Military Service, Deployments, and Exposures in Relation to Amyotrophic Lateral Sclerosis Etiology and Survival
Military Service, Deployments, and Exposures in Relation to Amyotrophic Lateral Sclerosis Etiology and Survival
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DOI：
10.1093/epirev/mxu001
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发表时间：
2015-01-01
影响因子：
5.5
通讯作者：
Kamel, Freya
中科院分区：
文献类型：
--
作者：
Beard, John D.;Kamel, Freya
据报道，肌萎缩侧索硬化症(ALS)的发病率在美国退伍军人中较高，目前退伍军人人数超过2100万，但原因(S)尚未确定。我们进行了一项综述，以检验服兵役、部署和暴露与肌萎缩侧索硬化症病因和存活率之间联系的证据的权重。回顾了2013年间发表的30篇文章或摘要。尽管目前的证据表明与肌萎缩侧索硬化症病因学呈正相关，但就服兵役与肌萎缩侧索硬化症病因学或存活率之间的关系得出确切的结论还太有限。一些证据表明，1990-1991年波斯湾战争的部署可能与ALS病因学有关，但目前没有强有力的证据表明任何特定的军事接触与ALS病因学有关。未来的研究应该解决以前研究的局限性，例如依赖死亡率作为发病率的替代指标，缺乏生存分析，缺乏临床数据，统计能力低，暴露评估有限。患有肌萎缩侧索硬化症的退伍军人的基因和环境暴露(日内瓦)研究就是这样一项研究，但需要进一步的研究来确定军事相关因素是否与肌萎缩侧索硬化症相关，并评估潜在的预防策略。
Rates of amyotrophic lateral sclerosis (ALS) have been reported to be higher among US military veterans, who currently number more than 21 million, but the causal factor(s) has not been identified. We conducted a review to examine the weight of evidence for associations between military service, deployments, and exposures and ALS etiology and survival. Thirty articles or abstracts published through 2013 were reviewed. Although the current evidence suggests a positive association with ALS etiology, it is too limited to draw firm conclusions regarding associations between military service and ALS etiology or survival. Some evidence suggests that deployment to the 1990-1991 Persian Gulf War may be associated with ALS etiology, but there is currently no strong evidence that any particular military exposure is associated with ALS etiology. Future studies should address the limitations of previous ones, such as reliance on mortality as a surrogate for incidence, a dearth of survival analyses, lack of clinical data, low statistical power, and limited exposure assessment. The Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis (GENEVA) Study is one such study, but additional research is needed to determine whether military-related factors are associated with ALS and to assess potential prevention strategies.