有机氯农药非职业暴露与乳腺癌患病风险的病例-对照研究

Serum organochlorines pesticides level of non-occupational exposure women and risk of breast cancer:a case-control study

目的研究有机氯农药二氯二苯三氯乙烷(DDT)和六氯环乙烷(HCH)类雌激素污染物在非职业暴露人群的内暴露水平及与乳腺癌患病风险的关系。方法采用成组病例对照研究方法,调查90名乳腺癌新确诊患者和136名社区健康女性对照。采用问卷调查表收集病例及对照的乳腺癌相关危险因素信息。采用气相色谱-电子捕获(GC-ECD)方法检测血清中有机氯农药残留物水平。运用logistic回归模型分析8种有机氯农药残留物的血清水平与乳腺癌患病风险的相对危险度(OR)。结果病例和对照血清中均能检出p,p’-DDT、p,p’-DDE、o,p’-DDT、p,p’-DDD以及α、β、γ、δ-HCHs有机氯农药残留物,其中β-HCH、p,p’-DDE及p,p’-DDT的总检出率为91·2%、92·1%和91·2%;各物质检出水平在乳腺癌组和对照组间差异无显著性(P>0·05);控制了混杂因素后,p,p’-DDT、p,p’-DDD及δ-HCH暴露与总乳腺癌患病呈正相关(OR>2,P<0·05)。分层分析中绝经前女性的p,p’-DDT、p,p’-DDD、β-HCH血清水平与乳腺癌呈正相关,调整OR分别为3·59、5·70和3·06(P<0·05)。结论有机氯农药残留物(DDTs和HCHs)可能增加妇女,尤其在绝经前妇女患乳腺癌的风险。

Objective To describe exposure level of organochlorines pesticides residues in non-occupational exposure population in China and testify the hypothesis that organochlorine pesticides exposure may be the risk factor to human breast cancer. Methods A case-control study based on community was designed. 90 new diagnostic breast cancer patients from the Second Hospital of Sichuan Province, and 136 health women from community, who settled down in the same district as case were enrolled, The risk factors of breast cancer were investigated by a questionnaire. GC-ECD was used to measure the serum level of Organochlorines pesticide residues. The adjusted odds rations （ OR ） of organochlorines pesticides residues to breast cancer were evaluated by logistic regression model, Results 8 organochlorines pesticide residues including p, p＇-DDT, p, p＇-DDE, o, p＇-DDT, p, p＇-DDD and α、β、γ、δ-HCHs （hexachlorocyclohexane） could be detected in serum of cases and controls. The detecting rates of β-HCH, p, p＇-DDE and p, p＇-DDT respectively were 91,2% ,92.1% and 91.2%, There were no significant differences of serum level of organochlorines pesticides residues between cases and controls （P 〉 0.05）. After adjusting confounding factors, serum p,p＇-DDT, p,p＇-DDD, and δ-HCH level were positively related to the risk of breast cancer （adjusted OR 〉 2, P 〈 0.05）. High serum p,p＇-DDT,p,p＇-DDD and β-HCH level were positively correlated to premenopausal women （adjusted ORs respectively were 3,59, 5.70 and 3,06, P 〈 0.05）.Conclusion Organochlorines pesticides resides, including DDTs and HCHs, may increase women＇s risk of breast cancer, particularly in premenopausal women in China.