Association of lead exposure with survival in amyotrophic lateral sclerosis
Association of lead exposure with survival in amyotrophic lateral sclerosis
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DOI：
10.1289/ehp.11193
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发表时间：
2008-07-01
影响因子：
10.4
通讯作者：
Sandler, Dale P.
中科院分区：
文献类型：
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作者：
Kamel, Freya;Umbach, David M.;Sandler, Dale P.
背景：ALS 病例生存差异的原因尚不清楚，但可能与环境神经毒物的暴露有关。 目的：我们旨在确定通过测量血铅和骨铅水平评估的铅暴露是否与肌萎缩侧索硬化症 (ALS) 的生存相关。方法：我们评估了 1993-1996 年在新英格兰进行的一项病例对照研究中的铅暴露与 ALS 生存的关系，该研究包括血铅和骨铅的测量。我们从 National Death Index Plus 和 Social Security Administration Death Index 中检索了截至 2003 年 12 月 31 日的死亡日期和原因信息。我们使用 Cox 比例风险分析评估了生存率与铅暴露的关系，并调整了年龄、性别和吸烟情况。 结果：我们找到了 110 例病例中 100 例的死亡率数据； 100 份死亡证明中有 93 份提到 ALS。从诊断到死亡的中位生存期为 28 个月。较短的生存期与诊断时年龄较大、女性、延髓发病、症状出现和诊断之间的间隔较短以及肺功能下降有关。从诊断到死亡的较短生存期与血铅呈弱负相关（风险比 = 0.9；95% 置信区间，0.8-1.0），与髌骨铅（0.5；0.2-1.0）和胫骨铅（0.3；0.1-0.7）呈较强负相关；从症状出现到死亡的生存期也有类似的结果。结论：这些结果表明，铅暴露与 ALS 病例的较长生存期相关，如果得到证实，可能会揭示疾病进展的机制。
BACKGROUND: Reasons for the variability in survival among ALS cases are unknown but may include exposure to environmental neurotoxicants.OBJECTIVES: We aimed to determine whether lead exposure, assessed by measuring blood and bone lead levels, is associated with survival in amyotrophic lateral sclerosis (ALS).METHODS: We evaluated the relationship of lead exposure to ALS survival in 110 cases from a case-control study conducted in New England in 1993-1996 that included measurements of blood and bone lead. We retrieved information on date and cause of death through 31 December 2003 from the National Death Index Plus and the Social Security Administration Death Index. We evaluated the relationship of survival to lead exposure using Cox proportional hazard analysis, with adjustment for age, sex, and smoking.RESULTS: We found mortality data for 100 of 110 cases; 93 of 100 death certificates mentioned ALS. Median survival from diagnosis to death was 28 months. Shorter survival was associated with older age at diagnosis, female sex, bulbar onset, shorter interval between symptom onset and diagnosis, and reduced lung function. Shorter survival from diagnosis to death had a weak inverse association with blood lead (hazard ratio = 0.9; 95% confidence interval, 0.8-1.0) and a stronger inverse association with patella lead (0.5; 0.2-1.0) and tibia lead (0.3; 0.1-0.7); similar results were found for survival from symptom onset to death.CONCLUSIONS: These results suggest that lead exposure is associated with longer survival in ALS cases and, if confirmed, may shed light on mechanisms involved in disease progression.