臨床医学に環境・労働の観点を

・以前農薬（殺虫剤）と悪性リンパ腫の関係について書いたと思いますが，表題のように殺虫剤とパーキンソン病，パーキンソン症候群が関係ありそうです．以下の文献にそういったことが書いています．OEM ONLINEというのでＦＲＥＥで見ることができます．サマリーをコピーしておきます．

 

Environmental risk factors for Parkinson’s disease and parkinsonism: the Geoparkinson study

Scott4, G J Prescott4, J Bennett4, S Semple1, S Dick1, C Counsell2, P Mozzoni6, N Haites3, S Bezzina Wettinger9, A Mutti5, M Otelea8, A Seaton1, P Söderkvist7, A Felice9, on behalf of the Geoparkinson study group

 
Objective: To investigate the associations between Parkinson’s disease and other degenerative parkinsonian syndromes and environmental factors in five European countries.

Methods: A case–control study of 959 prevalent cases of parkinsonism (767 with Parkinson’s disease) and 1989 controls in Scotland, Italy, Sweden, Romania and Malta was carried out. Cases were defined using the United Kingdom Parkinson’s Disease Society Brain Bank criteria, and those with drug-induced or vascular parkinsonism or dementia were excluded. Subjects completed an interviewer-administered questionnaire about lifetime occupational and hobby exposure to solvents, pesticides, iron, copper and manganese. Lifetime and average annual exposures were estimated blind to disease status using a job-exposure matrix modified by subjective exposure modelling. Results were analysed using multiple logistic regression, adjusting for age, sex, country, tobacco use, ever knocked unconscious and family history of Parkinson’s disease.

Results: Adjusted logistic regression analyses showed significantly increased odds ratios for Parkinson’s disease/parkinsonism with an exposure–response relationship for pesticides (low vs no exposure, odds ratio (OR) = 1.13, 95% CI 0.82 to 1.57, high vs no exposure, OR = 1.41, 95% CI 1.06 to 1.88) and ever knocked unconscious (once vs never, OR = 1.35, 95% CI 1.09 to 1.68, more than once vs never, OR = 2.53, 95% CI 1.78 to 3.59). Hypnotic, anxiolytic or antidepressant drug use for more than 1 year and a family history of Parkinson’s disease showed significantly increased odds ratios. Tobacco use was protective (OR = 0.50, 95% CI 0.42 to 0.60). Analyses confined to subjects with Parkinson’s disease gave similar results.

Conclusions: The association of pesticide exposure with Parkinson’s disease suggests a causative role. Repeated traumatic loss of consciousness is associated with increased risk.

 

^{＊私、残念ながら疫学の知識に乏しいので、この方法論をなんとも評価できないのが残念です。}

・私の持っている神経内科の教科書：Merritt's NEUROLOGY(ELEVENTH EDITION,2005)のPARKINSON DISEASEのEtiology, Pathogenesis, and Geneticsの項では，MPTPという物質のことが取り上げられ，the possibility that PD might be caused by an environmental toxin.といった記載がありますが，Pesticide（殺虫剤）という言葉は見られませんでした．私の朝倉の内科学，新臨床内科学にも殺虫剤に類する言葉はありませんでした．『神経内科ハンドブック 鑑別診断と治療 第３版，2002年』には，「・・農薬に含まれるrotenoneがLewy小体形成のあるパーキンソニズムモデルを再現することから，ＭＰＴＰなどの神経毒も含めて環境因子もその原因として推定されている．」という記載がありました．