Pesatori A C, Zocchetti C, Guercilena S, Consonni D, Turrini D, Bertazzi P A
Research Centre for Occupational, Clinical and Environmental Epidemiology (EPOCA), Institute of Occupational Health, University of Milan, Italy.
Occup Environ Med. 1998 Feb;55(2):126-31. doi: 10.1136/oem.55.2.126.
To investigate, in a population heavily exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the possible unusual occurrence of diseases other than cancer.
Five year extension of the follow up of the cohort involved in the Seveso accident. Soil measurements identified three exposure zones: (A) highest contamination, (B) substantial, and (R) low but higher than background contamination. Blood TCDD measurements, although limited in number, confirmed zone exposure ranking. The 15 year mortality in the exposed cohort was compared with that of a large population in the surrounding non-contaminated territory. Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated with Poisson regression techniques.
The already noted increased occurrence of cardiovascular deaths was confirmed, in particular in zone A, among males for chronic ischaemic heart disease (five deaths, RR 3.0, 95% CI 1.2 to 7.3), and among females for hypertensive disease (three deaths, RR 3.6, 95% CI 1.2 to 11.4) and chronic rheumatic heart disease. Novel findings were the increase of chronic obstructive pulmonary disease, most notably among males in zone A (four deaths, RR 3.7, 95% CI 1.4 to 9.9) and females in zone B (seven deaths, RR 2.4, 95% CI 1.1 to 5.1); and from diabetes, which was significantly increased in females in zone B (13 deaths, RR 1.9, 95% CI 1.1 to 3.2). In zone R, chronic ischaemic heart disease (males and females), hypertension (females), and diabetes (females) showed less pronounced, although significant excesses.
As well as high TCDD exposure, the accident caused a severe burden of strain in the population. Both these factors might have contributed to the noted increased risks (in particular, circulatory and respiratory). The cardiovascular and immune toxicity of TCDD, as well as its complex interaction with the endocrine system, might be relevant to the explanations of these findings. These results, although not conclusive, concur with previous data in suggesting cardiopulmonary and endocrine effects in humans highly exposed to TCDD.
在大量接触2,3,7,8-四氯二苯并对二恶英（TCDD）的人群中，调查除癌症以外其他疾病可能出现的异常情况。
对塞韦索事故所涉队列进行为期五年的随访延长。土壤测量确定了三个暴露区：（A）污染最严重区，（B）污染程度较高区，以及（R）污染程度较低但高于背景污染水平区。血液TCDD测量结果（尽管数量有限）证实了各区域暴露水平的排序。将暴露队列的15年死亡率与周围未受污染地区的大量人群的死亡率进行比较。采用泊松回归技术估计相对风险（RRs）和95%置信区间（95% CIs）。
已注意到的心血管疾病死亡人数增加得到证实，特别是在A区，男性慢性缺血性心脏病死亡人数增加（5例死亡，RR 3.0，95% CI 1.2至7.3），女性高血压疾病（3例死亡，RR 3.6，95% CI 1.2至11.4）和慢性风湿性心脏病死亡人数增加。新发现包括慢性阻塞性肺疾病增加，最明显的是A区男性（4例死亡，RR 3.7，95% CI 1.4至9.9）和B区女性（7例死亡，RR 2.4，95% CI 1.1至5.1）；以及糖尿病，B区女性糖尿病死亡人数显著增加（13例死亡，RR 1.9，95% CI 1.1至3.2）。在R区，慢性缺血性心脏病（男性和女性）、高血压（女性）和糖尿病（女性）的增加幅度虽不那么明显，但仍有显著超额。
除了高TCDD暴露外，事故还给人群造成了沉重的压力负担。这两个因素可能都导致了所观察到的风险增加（特别是循环系统和呼吸系统疾病风险）。TCDD的心血管和免疫毒性，以及它与内分泌系统的复杂相互作用，可能与这些发现的解释有关。这些结果虽然不具有决定性，但与之前的数据一致，表明高暴露于TCDD的人群存在心肺和内分泌方面的影响。
