Hotz P, Lauwerys R R
Unit of Industrial Toxicology and Occupational Medicine, Catholic University of Louvain, Brussels, Belgium.
Crit Rev Toxicol. 1997 Sep;27(5):443-94. doi: 10.3109/10408449709078443.
Although it is generally acknowledged that benzene causes leukemia, especially acute myeloid leukemia, considerable divergences persist in the assessment of the leukemia risk due to occupational low-level benzene exposure. Specifically, the risk for vehicle mechanics is considered by some authors as being nondetectable with epidemiologic methods, whereas others calculated that the incidence rate of leukemia (all types) in vehicle mechanics is increased more than 60 times. The purpose of this review is to examine the publications on this topic in light of criteria for causal inference and to discuss the possible role of bias, confounding factors, and chance. The results of this analysis reveal that there are surprisingly few epidemiologic observations supporting an increased incidence of leukemia in vehicle mechanics. Apparently, publications suggesting a leukemogenic effect of low-level benzene exposure in garage mechanics are more often quoted than their negative counterparts, although they are not better designed.
尽管人们普遍认为苯会引发白血病，尤其是急性髓系白血病，但在评估职业性低水平苯暴露导致的白血病风险方面，仍存在相当大的分歧。具体而言，一些作者认为，用流行病学方法无法检测出汽车修理工患白血病的风险，而另一些人则计算出，汽车修理工患白血病（所有类型）的发病率增加了60多倍。本综述的目的是根据因果推断标准审视关于该主题的出版物，并讨论偏倚、混杂因素和机遇可能发挥的作用。该分析结果显示，令人惊讶的是，几乎没有流行病学观察结果支持汽车修理工白血病发病率增加这一观点。显然，那些表明汽车修理工低水平苯暴露有致白血病作用的出版物，比那些持否定观点的出版物被引用得更频繁，尽管它们的设计并不更优。
