儿童、父母的行为生活方式及室内环境暴露与儿童急性白血病发病的关系

Relationship between risk of childhood acute leukemia and children＇s and parents＇ lifestyles and household environment exposure

目的：探讨儿童、父母的行为生活方式及室内环境暴露与儿童急性白血病（AL）发病关系。方法以2011年4月至2014年1月常住上海市年龄〈15岁的66例新发AL患儿为病例组，通过1∶2配对的病例-对照研究对性别、年龄、居住地进行匹配，排除有血液系统疾病、肿瘤等恶性疾病的儿童，选取132名儿童作为对照组。两组研究对象均排除领养儿童及同时患有唐氏综合征或HIV阳性或其他能够增高白血病发病风险的遗传性疾病者。对两组儿童的父母或监护人进行面对面的访谈式调查，获取研究对象的一般人口学特征、行为生活方式和室内环境暴露等信息。采用多因素条件logistic回归模型分析影响儿童AL发病的因素，计算OR（95%CI）值。结果病例组与对照组年龄分别为（5.0±3.7）、（6.0±3.8）岁（t=0.48,P=0.523）。病例组与对照组父亲日常饮酒率分别为57.6%（38/66）、31.1%（41/132）（χ2=4.91, P=0.027）。两组在最近1年内杀虫剂使用率分别为78.8%（52/66）、65.2%（86/132）（χ2=3.87, P=0.049）。儿童化学物质接触史（OR=4.76,95%CI：1.34~16.89）、母亲化学物质接触史（OR=4.51,95%CI：1.65~12.33）、在儿童0~3岁期间使用过杀虫剂（OR=2.90,95%CI：1.31~6.39）和在儿童出生后有室内装修史（OR=3.12,95%CI：1.26~7.74）均会增加儿童AL的发病风险。此外，儿童3岁前经常接触其他小朋友（OR=0.32,95%CI：0.15~0.69）和儿童夏季睡眠时保持通风（OR=0.43,95%CI：0.18~0.98）会降低儿童患AL的危险。结论儿童、父母的行为生活方式及室内环境可能与儿童AL的发病有关。

Objective To investigate the association between children＇s and their parents＇ lifestyles, household environmental exposures and risk of childhood acute leukemia （AL） . Methods A 1∶2 matched case-control study of childhood AL was conducted in Shanghai between April 2011 and January 2014. The study enrolled 66 cases aged〈15, diagnosed with AL and 132 controls matched by age, gender and residence. All of the controls had no hematological diseases or previous history of malignancy. Children who had been adopted and had congenital genetic syndromes such as Down＇s syndrome or a positive HIV test result were not eligible as either cases or controls. Information was obtained from standardized face-to-face interviews of their parents/guardians with detailed questions on demographic characteristics, lifestyle, and household environment. Conditional logistic regression models were used to analyze effecting factors of childhood AL, odds ratios （OR） and their 95%confidence intervals （CI） were calculated . Results Among 198 cases, 66 cases were aged （5.0±3.7） years old, and 132 controls were aged （6.0±3.8）years old （t=0.48, P= 〈br〉 0.523）. The paternal drink frequencies of cases and controls were 57.6% （38/66）, and 31.1% （41/132）, respectively （χ2=4.91, P=0.027）. And the frequencies of household insecticides usage in the last year in the two groups were 78.8% （52/66）, and 65.2% （86/132） （χ2=3.87, P=0.049）. Chemical exposure during childhood （OR=4.76, 95%CI：1.34-16.89）, maternal exposure to chemicals （OR=4.51, 95%CI：1.65-12.33）, household insecticides use during 0-3 years of child （OR=2.90, 95%CI： 1.31-6.39）, and renovating after their children＇s birth （OR=3.12, 95%CI：1.26-7.74） were associated with an increased risk of childhood AL and these differences between the cases and the controls have statistical significance. Besides, we found that frequent contaction with other children during 0-3 years old （OR=0.32, 95%CI：0.15-0.69） and ventilation during sleeping in summer （OR=0.43, 95%CI：0.18-0.98） were associated with a decreased risk of childhood AL. Conclusion Our results support the association between children＇s and their parents＇ lifestyles, household environmental exposures and childhood AL.