American Journal of Epidemiology Original Contribution Parkinson's Disease and Residential Exposure to Maneb and Paraquat from Agricultural Applications in the Central Valley of California
American Journal of Epidemiology Original Contribution Parkinson's Disease and Residential Exposure to Maneb and Paraquat from Agricultural Applications in the Central Valley of California
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通讯作者：
S. Costello;M. Cockburn;J. Bronstein;Xinbo Zhang;B. Ritz
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作者：
S. Costello;M. Cockburn;J. Bronstein;Xinbo Zhang;B. Ritz
来自动物和细胞模型的证据表明，农药会导致神经退行性过程，导致帕金森病（PD）。人类数据不足以支持任何特定农药的这一说法，主要是因为暴露评估方面的挑战。作者开发并验证了一种基于地理信息系统的暴露评估工具，该工具整合了来自加州农药使用报告和土地利用地图的信息，以估计住宅环境中农药的历史暴露。1998-2007年，作者在一项病例对照研究中纳入了来自加州中央谷的368例PD事件病例和341例人群对照。他们得出了1974年至1999年期间接触代森锰和百草枯的估计数。在距离家500米范围内暴露于这两种农药使PD风险增加75%（95%置信区间（CI）：1.13，2.73）。诊断时年龄为60岁的人单独接触代森锰锌或百草枯时，其风险要高得多（比值比½）这项研究提供了证据，表明接触代森锰锌和百草枯的组合会增加PD风险，特别是在年轻受试者中和/或当暴露发生在年轻时。据报道，帕金森病（PD）在农民和农村人口中的发病率很高，这有助于农业杀虫剂可能是致病因子的假设（1-4）。动物研究已经将某些杀虫剂与帕金森症和多巴胺能细胞死亡联系起来。农药鱼藤酮可通过线粒体复合物I的慢性全身抑制在一些啮齿动物模型中产生PD的行为和神经病理学特征（5，6）。在小鼠中暴露于杀真菌剂代森锰和除草剂百草枯的组合导致黑质神经元病理学增加（7）、年龄依赖性运动退化、多巴胺代谢物和周转率进行性减少（8）以及酪氨酸羟化酶和多巴胺转运蛋白免疫反应性降低（9，10）。人类证据不足以确定任何特定的农药化合物，包括动物研究所涉及的化合物，作为导致PD的原因（11）。方法学的局限性使大多数探索人类农药暴露和PD的流行病学研究的解释变得模糊。过去的研究通常依赖于自我报告和对化学品使用的回忆，这使得它们容易受到信息偏差和差异回忆偏差的影响（12）。由于从空中或地面施用的农药可能会从其预定的处理地点漂移，随后在距离施用地点数百米的空气、植物和动物中检测到可测量的浓度（13-15），因此估计农村环境暴露的准确方法......
Evidence from animal and cell models suggests that pesticides cause a neurodegenerative process leading to Parkinson's disease (PD). Human data are insufficient to support this claim for any specific pesticide, largely because of challenges in exposure assessment. The authors developed and validated an exposure assessment tool based on geographic information systems that integrated information from California Pesticide Use Reports and land-use maps to estimate historical exposure to agricultural pesticides in the residential environment. In 1998–2007, the authors enrolled 368 incident PD cases and 341 population controls from the Central Valley of California in a case-control study. They generated estimates for maneb and paraquat exposures incurred between 1974 and 1999. Exposure to both pesticides within 500 m of the home increased PD risk by 75% (95% confidence interval (CI): 1.13, 2.73). Persons aged 60 years at the time of diagnosis were at much higher risk when exposed to either maneb or paraquat alone (odds ratio ¼ This study provides evidence that exposure to a combination of maneb and paraquat increases PD risk, particularly in younger subjects and/or when exposure occurs at younger ages. Parkinson's disease (PD) has been reported to occur at high rates among farmers and in rural populations, contributing to the hypothesis that agricultural pesticides might be causal agents (1–4). Animal studies have linked certain pesticides to Parkinsonism and dopaminergic cell death. The pesticide rotenone can produce the behavioral and neuro-pathologic features of PD in some rodent models through chronic systemic inhibition of mitochondrial complex I (5, 6). Exposure to a combination of the fungicide maneb and the herbicide paraquat in mice leads to increased substantia nigra neuronal pathology (7), age-dependent motor degen-eration, progressive reductions in dopamine metabolites and turnover (8), and reduced tyrosine hydroxylase and dopa-mine transporter immunoreactivity (9, 10). Human evidence is insufficient to identify any particular pesticide compound, including those implicated by animal studies, as being responsible for causing PD (11). Method-ological limitations have clouded the interpretation of most epidemiologic studies exploring pesticide exposures and PD in humans. Past studies have generally relied on self-reports and recall of chemical usage, making them vulnerable to information bias and differential recall bias (12). Because pesticides applied from the air or ground may drift from their intended treatment sites, with measurable concentrations subsequently detected in the air, in plants, and in animals up to several hundred meters from application sites (13–15), accurate methods of estimating environmental exposures in rural …