环境因素与儿童急性白血病发病风险的病例对照研究

Case-control study of environmental risk factors associated with childhood acute leukemia

目的探讨儿童急性白血病发病的室内外环境危险因素。方法2007年9月～2008年8月,对115例0～15岁新发急性白血病患儿(急性淋巴细胞白血病87例,急性髓细胞白血病28例)进行相同性别和年龄及入住相同医院的1∶1配对病例对照研究。对患儿父母采用面对面问卷调查一般情况和可能的危险因素(室内和室外相关环境因素)。运用Logistic模型对数据进行单因素和多因素回归分析,计算比值比(OR)和95%置信区间(CI)。结果母亲孕前和(或)孕期化学物质接触史(OR=2.68,95%CI1.22～5.90)、父亲既往医源性放射性物质接触史(OR=2.78,95%CI1.24～6.23)、居室周围高压变电器和(或)电线分布(OR=3.35,95%CI1.38～8.17)、居室内非实木地板装修(OR=1.91,95%CI1.04～3.51)、儿童冬季睡眠时门窗关闭(OR=3.30,95%CI1.80～6.06)和儿童经常使用解热镇痛药和(或)抗生素(β=-1.011,OR=0.36,95%CI0.19～0.72)与儿童急性白血病发病相关。亚型分析中,上述6项因素除居室内非实木地板装修外均与急性淋巴细胞白血病发病相关;而急性髓细胞白血病发病的危险因素为母亲孕前和(或)孕期化学物质接触史、居室周围有工业三废、儿童冬季睡眠时门窗关闭。结论室内外环境因素是儿童急性白血病发病相关的危险因素,对不同亚型急性白血病发病的影响作用可能不同。

Objective To investigate the indoor and outdoor environmental risk factors for childhood acute leukemia. Methods From September 2007 to August 2008,115 children aged 0 to 15 years with newly-onset acute leukemia were enrolled,among whom 87 were diagnosed as acute lymphocytic leukemia and the other 28 as acute myeloid leukemia. Besides,another 115 gender-,age-and hospital-matched controls were included for the case-control study. The general data and potential risk factors such as indoor and outdoor environmental factors were obtained from parents by face-to-face interviews. Univariate and multivariate Logistic regression analysis was conducted,and odds ratio （OR） and 95% confidence interval （CI） were calculated. Results Maternal exposure to chemicals before pregnancy and/or during pregnancy （OR=2.68,95%CI 1.22-5.90）,paternal exposure to iatrogenic radioactive substances （OR=2.78,95%CI 1.24-6.23）,dwelling surrounding with high-voltage transformers and/or wires （OR=3.35,95%CI 1.38-8.17）,residence decoration with plywood floor or marble （OR=1.91,95%CI 1.04-3.51）,sleeping with doors and windows closed in winter （OR=3.30,95%CI 1.80-6.06） and frequent use of child antipyretic and analgesic drugs and/or antibiotics （β=-1.011,OR=0.36,95%CI 0.19-0.72） were environmental risk factors for acute myeloid leukemia. Except the factor of residence decoration with plywood floor or marble,the other five factors were associated with acute lymphocytic leukemia. And maternal exposure to chemicals before pregnancy and/or during pregnancy,dwelling surrounding with industrial wastes and sleeping with doors and windows closed in winter were environmental risk factors for acute myeloid leukemia. Conclusion Indoor and outdoor environmental factors are risk factors for childhood acute leukemia,and the effects of environmental risk factors may vary on different subtypes of childhood acute leukemia.