically significant association with CKDu was observed with chewing betel (adjusted odds ratio [aOR]: 6.11, 95% confidence interval [CI]: 1.93, 19.35), age (aOR: 1.07, 95% CI: 1.02, 1.13), owning a pet dog (aOR: 3.74, 95% CI: 1.38, 10.11), water treatment (aOR: 3.68, 95% CI: 1.09, 12.43) and pests in the house (aOR: 5.81, 95% CI: 1.56, 21.60).
CONCLUSIONS
The findings of this study suggest future research should focus on practices associated with chewing betel, potential animal interactions including pests in the home and pets, and risk factors associated with water.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s42522-020-00034-3.
背景
病因不明的慢性肾脏病（CKDu）于20世纪90年代初在斯里兰卡首次被发现，自那时起，该国中北部省份的CKDu已达到流行程度。据报道，CKDu在从事刀耕火种和水稻种植的社区中患病率最高，这种农业活动在包括斯里兰卡中北部和中东部省份在内的干旱地区最为常见。先前的研究对CKDu的病因提出了各种假设；然而，对于主要风险因素尚未达成共识，这可能是由于研究设计、样本群体和方法存在差异。
方法
本试点病例对照研究的目的是评估关键的人口统计学、文化和职业变量作为CKDu风险因素之间的关系，主要关注职业性农药暴露以及农药作为酿造卡西普酒的成分可能带来的暴露。与斯里兰卡肾脏病研究、教育和培训中心合作开展了一项广泛的以“同一个健康”为重点的调查。
结果
使用监考的自我报告问卷对56例CKDu病例和54名对照个体进行了调查。未发现职业性农药暴露和饮酒是CKDu的显著风险因素。然而，观察到与CKDu有统计学显著关联的因素有嚼槟榔（调整后的优势比[aOR]：6.11，95%置信区间[CI]：1.93，19.35）、年龄（aOR：1.07，95%CI：1.02，1.13）、拥有宠物狗（aOR：3.74，95%CI：1.38，10.11）、水处理（aOR：3.68，95%CI：1.
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