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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 investigate the occupational and environmental factors associated with the pathogenesis of myelodysplastic syndrome (MDS). Methods A 1: 2 case-control study in the hospital was taken. 266 case patients were from inpatients from 2003 to 2005 in major city-level hospitals in Shanghai. All cases were in accordance with the diagnostic criteria of FAB cooperation group, with the history of tumor radiotherapy and chemotherapy, MDS with a history of aplastic anemia Except for the other patients in the same hospital as the case group. The age, gender, ethnicity and hospitalization day were paired with the case group. The survey was conducted within 5 years prior to the onset of MDS and within 5 years prior to the diagnosis of the control cases (including chloramphenicol, sulfonamides, diazepam, phenobarbital, colchicine, cyclophosphamide, antithyroid drugs, anti-TB drugs, D860, antimalarial drugs: traditional Chinese medicines including bezoar, angelica, arsenic, realgar or arsenic, Tripterygium), occupational hazards (including benzene, heavy metals, organophosphorus pesticides, pesticides, herbicides, Diesel, epoxy, dye, ionizing radiation or X-rays) and harmful to life (including hair coloring, high voltage transmission lines, decorating). Results Occupational exposure to benzene increased the incidence of MDS (OR: 8.52, 95% CI: 2.30-31.10) and increased the incidence of MDS within 100 m of the high-voltage transmission line (OR: 1.60, 95% CI: 1.10-2.32 ), New decoration of residence or office can increase the incidence of MDS (OR: 2.40, 95% CI: 1.38 ~ 4.14). No other occupational harmful factors such as pesticides and organic matter were found to be associated with MDS. The study found no increase in the incidence of MDS. Conclusions Occupational exposure to benzene resides within 100 m of the high-voltage transmission line and the new decoration of residence or office building is a risk factor for the development of MDS.