职业接触抗癌药对护士生殖结局影响的流行病学研究

Abstract

目的 探讨护士职业接触抗癌药及其接触水平与不良生殖结局的关系。 方法 对北京、天津、包头24所医院873名护士1 021次妊娠情况进行了回顾性群组研究，接触组(350名，433次妊娠)孕前及孕期有明确抗癌药接触史，对照组(523名，588次妊娠)孕期及孕前均不接触抗癌药。应用暴露指数评估护士接触抗癌药的水平。 结果 接触组自然流产率(14.1%)、先天畸形率(2.82%)及妊娠剧吐发生率(18.9%)、妊娠贫血发生率(10.2%)高于对照组(分别为8.3%、0.76%、12.7%、5.6%),差异有显著性(P<0.05)。经Logistic回归分析,调整年龄、吸烟、饮酒等混杂因素后显示，接触抗癌药自然流产(OR=2.29,95%CI=1.46～3.59)、先天畸形(OR=3.63,95%CI=1.07～12.36)及妊娠贫血(OR=1.77,95% CI=1.03～3.05)的危险显著增加(P<0.01，P<0.05)。护士职业接触抗癌药的接触水平-反应关系的趋势χ2检验，自然流产及先天畸形均随抗癌药接触水平的增加有增高的趋势，其χ2值分别为3.86和14.62(P<0.05，P<0.001)。 结论 护士职业接触抗癌药可导致妊娠并发症(妊娠剧吐、妊娠贫血)及不良妊娠结局(自然流产、先天畸形)的危险增加，其不良妊娠结局随抗癌药接触水平的增高而增加。

Objective To examine the relationship between adverse reproductive outcome and occupational exposure to antineoplastic drugs or exposure level among nurses. Methods The retrospective cohort study was carried out in 24 Beijing,Tianjin and Baotou hospitals.873 nurses,1 021 pregnancies were investigated,in which 350 nurses(433 pregnancies) who regularly handled antineoplastic agents were as exposed group and 523 nurses(588 pregnancies) who did not expose to such agents were as control group.The antineoplastic drugs exposure index was assessed to evaluate the exposure level. Results The rates of spontaneous abortion(14.1%),congenital malformation(2.82%),anemia during pregnancy(10.2%) and hyperemesis gravidarum(18.9%) in exposed group were higher than those of control group(8.3%,0.76%,12.7% and 5.6% respectively)，P<0.05.Logistic regression analysis after adjustment of age,smoking and drinking etc. showed that the risk of spontaneous abortion(OR=2.29,95%CI=1.46～3.59),congenital malformation(OR=3.63,95%CI=1.07～12.36) and anemia during pregnancy(OR=1.77,95% CI=1.03～3.05) were increased after exposure to antineoplastic drugs respectively(P<0.01，P<0.05).χ2 test showed that there was an exposure level-response relationship between exposure level and spontaneous abortion or congenital malformation(χ2=3.86,P<0.05 and χ2=14.62,P<0.001,respectively). Conclusions The risks of pregnant complications and adverse pregnant outcome in nurses could be induced by exposure to antineoplastic drugs and the adverse pregnant outcome was increased as the exposure level increased.