Goel Charu, Kumar Nidhish, Tripathi Anil, Tiwari Sunita, Shrivastava Ashutosh
Physiology, King George's Medical University, Lucknow, IND.
Physiology, Kalyan Singh Government Medical College, Bulandshahr, IND.
Cureus. 2024 May 5;16(5):e59698. doi: 10.7759/cureus.59698. eCollection 2024 May.
Background There is little evidence that pesticide exposure is the primary cause of acquired aplastic anemia (AAA), even though the prevalence of aplastic anemia (AA) is substantially higher in underdeveloped countries than in affluent countries. AA caused by pesticides has not yet been fully understood. This study aimed to examine the potential link between plasma levels of malondialdehyde (MDA) and organochlorine pesticides (OCPs) as risk factors for developing AAA in the North Indian population. Methods This case-control study was conducted at a tertiary care hospital in North India. A total of 99 participants were chosen for the study, of whom 45 were cases of AA. These cases attended the Clinical Hematology department over a period of 1.5 years (May 2018 to November 2019). Forty-five controls were age and sex-matched, apparently healthy subjects. Written informed consent was obtained from each subject before performing the study. Exclusion criteria included patients unwilling to give consent, those using medication to treat AA, those genetically predisposed to AA, those with characteristics including granuloma and dysplasia of bone marrow, any other systemic illness, and subjects with a history of smoking, drinking, or using tobacco in any form. Gas chromatography-tandem mass spectrometry (GC-MS/MS) was used to evaluate the plasma levels of organochlorines. The estimation of plasma MDA, i.e., the lipid peroxide content, was measured. Results The severity of AA is significantly associated with plasma levels of α-Hexachlorocyclohexane (p = 0.040), Heptachlor (p = 0.006), Aldrin (p < 0.001), p,p'-Dichlorodiphenyldichloroethane (p = 0.004), Endosulfan sulfate (p = 0.010), and Methoxychlor (p = 0.001). There was a statistically non-significant difference in MDA levels between cases and controls (p = 0.145); however, a statistically significant linear increase in MDA levels (p < 0.001) was observed according to the severity of AA. Conclusion Our study suggests that oxidative stress may be linked to the severity of AA. Pesticide exposure (plasma organochlorine levels) could act as a stressor, potentially initiating an alarmin response of oxidative stress in the form of lipid peroxidation (MDA) from damaged tissue, which could then lead to suppression of hematopoiesis and be a possible factor in the development of AA.
几乎没有证据表明农药暴露是获得性再生障碍性贫血（AAA）的主要病因，尽管再生障碍性贫血（AA）在欠发达国家的患病率显著高于富裕国家。由农药引起的AA尚未得到充分了解。本研究旨在探讨血浆丙二醛（MDA）水平与有机氯农药（OCPs）作为北印度人群发生AAA的危险因素之间的潜在联系。
本病例对照研究在印度北部的一家三级医疗医院进行。共选择99名参与者进行研究，其中45例为AA患者。这些病例在1.5年期间（2018年5月至2019年11月）就诊于临床血液科。45名对照为年龄和性别匹配的明显健康受试者。在进行研究前，从每个受试者处获得书面知情同意书。排除标准包括不愿给予同意的患者、正在使用药物治疗AA的患者、有AA遗传易感性的患者、具有包括骨髓肉芽肿和发育异常特征的患者、任何其他全身性疾病患者以及有吸烟、饮酒或使用任何形式烟草史的受试者。采用气相色谱 - 串联质谱法（GC - MS/MS）评估血浆中有机氯的水平。测定血浆MDA，即脂质过氧化物含量。
AA的严重程度与α - 六氯环己烷（p = 0.040）、七氯（p = 0.006）、艾氏剂（p < 0.001）、p,p'-二氯二苯二氯乙烷（p = 0.004）、硫丹硫酸盐（p = 0.010）和甲氧滴滴涕（p = 0.001）的血浆水平显著相关。病例组和对照组之间MDA水平在统计学上无显著差异（p = 0.145）；然而，根据AA的严重程度观察到MDA水平有统计学上显著的线性增加（p < 0.001）。
我们的研究表明氧化应激可能与AA的严重程度有关。农药暴露（血浆有机氯水平）可能作为一种应激源，潜在地引发受损组织以脂质过氧化（MDA）形式的氧化应激警报反应，进而可能导致造血抑制并成为AA发生的一个可能因素。
