The epidemiology of aplastic anemia in Thailand
The epidemiology of aplastic anemia in Thailand
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DOI：
10.1182/blood-2005-01-0161
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发表时间：
2006-02-15
期刊：
影响因子：
20.3
通讯作者：
Young, NS
中科院分区：
文献类型：
--
作者：
Issaragrisil, S;Kaufman, DW;Young, NS
再生障碍性贫血与环境暴露有关，从化学品和医疗药物到传染性病原体。这种疾病在亚洲比西方更常见，发病率高2至3倍。我们报告了1989年至2002年在泰国进行的一项流行病学研究的最新结果，该研究共招募了541例患者和2261例对照。通过面对面访谈确定暴露量。我们观察到苯（3.5）和其他溶剂（2.0）以及磺胺类（5.6），噻嗪类（3.8）和甲苯咪唑（3.0）的相对风险估计值显着升高。氯霉素的使用不常见，未观察到显著相关性。孔敬（泰国东北部）涉及农药。与有机磷（2.1）、滴滴涕（6.7）和氨基甲酸酯（7.4）有显著关联。我们发现农民接触鸭和鹅（3.7）和动物肥料（2.1）的边缘关联的显着风险。孔敬与饮用瓶装水或蒸馏水以外的水有显著关联（2.8）。非医疗针头暴露与曼谷和孔敬合并（3.8）。最引人注目的是农村地区的大部分病因是动物暴露和饮用威尔斯、农村水龙头和雨水等水源，与泰国许多再生障碍性贫血病例的感染性病因一致。
Aplastic anemia has been linked to environmental exposures, from chemicals and medical drugs to infectious agents. The disease occurs more frequently in Asia than in the West, with incidence rates 2- to 3-fold higher. We report updated results of an epidemiologic study conducted in Thailand from 1989 to 2002, in which 541 patients and 2261 controls were enrolled. Exposures were determined by in-person interview. We observed significantly elevated relative risk estimates for benzene (3.5) and other solvents (2.0) and for sulfonamides (5.6), thiazides (3.8), and mebendazole (3.0). Chloramphenicol use was infrequent, and no significant association was observed. Agricultural pesticides were implicated in Khonkaen (northeastern Thailand). There were significant associations with organophosphates (2.1), DDT (6.7), and carbamates (7.4). We found significant risks for farmers exposed to ducks and geese (3.7) and a borderline association with animal fertilizer (2.1). There was a significant association in Khonkaen with drinking other than bottled or distilled water (2.8). Nonmedical needle exposure was associated in Bangkok and Khonkaen combined (3.8). Most striking was the large etiologic fraction in a rural region accounted for by animal exposures and drinking of water from sources such as wells, rural taps, and rainwater, consistent with an infectious etiology for many cases of aplastic anemia in Thailand.