World Trade Center Exposures, Neuropathic Symptoms and Nervous System Injury

摘要 我们研究的长期目标是确定暴露于世贸中心的污染物是否 (WTC)2001年9月11日的灾难造成了神经病症状，神经系统损伤， 世贸中心“幸存者”人口。我们的初步研究结果表明， 在普通社区的幸存者和第一反应者中。有许多原因 然而，神经性症状，如糖尿病，贫血，焦虑，和暴露于非WTC相关 神经毒素因此，需要调查神经病性症状，以了解它们是否是由于WTC 暴露。本项目的第一个目标是探索世贸中心暴露与 通过使用现有的纵向数据和神经学研究来评估神经性症状。我们的第二 目的是通过更完整的问卷调查来完善我们对神经症状的理解， 神经系统检查和客观测试（肌电图/神经传导速度[EMG/NCV]; 组织病理学评价; HgbA 1c、B12、神经毒性感染因子暴露和 神经元特异性烯醇化酶）在有和无神经病变患者的病例对照研究中， 症状我们的具体目标是：（1）分析纵向数据，以描述感觉异常的演变， 幸存者群体;和（2）分析EMG/NCV数据，以研究 报告的感觉异常;（3）检查幸存者和应答者中的神经病性症状 与神经纤维密度或EMG/神经传导研究异常有关。已经- 将分析进行的EMG/NCV研究神经学研究（n=80），以确定其与 神经病性症状，并探索随着时间的推移持续，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理性症状的危险因素， 病例对照研究病例为40例至少2次研究访视时出现持续神经病性症状的患者 从贝尔维尤世贸中心环境健康中心（WTC EHC）登记的患者中抽取。对照组（n=40） 将从相同的WTC EHC人群中抽取;根据年龄、种族、性别和 在2001年9月11日之前没有糖尿病、癌症和感觉异常或神经系统疾病病史;但免费 所有研究访视时的感觉异常。一个以社区为基础的非WTC暴露对照组（n=20）也将 入组，与WTC EHC对照相同匹配变量的病例频率匹配，以便 确定无WTC暴露的一般人群中异常的患病率。病例对照 发现有神经病性症状的研究参与者将被转诊进行可选的EMG/NCV研究， 阐明神经病理性症状的潜在机制。该项目的成功完成将澄清 暴露于WTC毒素是否引起所观察到的神经性症状。

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.