World Trade Center Exposures, Neuropathic Symptoms and Nervous System Injury

摘要 我们研究的长期目标是确定是否暴露在世界贸易中心的污染物中 2001年9月11日的世界贸易中心(WTC)灾难造成了神经病症状和神经系统损伤。 WTC“幸存者”人口。我们的初步研究结果显示神经系统症状的发生率很高。 在普通社区的幸存者和急救人员中。有许多原因导致 然而，神经性症状，如糖尿病、贫血、焦虑和暴露于与WTC无关的环境 神经毒素。因此，需要对神经性症状进行调查，以了解它们是否由WTC引起 曝光。该项目的第一个目标是探索WTC暴露和 通过使用现有的纵向数据和神经学研究得出神经病理性症状。我们的第二个 目的是用更完整的问卷来提炼我们对神经症状的理解， 神经学检查和客观测试(肌电/神经传导速度[EMG/NCV]； 组织病理学评估；HgbA1c、B12的血液测试，暴露于神经毒性感染剂，以及 神经元特异性烯醇化酶)在有和没有神经性疾病患者的病例对照研究中的应用 症状。我们的具体目标是(1)分析纵向数据以描述异常感的演变 以及(2)分析EMG/NCV数据，以调查 报告感觉异常；以及(3)检查幸存者和应答者中的神经病理性症状 与神经纤维密度异常或肌电/神经传导研究有关。已经- 进行的肌电/神经传导速度研究将分析神经学研究(n=80)，以确定它们与 神经性症状，并探讨持续、恶化或改善的相关性 这些症状。我们将评估神经纤维密度作为神经病症状的危险因素作为 病例对照研究。病例将是40名有持续性神经病症状的患者，至少进行2次研究访问 取自贝尔维尤WTC环境卫生中心(WTC EHC)登记的患者。对照(n=40) 将来自相同的WTC EHC人群；分别与年龄、种族、性别和 9/11/2001年9/11之前无糖尿病、癌症、感觉异常或神经系统疾病史；但免费 在所有的学习访问中都有异常感。以社区为基础的、非WTC暴露的对照组(n=20)也将 登记，频率匹配到与WTC EHC对照相同匹配变量的病例，以便 确定未接触WTC的普通人群中异常的流行率。病例对照 被发现有神经病症状的研究参与者将被转介进行可选的EMG/NCV检查，以 阐明神经性症状的潜在机制。该项目的成功完成将澄清 是否暴露于WTC毒素导致观察到的神经病变症状。

ABSTRACT The long-term goal of our research is to determine if exposure to contaminants from the World Trade Center (WTC) disaster of September 11, 2001 caused neuropathic symptoms, and nervous system injuries in the WTC “Survivor” population. Our preliminary findings demonstrate a high prevalence of neurologic symptoms among both Survivors from the general community and first responders. There are numerous causes of neuropathic symptoms, however, such as diabetes, anemia, anxiety, and exposure to non-WTC-related neurotoxins. Neuropathic symptoms thus need to be investigated to understand whether they are due to WTC exposures. The first objective of this project is to explore the connection between WTC exposure and neuropathic symptoms through use of existing longitudinal data and neurological studies. Our second objective is to refine our understanding of neurologic symptoms with more complete questionnaires, neurological examination and objective testing (electromyography/nerve conduction velocity [EMG/NCV]; histopathologic evaluations; and blood tests for HgbA1c, B12, exposure to neurotoxic infectious agents, and neuron-specific enolase) in the context of a case-control study of patients with and without neuropathic symptoms. Our specific aims are (1) to analyze longitudinal data to describe the evolution of paresthesias in the survivor population; and (2) to analyze EMG/NCV data in order to investigate the pathophysiology of the reported paresthesias; and (3) to examine whether neuropathic symptoms among Survivors and Responders are associated with abnormalities in nerve fiber densities or EMG/nerve conduction studies. Already- performed EMG/NCV studies neurologic studies (n=80) will be analyzed to determine their relationship to neuropathic symptoms and to explore correlates of persistence, deterioration or improvement over time in these symptoms. We will evaluate nerve fiber densities as risk factors for neuropathic symptoms as part of the case-control study. Cases will be 40 patients with persistent neuropathic symptoms on at least 2 study visits drawn from patients enrolled in the Bellevue WTC Environmental Health Center (WTC EHC). Controls (n=40) will be drawn from the same WTC EHC population; individually matched to cases on age, race, gender and absence of histories of diabetes, cancer and paresthesias or neurologic disorders prior to 9/11/2001; but free of paresthesias on all study visits. A community-based, non-WTC-exposed control group (n=20) also will be enrolled, frequency-matched to cases on the same matching variables as the WTC EHC controls, in order to determine the prevalence of abnormalities in the general population without WTC-exposure. Case-control study participants found to have neuropathic symptoms will be referred for optional EMG/NCV studies to elucidate mechanisms underlying neuropathic symptoms. Successful completion of this project will clarify whether exposure to WTC toxins caused the observed neuropathic symptoms.