Selevan S G, Lindbohm M L, Hornung R W, Hemminki K
N Engl J Med. 1985 Nov 7;313(19):1173-8. doi: 10.1056/NEJM198511073131901.
In a case--control study, we examined the relation between fetal loss and occupational exposure to antineoplastic drugs in nurses in 17 Finnish hospitals. The pregnancies studied occurred in 1973 through 1980 and were identified using three national sources: the Central Register of Health Care Personnel, the Hospital Discharge Registry, and policlinic data. Each nurse with fetal loss was matched with three nurses who gave birth. Data on health and exposure were obtained by self-administered, mailed questionnaires; a response rate of 87 per cent was achieved after three mailings. A statistically significant association was observed between fetal loss and occupational exposure to antineoplastic drugs during the first trimester of pregnancy: odds ratio = 2.30 (95 per cent confidence interval, 1.20 to 4.39). Analyses suggested associations between fetal loss and cyclophosphamide, doxorubicin, and vincristine, although the independent effect of each individual drug could not be specifically identified, since many nurses reported handling more than one of these agents. The results of this study, combined with existing data on animals and human beings, suggest that caution be exercised in the handling of these valuable drugs.
在一项病例对照研究中，我们调查了芬兰17家医院护士的胎儿丢失与职业接触抗肿瘤药物之间的关系。所研究的妊娠发生在1973年至1980年期间，通过三个全国性数据源进行识别：医护人员中央登记册、医院出院登记册和门诊数据。每例有胎儿丢失的护士与三名分娩护士进行匹配。健康和接触情况的数据通过自行填写、邮寄问卷获得；三次邮寄后回复率达到87%。在妊娠头三个月期间，观察到胎儿丢失与职业接触抗肿瘤药物之间存在统计学上的显著关联：比值比=2.30（95%置信区间，1.20至4.39）。分析表明胎儿丢失与环磷酰胺、阿霉素和长春新碱之间存在关联，尽管由于许多护士报告接触过不止一种这些药物，无法具体确定每种药物的独立作用。这项研究的结果，结合现有的动物和人类数据，表明在处理这些有价值的药物时应谨慎行事。
