骨髓增生异常综合征发病的危险因素

A case-control study of risk factors for myelodysplastic syndromes

目的研究与骨髓增生异常综合征(MDS)发病有关的职业和环境因素。方法采取医院内的1:2病例对照研究方法。病例组266例,来自上海市各大市区级医院2003至2005年住院患者,全部病例符合法美英(FAB)合作组诊断标准,有肿瘤放疗及化疗史、有再生性障碍性贫血史的MDS除外;对照组为与病例组同一医院内的其他病种患者,年龄、性别、种族、住院日均与病例组配对。调查内容为MDS发病前5年内及对照病例确诊前5年内的用药史(包括氯霉素、磺胺药、安定、苯巴比妥、秋水仙碱、环磷酰胺、抗甲状腺药物、抗结核药、D860、抗疟药:中药包括牛黄类、当归类、砷剂、雄黄或砒霜类药物、雷公藤)、职业有害因素(包括苯、重金属、有机磷农药、杀虫剂、除草剂、汽油、柴油、环氧树脂、染料、电离辐射或X线)和生活有害因素(包括染发、高压电传输线、装潢)。结果职业性接触苯可明显增加MDS的发病(OR:8.52,95%CI:2.30～31.10),居住在高压电传输线100m以内可增加MDS的发病(OR:1.60,95%CI:1.10～2.32),居所或办公房新装修可增加MDS的发病(OR:2.40,95%CI:1.38～4.14)。未发现其他职业有害因素如农药、有机物与MDS发病有关。研究未发现染发增加MDS的发病。结论职业性接触苯、居住在高压电传输线100m以内、居所或办公房新装修是MDS的发病危险因素。

Objective To determine the risk factors involved in myelodysplastic syndromes （MDS）. Methods A 1 ：2 case-control study was conducted in 20 Shanghai＇ hospitals over a 3-year period, covering 266 ＂de novo＂ MDS cases corresponded to FAB criteria, and 532 age- and gender-matched controls from same hospitals with MDS cases. Subjects were all surveyed using the same standard questionnaire including histories of medications（Chloramphenicol, Sulfonamides, Meprobamate, Phenatoin, Colchicine, Cyclophosphamide, Propy- hhiouracil, Anti-TB medication,Tolbutamind, Primaquine and Chinese traditional herbs such as Bezoar,Angelica,Arsennic, Thunder cloud vine ） at least 5 years prior to the onset of the disease, tumors, exposure to benzene, heavy metal, organic phosphates, pesticides, petrol/diesel, organic solvents, dye and hair dye products, radiation, house decorating, alcohol and smoking. Results Occupational exposure to benzene increased significantly the risk of MDS（OR ：8.52,95%CI： 2.30-31.10 ）. Living near high voltage power lines（100 m） increased significantly the risk of MDS（OR ： 1.60,95%CI： 1.10-2.32）. House decorating（one year prior to the onset of the disease） increased significantly the risk of MDS（OR ：2.40,95%CI： 1.38-4.14）. Other investigated occupational poisons did not increase significantly the risk of MDS. Hair dye products ,alcohol and smoking did not increase significantly the risk of MDS. Conclusion Occupational exposure to benzene, living near high voltage power lines and house decorating are the risk factors of MDS.