唐山震后有机氯农药暴露与乳腺癌关系的病例对照研究

目的探讨唐山震后有机氯农药暴露与乳腺癌发生的关系。方法收集2006年4月—2007年6月在唐山市3家医院就诊的经病理学确诊的新发女性乳腺癌患者150例,以同期住院的非肿瘤、非生殖内分泌系统疾病的女性患者为对照,进行1∶1配比的病例对照研究。在进行流行病学调查的同时用气相色谱法测定血清中有机氯农药滴滴涕(DDT)和六六六(HCH)的含量。应用条件Logistic回归模型分析有机氯农药残留与乳腺癌发病的关系。结果 p,p’-DDD及o,p’-DDT两组检出率比较差异有统计学意义,病例组高于对照组;血清中p,p’-DDE、α-HCH及δ-HCH残留水平在乳腺癌病例组和对照组差异有统计学意义,病例组高于对照组,唐山震后农药不同暴露地区血清中δ-HCH、p,p’-DDE及o,p’-DDT残留水平差异有统计学意义,高暴露地区高于低暴露地区;多因素条件Logistic回归分析显示震后农药高暴露、p,p’-DDE和p,p’-DDT均与乳腺癌的发生有关联,OR值分别为6.592(95%CI:1.402～31.002)、2.405(95%CI:1.033～5.600)和1.845(95%CI:1.028～3.353)。结论环境有机氯农药暴露可能是乳腺癌发生的危险因素;唐山震后农药的高暴露可能增加当地乳腺癌的发病危险。

Relationship between Organochlorine Pesticides Exposure after Tangshan Earthquake and Breast Cancer: a Case-control Study

Objective To explore the relationship between organochlorine pesticides exposure after Tangshan earthquake and the breast cancer. Methods 1:1 matched case-control study was conducted in 150 newly diagnosed cases of breast cancer with histopathological diagnosis from three city-level hospitals in Tangshan, China and 150 matched controls at the same hospitals, without the related diseases. The levels of derivatives of DDT and HCH in serum were measured by gas chromatography (GC) method and epidemiological survey were conducted by questionnaire for 150 pairs of cases and controls. The relationship between the organochlorine pesticides metabolites and the breast cancer of the exposed population was analyzed by conditional logistic regression model by SAS 8.2 Software. Results Compared with the control significant higher rates of detection of p,p'-DDD and o,p' - DDT were seen in the case group and the levels of p,p'-DDE, α-HCH and δ-HCH in serum were higher in the case group, and there was a significant difference in serum residues levels of δ-HCH, p,p'-DDE and o,p'-DDT in different exposure areas in Tangshan, the high exposure area showed higher residues levels than the low exposure area. Multivariate conditional logistic regression analysis showed high pesticides exposure, after the earthquake, the serum residues of p,p'-DDE and p,p'-DDT were associated with breast cancer risk, ORs were 6.592(95%CI: 1.402-31.002), 2.405(95%CI:1.033-5.600)and 1.845(95%CI:1.028-3.353) respectively. Conclusion Exposure to environmental organoehlorines may be one of the risk factors for breast cancer; Higher pesticides exposure after the earthquake may increases breast cancer risk in Tangshan area.