低浓度青石棉污染区间皮瘤的回顾性队列研究

目的 探明云南省大姚县间皮瘤高发的原因。方法 用回顾性队列研究的方法对暴露组和对照组人群的人口学特征，青石棉暴露史，吸烟，被动吸烟，饮茶和家庭肿瘤史的暴露情况及其与间皮瘤的发病关系进行研究。用死亡人群亚队列研究0.015f/cm^3浓度青石棉暴露水平下潜伏期与间皮瘤发病的关系。结果 吸烟，被动吸烟，饮茶，家庭肿瘤史与间皮瘤发病无关，低浓度（0.015f/cm^3)青石棉接触与间皮瘤有关。结论 暴露组间皮瘤高发的原因在于当地人群暴露于0.015f/cm^3浓度青石棉水平并经历一个较长的潜伏期（下限为29-33年）。     

环境青石棉污染所致间皮瘤47例临床病理分析

环境青石棉污染所致间皮瘤４７例临床病理分析周亚康罗素琼宋云和廖鹏书王怀平间皮瘤在一般人群中较少见，流行病学和动物实验结果显示间皮瘤的增多与接触石棉高度相关［１～３］。我们地区部分乡镇地质中青石棉分布表浅，造成空气污染而致间皮瘤高发，１９８５年与１９９...     

青石棉致胸膜间皮瘤42例临床分析

分析42例资料完整的接触青石棉致胸膜间皮瘤病例的临床症状及诊断方法,并结合该病的发病机理,探讨本地区胸膜间皮瘤高发的原因。     

环境低浓度石棉暴露与肺癌危险性的巢式病例对照研究

目的探讨云南省大姚县环境低浓度青石棉暴露与肺癌之间的关联以及肺癌高发的主要危险因素，为当地的肺癌防制提供依据。方法采用巢式病例对照研究方法，从队列中获得53例肺癌病例，按1：3的比例分别匹配以性别相同、年龄相当的对照。结果单因素条件logistic回归分析发现石棉环境污染、吸烟、饮酒、喝茶与肺癌有统计学关联，石棉环境污染的各种形式中，只有使用石棉炉对肺癌发生有显著性意义。用多因素条件logistic回归进一步分析，使用石棉炉和吸烟与肺癌有统计学关联，OR值分别是3．38(95％CI1．43～7．95)和2．62(95％CI1．08～6．56)．其他各因素对肺癌的影响未发现有显著性意义。对吸烟与使用石棉炉的交互作用进行相乘模型的拟合，未发现两因素存在相乘模型的交互作用(P=0．310)。相加模型交互作用分析结果显示，吸烟和使用石棉炉对肺癌发病的影响可能存在着相加模型的交互作用。结论吸烟和使用石棉炉是当地肺癌高发的主要危险因素，且两者存在着相加模型的交互作用。     

大姚县青石棉污染区肺癌、间皮瘤危险因素的病例对照研究

目的：探索云南省大姚县肺癌、间皮瘤高发的主要危险因素，为预防控制工作提供依据。方法：采用1：2配比病例对照研究的方法，对当地发现的47例病例（31例肺癌和16例间皮瘤）和匹配了性别、年龄的94例对照的各种可能与肺癌、间皮瘤有关的危险因素（包括吸烟习惯、石棉暴露情况及肿瘤家族史等）进行调查，用条件Logistic回归模型对资料进行分析。结果：资料分析显示，家庭环境中石棉污染、吸烟同肺癌和间皮瘤之间关联差异有显著性，OR分别为3．60（95％CI 1．03，12．62）和3．30（95％CI 1．90 ，10．02）；在石棉污染的几个因素中，使用石棉炉与肺癌的关联差异有显著性，OR为1．63（95％CI 1．30，20．24）。单因素分析发现，使用石棉炉时间的长短与肺癌有关，使用石棉炉在11－20年、21－30年及31年以上者的OR分别是5．34（95％CI 1．12，25．47）、8．50（95％CI0．78 ，93．23）、14．09（95％CI0．91，218．61）。结论：大姚县肺癌和间皮瘤的高发可能与当地的石棉环境污染有关，特别是与生活中石棉炉的使用有关。     

青石棉污染与间皮瘤

本文对某县乡镇企业发展后青石棉污染及其危害进行了调查。近年来临床发现10余例间皮瘤病人,其中5人经活检,尸解证实。发病到死亡最短3个月,最长23个月,发病年龄最小仅24岁。横断面调查发现胸膜斑包括胸膜斑钙化,检出率高达19.8%(40岁以上),另有16例农民石棉肺。回顾性队列流行病学调查表明,肺癌标化死亡比(SMR)为6.93,死亡年龄45岁,比全国肺癌死亡年龄提前14年。胸膜间皮瘤年发病率为85/百万/年。动物实验大鼠胸膜间皮瘤诱发率为56%,与UICC青石棉相似(57%)。     

大姚县农村疾病死亡回顾性队列研究

本文采用回顾性队列研究的方法，调查了云南省大姚县青石棉污染区农民疾病死亡率。结果显示：农村中肺心病的死亡率仍占第一位。观察组恶性肿瘤死亡的危险性高于对照组（ＲＲ＾＝１．８３，Ｐ＜０．０５）。在不同部位的肿瘤中，以肺癌占首位，年死亡率为８０．１２／１０万（ＲＲ＾＝５．５３，Ｐ＜０．０５）；间皮瘤死亡率为３６．４６／１０万，对照组中无一例死于间皮瘤。提示非职业性环境接触青石棉可导致石棉相关肿瘤肺癌和间皮瘤的死亡率增高。     

石棉工人肺癌134例分析

本协作组八十年代初对我国有代表性的14个石棉厂、矿的一万多名工人进行了10年(1972.1.1～1981.12.31)回顾性队列调查,结果表明我国石棉作业工人中肺癌发病、死亡率显著地高于对照人群。1987年,卫生部修订颁发的职业病名单中,将石棉所致肺癌、间皮瘤列在职业性肿瘤项内。为了解决职业性石棉所致肺癌、间皮瘤的病因学诊     

天然青石棉暴露区肺癌、胸膜间皮瘤与饮食习惯的病例-对照研究

目的探讨青石棉污染区与肺癌、胸膜间皮瘤相关的饮食偏好及其与青石棉暴露的交互作用。方法对云南省大姚县2011年随访队列发现的53例病例(27例肺癌和26例胸膜间皮瘤)和匹配了性别、年龄的106例对照进行1∶2匹配的病例-对照研究,采用条件Logistic回归方法计算比值比(OR)及其95%CI,并进行单因素和调整混杂因素的多因素数据分析,探索与肺癌、间皮瘤有关的饮食偏好及其保护作用,并进行交互作用分析。结果饮用绿茶(OR=0.88,95%CI 0.66~0.87)、食用野生菌(OR=0.85,95%CI 0.23~0.95)与肺癌、胸膜间皮瘤发生呈负相关,并均减弱青石棉暴露与肺癌、胸膜间皮瘤发生的正性关联。食用野生菌与青石棉暴露存在相加交互作用,超额相对危险因素(RERI)、交互作用归因比(API)和交互作用指数(S)分别为-0.86、-0.26和0.61。结论饮用绿茶和食用野生菌是肺癌、胸膜间皮瘤发生的保护因素。     

青石棉污染区恶性胸膜间皮瘤发病危险因素的调查

目的　探讨间皮瘤发病的影响因素 ,以期为间皮瘤的预防及进一步研究发病机制提供流行病学依据。方法　采用 1∶1配比的病例 -对照设计调查了 2 3例间皮瘤病例和对照 ,比较两组间的石棉接触情况、生活方式及一级亲属恶性肿瘤发病情况。结果　病例组平均年龄 5 7.96岁 ,间皮瘤平均潜伏期为 5 2年 ,与对照组相比 ,其石棉接触年龄、接触时间以及吸烟、饮酒习惯的差异均无显著性 (P >0 .0 5 ) ;病例组平均累积石棉纤维接触剂量为 37.2× 10 5f,明显高于对照组 (32 .3× 10 5f) ,差异有显著性 (P =0 .0 0 5 ) ,且随剂量的增高 ,OR值有升高趋势。病例组一级亲属患恶性肿瘤的比例(2 6 .1%)高于对照组 (4 .4%) ,差异有显著性 (P <0 .0 5 ) ,OR =7.75 (95 %CI:0 .85～ 71.43)。结论　石棉接触与间皮瘤发病间可能存在剂量 -效应关系 ;癌家族史可能是间皮瘤的一个危险因素 ,或者在相同的石棉接触水平下可增加个体对间皮瘤的易感性。     

青石棉污染区恶性肿瘤9年回顾队列研究

为了证实非职业性环境接触青石棉与恶性肿瘤，特别是肺癌和间皮瘤危险的关系，采用回顾性队列调查方法对大姚县青石棉污染区进行９年的死亡率调查。选择同省无石棉污染的禄丰县作为对照。结果表明：恶性肿瘤的死亡率为１８２．６０／１０万，其中肺癌死亡率为５３．２６／１０万，相对危险度高于对照，ＲＲ分别为１．４７，２．１４（Ｐ＜０．０１）；观察组中７例死于间皮瘤。提示：间皮瘤的死亡率在青石棉污染区是很高的，在３０岁以上人中，年死亡率为１７．７５／１０万人年，而对照组中未观察到间皮瘤。     

青石棉污染区农民恶性肿瘤死亡率的回顾队列调查

目的：了解在生活环境中接触低浓度青石棉、农民患恶性肿瘤,特别是间皮瘤和肺癌之间的关系。方法：采用回顾队列调查方法对青石棉污染区的农民进行恶性肿瘤死亡率的调查,以该县无石棉污染的农民为对照,结果：观察组有5人死于间皮瘤死亡率为36．46／10万人年,而对照组无1例发生;肺癌死亡率为43．75／10万人年,与对照组比较,差别有非常显著性意义（P＜0．001）,结论：间皮瘤死亡率在青石棉污染区很高,青石棉与间皮瘤,肺癌之间存在很强的病因学联系。     

Malignant mesothelioma in Australia, 1945-2000

BACKGROUND: Australia has maintained a total national malignant mesothelioma case register since 1980. There has been a marked increase in the incidence of mesothelioma in the last 20 years. Currently 450-600 cases are notified annually in a population of 20 million. While the history of the Wittenoom (Western Australia) crocidolite mine and its aftermath is well known, these cases comprise only 5% of the total. This study describes the incidence of mesothelioma in Australia from 1945 to 2000. METHODS: Using register data, time trends in mesothelioma incidence were calculated. Analyses of incidence are reported by age, sex, anatomical site, and state of notification. Associations with occupational and environmental asbestos exposure histories are described. Lung fiber content measurements were made on a subset of cases. RESULTS: Australia has had 6,329 cases of mesothelioma from 1 January 1945 to 31 December 2000. (A further 620 cases were notified in the period from 1 January 2001 to 31 October 2001.) Annual incidence rates for Australia per million population > or = 20 years (1997) were: male, 59.8; female, 10.9; total, 35.4. Incidence rates have been continually increasing and are the highest reported national rates in the world. While Western Australia has the highest rate (1997 total rate, 52.8), most cases arise from the two most populous eastern states, New South Wales and Victoria. In 88% (male 90%, female 61%) of cases, a history of asbestos exposure was obtained. Exposures occurred in a wide variety of occupational and environmental circumstances. In 80% of cases with no history of exposure, TEM lung asbestos fiber counts > 200,000 fibers > 2 microm length per gm dry lung were obtained, suggesting unrecognized exposure. CONCLUSIONS: Australia's high incidence of mesothelioma is related to high past asbestos use, of all fiber types, in a wide variety of occupational and environmental settings. The number of cases in total is expected to be about 18,000 by 2020, with about 11,000 yet to appear.     

青石棉污染区恶性肿瘤死亡率10年回顾队列研究

为了探讨环境低浓度石棉接触对居民恶性肿瘤尤其是肺癌和间皮瘤发生绎大姚县部门青石棉污染区３０岁以上的农村居民进行了１０年回顾性队列调查。队列人数为３３６３人,其中男１５０３人,女１８６０人。对照选用石青石棉污染的该县龙街乡农民和远离该县２３０多公里的禄丰县金山镇农民居民共７６３９人,观察期９年。     

High risk of pleural mesothelioma among the state railroad carriage repair workers

Exposure to asbestos in a facility for the repair of railroad carriages in Bologna was initially studied in 1980, when the Local Health Unit started a program of primary prevention on request of the Unions. At that time workers employed in jobs with high exposure to asbestos were identified. The mortality experience of these 173 subjects was investigated from 01.01.1979 through 31.12.1997, and compared to that of the population of Emilia Romagna. SMR for all causes was 69, with upper limit of the confidence interval lower than 100; this was largely due to a significant decrease of cardiovascular mortality. Among neoplasms, there was a significant excess of pleural mesothelioma (6 observed, 0.09 expected); one more subject died for peritoneal mesothelioma and one for malignant mesothelioma of unspecified site. About half of the subjects deceased for neoplastic disease (8/17) were affected by mesothelioma.     

Exposure to crocidolite and the incidence of different histological types of lung cancer.

OBJECTIVES: To estimate the relations between exposure to both tobacco smoke and crocidolite and the incidence of various histological types of lung cancer. METHODS: In 1979 all former workers from the Wittenoom asbestos industry who could be traced were sent a questionnaire on smoking history. Of 2928 questionnaires sent, satisfactory replies were received from 2400 men and 149 women. Of the men, 80% had smoked at some time and 50% still smoked. Occupational exposure to crocidolite was known from employment records and follow up was maintained through death and cancer registries in Australia with histological diagnoses obtained from the relevant State Cancer Registry. Conditional logistic regression was used to estimate the effects of tobacco and asbestos exposure on incidence of different cell types of lung cancer in a nested case-control design. RESULTS: Between 1979 and 1990, 71 cases of lung cancer occurred among men in this cohort: 27% squamous cell carcinoma, 31% adenocarcinoma, 18% small cell carcinoma, 11% large cell carcinoma, and 13% unclassified or indeterminate. Two of the classified cases and one unclassified case had never smoked. The incidence of both squamous and adenocarcinoma types of lung cancer were greatest in ex-smokers and in those subjects with the highest levels of exposure to crocidolite. After adjustment for smoking habit, the increase in incidence of lung cancer with increasing exposure to crocidolite was greater for squamous cell carcinoma than for adenocarcinoma. CONCLUSIONS: The results from this study have shown significant exposure-response effects for exposure to crocidolite, and both adenocarcinoma and squamous cell carcinoma of the lung. They also provide some further evidence against the theory that parenchymal fibrosis induced by asbestos is a necessary precursor to asbestos induced lung cancer.     

Asbestos related diseases from environmental exposure to crocidolite in Da-yao,China. I. Review of exposure and epidemiological data

Background: Scattered patches of crocidolite, one form of asbestos, were found in the surface soil in the rural county of Da-yao in southwestern China. In 1983, researchers from the West China University of Medical Sciences (WCUMS) discovered that residents of two villages in Da-yao had hyperendemic pleural plaques and excessive numbers of pleural mesotheliomas.

Aims: To review and summarise epidemiological studies, along with other relevant data, and to discuss the potential contribution to environmental risk assessment.

Methods: This report is based on a review of several clinical/epidemiological studies conducted by WCUMS researchers since 1984, which included one cross sectional medical examination survey, one clinical/pathological analysis of 46 cases of mesothelioma, and three retrospective cohort mortality studies. Additional information acquired from reviewing original data first hand during a personal visit along with an interview of medical specialists from Da-yao County Hospital was also incorporated.

Results: The prevalence of pleural plaque was 20% among peasants in Da-yao over 40 years of age in the cross sectional survey. The average number of mesothelioma cases was 6.6 per year in the 1984–95 period and 22 per year in the 1996–99 period, in a population of 68 000. For those mesothelioma cases that were histology confirmed, there were 3.8 cases/year in the first period and 9 cases/year in the second. Of the 2175 peasants in this survey, 16 had asbestosis. Lung cancer deaths were significantly increased in all three cohort studies. The annual mortality rate for mesothelioma was 85 per million, 178 per million, and 365 per million for the three cohort studies, respectively. The higher exposed peasants had a fivefold increased mesothelioma mortality compared to their lower exposed counterparts. There were no cases of mesothelioma in the comparison groups where no crocidolite was known to exist in the environment. In the third cohort study, almost one of five cancer deaths (22%) was from mesothelioma. The ratio of lung cancer to mesothelioma deaths was low for all three studies (1.3, 3.0, and 1.2, respectively).

Conclusions: The observation of numerous mesothelioma cases at Da-yao was a unique finding, due mainly to their lifetime exposure to crocidolite asbestos. The finding of cases dying at a younger age and the relatively high ratio of mesothelioma cases to lung cancer could also be another unique result of lifetime environmental exposure to crocidolite asbestos. Although the commercial use of crocidolite has been officially banned since 1984, the incidence of mesothelioma has continued to show a steady increase, particularly among peasants. Since the latency of mesothelioma is approximately 30–40 years, the ban had little effect in the 1990s. The increased awareness and changes in diagnosis over time may also contribute to the increase. Furthermore, exposure to asbestos stoves and walls continued. The government implemented reduction of these exposures. However, from a public health standpoint, the most important issue is the complete avoidance of further exposure to asbestos.

     

Nicotine and cotinine in adults' urine: The German Environmental Survey 1998

In 1998, the German Environmental Survey (GerES III) recruited approximately 5000 adults between the ages of 18 and 69 years. The study population for these analyses consisted of 1580 smokers (34% of the total population) and 3126 nonsmokers. Nicotine and cotinine concentrations in urine were determined by HPLC methods with UV-detection and corrected for creatinine. Nicotine and cotinine concentrations differed between smokers and nonsmokers by factors of 10-100. The multiple linear regression models used for the analyses of nicotine detection in the urine of smokers explained 43.2% and 42.3% of the total volume-specific and creatinine-specific variances, respectively. Cigarette smoking was the major factor responsible for 41% of the total variance. The explained variances of the cotinine results were larger, 51.0% and 49.3% of the total variance were volume-specific and creatinine-specific, respectively. More than 20% of nonsmokers in GerES III were exposed to environmental tobacco smoke at home, at work or in other places. The logistic regression analysis approach used for the group of nonsmokers showed the greatest effects for those exposed to tobacco smoke at home (adjusted OR varied between 4 and 6). These results were seen for nicotine as well as for cotinine excretion. Exposure to tobacco smoke in the workplace doubled the risk for the detection of nicotine and cotinine in urine. When other risk factors such as age, sex, social status, community size, season of urine collection, and the consumption of food containing nicotine such as potatoes, cabbage, tea were included, the effect estimates for tobacco smoke exposure remained unchanged. A new federal bill to diminish environmental tobacco smoke (ETS) exposure in the workplace was recently passed in Germany, but protection of nonsmokers from smoking family members at home needs more attention.     

The incidence of malignant mesothelioma in Australia 1982-1988.

From 1980 to 1985, the Australian Mesothelioma Surveillance Program, and since 1986, the Australian Mesothelioma Register, have been collecting data on all cases of malignant mesothelioma that could be ascertained in Australia. Incidence rates were calculated on 854 Program and 696 Register cases (total 1271) diagnosed in Australia between January 1, 1982 and December 31, 1988. Australia has one of the highest national rates of mesothelioma in the world (15.8 cases per million of population aged 20 years and older), and the rate is rising. The rate is far higher in males (28.3) than females (3.3). The Western Australian rate (28.9) is the highest among the states, as may be expected because of the crocidolite mine at Wittenoom; however, the largest numbers of cases occur in the more populous and industrial New South Wales. The high incidence rate, its expected continuing increase, and absence of a history of exposure to asbestos in approximately 28% of cases, demand consideration of potential environmental factors other than asbestos in the causation of this tumor, as well as continued surveillance.