肌萎缩侧索硬化外源性危险因素的Meta分析
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摘要
目的:评价肌萎缩侧索硬化(ALS)部分外源性危险因素的作用,探讨肌萎缩侧索硬化(ALS)的病因。
方法:运用meta分析方法对国内外发表的有关肌萎缩侧索硬化(ALS)的部分外源性危险因素病例对照研究的15篇文献资料进行定量综合分析。
结果:各因素合并OR值分别为:吸烟OR=1.27(95%CI:1.11～1.46);饮酒OR=0.88(95%CI:0.71～1.10);受教育程度:高中及以下OR=1.45(95%CI:1.24～1.71),高中以上OR=0.69 (95%CI:0.59～0.81);接触金属OR=1.46(95%CI:1.10～1.93);接触农药OR=1.58 (95%CI: 1.16～2.16);暴露于有机溶剂OR=1.71 (95%CI:1.30～2.25);外科手术OR=0.77(95%CI:0.56～1.08);体力活动OR=1.23 (95%CI:0.64～2.33);外伤伴或不伴骨折OR=1.17 (95%CI:0.75～1.83);非城区居住OR=1.05(95%CI:0.81～1.36);电休克OR=1.05(95%CI:0.81～1.36)。
结论:吸烟、接触农药、金属、有机溶剂、受教育程度低与ALS风险相关;饮酒、体力活动、创伤伴或不伴骨折、居住在非城区、外科手术、电休克可能等不是ALS的危险因素。
Purpose: To explore the pathogenesis of amyotrophic lateral sclerosis (ALS)through appraising the main exogenous risk factors related to the incidence of ALS .
Method: The results from 15 case-control studies on risk factors of amyotrophic lateral sclerosis from were analyzed by meta-analysis.
Results: The pooled odds ratio values were: smoking OR=1.27(95%CI:1.11～1.46); alcohol drinking OR=0.88(95%CI:0.71～1.10); exposure to metal OR=1.46(95% CI:1.10～1.93); exposure to agricultural chemical OR=1.58 (95% CI: 1.16～2.16) ;exposure to solvents OR=1.71(95%CI:1.30～2.25); surgery OR=0.77(95%CI:0.56～1.08); physical activity OR=1.23 (95%CI:0.64～2.33); trauma with/without fracture OR=1.17 (95%CI:0.75～1.83); agricultural chemical OR=1.71(95%CI:1.22～2.38); solvents OR=1.51(95%CI:1.15～1.97);education≤high school OR=1.45(95%CI:1.24～1.71); education>high school OR=0.69 (95%CI:0.59～0.81); Non city resided OR=1.05(95%CI:0.81～1.36)electic shock OR=1.05(95%CI:0.81～1.36)
Conclusion: The risk factors influencing the incidence of ALS were smoking ;exposure to agricultural chemical; exposure to solvents; exposure to metal and fewer years of education(≤high school)
方法:运用meta分析方法对国内外发表的有关肌萎缩侧索硬化(ALS)的部分外源性危险因素病例对照研究的15篇文献资料进行定量综合分析。
结果:各因素合并OR值分别为:吸烟OR=1.27(95%CI:1.11～1.46);饮酒OR=0.88(95%CI:0.71～1.10);受教育程度:高中及以下OR=1.45(95%CI:1.24～1.71),高中以上OR=0.69 (95%CI:0.59～0.81);接触金属OR=1.46(95%CI:1.10～1.93);接触农药OR=1.58 (95%CI: 1.16～2.16);暴露于有机溶剂OR=1.71 (95%CI:1.30～2.25);外科手术OR=0.77(95%CI:0.56～1.08);体力活动OR=1.23 (95%CI:0.64～2.33);外伤伴或不伴骨折OR=1.17 (95%CI:0.75～1.83);非城区居住OR=1.05(95%CI:0.81～1.36);电休克OR=1.05(95%CI:0.81～1.36)。
结论:吸烟、接触农药、金属、有机溶剂、受教育程度低与ALS风险相关;饮酒、体力活动、创伤伴或不伴骨折、居住在非城区、外科手术、电休克可能等不是ALS的危险因素。
Purpose: To explore the pathogenesis of amyotrophic lateral sclerosis (ALS)through appraising the main exogenous risk factors related to the incidence of ALS .
Method: The results from 15 case-control studies on risk factors of amyotrophic lateral sclerosis from were analyzed by meta-analysis.
Results: The pooled odds ratio values were: smoking OR=1.27(95%CI:1.11～1.46); alcohol drinking OR=0.88(95%CI:0.71～1.10); exposure to metal OR=1.46(95% CI:1.10～1.93); exposure to agricultural chemical OR=1.58 (95% CI: 1.16～2.16) ;exposure to solvents OR=1.71(95%CI:1.30～2.25); surgery OR=0.77(95%CI:0.56～1.08); physical activity OR=1.23 (95%CI:0.64～2.33); trauma with/without fracture OR=1.17 (95%CI:0.75～1.83); agricultural chemical OR=1.71(95%CI:1.22～2.38); solvents OR=1.51(95%CI:1.15～1.97);education≤high school OR=1.45(95%CI:1.24～1.71); education>high school OR=0.69 (95%CI:0.59～0.81); Non city resided OR=1.05(95%CI:0.81～1.36)electic shock OR=1.05(95%CI:0.81～1.36)
Conclusion: The risk factors influencing the incidence of ALS were smoking ;exposure to agricultural chemical; exposure to solvents; exposure to metal and fewer years of education(≤high school)
引文
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23 Valenti M, Pontieri FE, Conti F. Amyotrophic lateral sclerosis and sports: a case-control study. Eur J Neurol. 2005. 12(3): 223-5
24 Morahan JM, Pamphlett R. Amyotrophic lateral sclerosis and exposure to environmental toxins: an Australian case-control study. Neuroepidemiology. 2006. 27(3): 130-5
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2 McGuire V, Longstreth WT Jr, Koepsell TD. Incidence of amyotrophic lateral sclerosis in three counties in western Washington state. Neurology. 1996. 47(2): 571-3
3 McGuire V, Nelson LM: Epidemiology of ALS; in Mitsumoto H, Przedborski S, Gordon P (eds): Amyotrophic Lateral Sclerosis.New York, Taylor & Francis, 2006, pp 17–21
4 Qureshi MM, Hayden D, Urbinelli L, et al. Analysis of factors that modify susceptibility and rate of progression in amyotrophic lateral sclerosis (ALS). Amyotroph Lateral Scler. 2006. 7(3): 173-82
5 Kelly P, Shapiro B. Amyotrophic lateral sclerosis and other motor neuron disorders. In: Batchelor T, Cudkowicz M,editors. Principles of Neuroepidemiology. Woburn:Butterworth-Heinemann; 2001. pp 265–88
6 Kurtzke JF. Risk factors in amyotrophic lateral sclerosis. Adv Neurol. 1991. 56: 245-70
7 Mitchell JD, Davies RB, al-Hamad A. MND risk factors: an epidemiological study in the north west of England. J Neurol Sci. 1995. 129 Suppl: 61-4
8 Armon C, Kurland LT, Daube JR. Epidemiologic correlates of sporadic amyotrophic lateral sclerosis. Neurology. 1991. 41(7): 1077-84
9 Armon C. An evidence-based medicine approach to the evaluation of the role of exogenous risk factors in sporadic amyotrophic lateral sclerosis. Neuroepidemiology. 2003. 22(4): 217-28
10 Nelson LM. Epidemiology of ALS. Clin Neurosci. 1995. 3(6): 327-31
11 Nelson LM, Matkin C, Longstreth WT Jr. Population-based case-control study of amyotrophic lateral sclerosis in westernWashington State. II. Diet. Am J Epidemiol. 2000. 151(2): 164-73
12 Weisskopf MG, Ascherio A. Cigarettes and amyotrophic lateral sclerosis: only smoke or also fire. Ann Neurol. 2009. 65(4): 361-2
13 Lichtenstein MJ, Mulrow CD, Elwood PC. Guidelines for reading case-control studies. J Chronic Dis. 1987. 40(9): 893-903
14 Provinciali L, Giovagnoli AR. Antecedent events in amyotrophic lateral sclerosis: do they influence clinical onset and progression. Neuroepidemiology. 1990. 9(5): 255-62
15 Savettieri G, Salemi G, Arcara A. A case-control study of amyotrophic lateral sclerosis. Neuroepidemiology. 1991. 10(5-6): 242-5
16 Riggs JE. Amyotrophic lateral sclerosis, heterogeneous susceptibility, trauma, and epidemiology. Arch Neurol. 1996. 53(3): 225-7
17 McGuire V, Longstreth WT Jr, Nelson LM. Occupational exposures and amyotrophic lateral sclerosis. A population-based case-control study. Am J Epidemiol. 1997. 145(12): 1076-88
18 Longstreth WT, McGuire V, Koepsell TD. Risk of amyotrophic lateral sclerosis and history of physical activity: a population-based case-control study. Arch Neurol. 1998. 55(2): 201-6
19 Cruz DC, Nelson LM, McGuire V. Physical trauma and family history of neurodegenerative diseases in amyotrophic lateral sclerosis: a population-based case-control study. Neuroepidemiology. 1999. 18(2): 101-10
20 Nelson LM, McGuire V, Longstreth WT Jr. Population-based case-control study of amyotrophic lateral sclerosis in western Washington State. I. Cigarette smoking and alcohol consumption. Am J Epidemiol. 2000. 151(2): 156-63
21 Longnecker MP, Kamel F, Umbach DM. Dietary intake of calcium, magnesium and antioxidants in relation to risk of amyotrophic lateral sclerosis. Neuroepidemiology. 2000. 19(4): 210-6
22 Veldink JH, Kalmijn S, Groeneveld GJ. Physical activity and the association with sporadic ALS. Neurology. 2005. 64(2): 241-5
23 Valenti M, Pontieri FE, Conti F. Amyotrophic lateral sclerosis and sports: a case-control study. Eur J Neurol. 2005. 12(3): 223-5
24 Morahan JM, Pamphlett R. Amyotrophic lateral sclerosis and exposure to environmental toxins: an Australian case-control study. Neuroepidemiology. 2006. 27(3): 130-5
25 Chen H, Richard M, Sandler DP. Head injury and amyotrophic lateral sclerosis. Am J Epidemiol. 2007. 166(7): 810-6
26 Sutedja NA, Veldink JH, Fischer K. Lifetime occupation, education, smoking, and risk of ALS. Neurology. 2007. 69(15): 1508-14
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