核工人循环系统疾病死亡率的剂量依赖性(系统回顾和汇总分析):缺乏低剂量效应并确认 0.5 Gy 时的 Unscear 和 Icrp 阈值

Q4 Medicine
A. N. Koterov, L. Ushenkova, A. A. Wainson, I. G. Dibirgadzhiev, M. Kalinina, A.Yu. Bushmanov
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引用次数: 0

摘要

根据已维护的核工作人员(NW)影响数据库(源数据库),选取了循环系统疾病(CVD;根据 ICD-9 编码为 390-459 和根据 ICD-10 编码为 I00-I99)死亡率与外部辐射剂量之间关系的主要研究。样本包括 30 篇论文,涵盖 6 个国家的队列和 15 个国家的西北队列。对于样本,在大多数情况下以已发表的标准化死亡率(SMR)为基础,计算所选剂量组心血管疾病死亡率的相对风险(RR),并对异常值材料进行后续处理。初始样本:n = 207;最终样本:n = 199;涵盖了极低剂量(0-10 mSv;占样本的 15.8%)、低剂量(>10-100 mSv;占样本的 45.8%)和中等剂量(>100-1000 mSv;占样本的 36.4%);高剂量(>1000 mSv;n = 4;占样本的 2%)的数据因可疑而被排除。我们对最终样本进行了系统回顾和汇总分析,分析了不同剂量下心血管疾病死亡率的序数比。对于整个剂量范围(0-1000 毫希沃特)和中等剂量,在五种回归中(除整个剂量范围的对数回归外)均发现死亡率呈统计学意义上的显著上升趋势。虽然 r 值很小(0.230-0.293),但效果很明显。使用线性回归法计算出的中等剂量每 1 Gy (Sv) 的ERR为 0.54。这一数值高于以往荟萃分析得出的数值,但应被视为最充分的数值。在极低+低剂量范围(0-100 mGy)内,没有发现任何剂量关系;回归的 r 系数要么可以忽略不计,要么为负值,统计意义不大。对于暴露后心血管疾病死亡率的阈值以下剂量范围(根据联合国辐射防护委员会和国际癌症研究计划:500 毫希沃特),尽管样本量很大(n = 191),但只发现了 RR 增加的微弱趋势,在统计学上不显著;而对于 500-1000 毫希沃特的剂量范围,汇总分析显示风险增加的最大趋势取决于暴露水平(r = 0.297-0.423 ;由于样本量小,在统计学上不显著:n = 8)。由此得出结论,对于辐照后心血管疾病的死亡率,应严格遵守联合国辐射防护委员会和国际辐射防护委员会确定并在本汇总分析中得到证实的 0.5 Gy 临界值。由于缺乏低剂量效应,在这些病理情况下提出低剂量效应问题是不恰当的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dose Dependence for Mortality from Circulatory Diseases in Nuclear Workers (Systematic Review and Pooled Analysis): Lack of Low Doses Effect and Confirmation of Unscear and Icrp Threshold at 0.5 Gy
Based on the maintained database (source database) on effects in nuclear workers (NW), a selection of major studies of the relationship between mortality from diseases of the circulatory system (CVD; codes 390–459 according to ICD-9 and I00–I99 according to ICD-10) and external radiation dose. The sample included 30 papers and covered cohorts from 6 countries plus an NW cohort from 15 countries. For the sample, in most cases based on published standardized mortality rates (SMR), the relative risks (RR) of mortality from CVD were calculated for the selected dose groups with subsequent processing of the material for outliers. Initial: n = 207; final sample: n = 199; covers very low (0–10 mSv; 15.8 % of the sample), low (>10–100 mSv; 45.8 %) and moderate (>100–1000 mSv; 36.4 %) doses; data for high doses (>1000 mSv; n = 4; 2 % of the sample), due to dubiousness, were excluded. A systematic review and pooled analysis of the RR for mortality from CVD depending on the dose on an ordinal scale was performed on the final sample. For the entire dose range (0–1000 mSv) and for moderate doses, statistically significant trends in increasing RR were found when expressed in five types of regressions (except for the logarithmic one for the entire range). Although the r values were small (0.230–0.293), the effect was clear. The ERR per 1 Gy (Sv) calculated for moderate doses using linear regression was 0.54. This value is higher than those obtained previously in meta-analyses, but should be considered as the most adequate. No dose relationship was found for the very low + low dose range (0–100 mGy); the r coefficients for the regressions were either negligible or negative at statistical insignificance. For the subthreshold dose range for CVD mortality after exposure (according to UNSCEAR and ICRP: 500 mSv), only a weak trend towards an increase in RR was found, statistically insignificant, despite the large sample size (n = 191), while for the dose range 500–1000 mSv, the highest tendency among the pooled analyzes was revealed to increase the risk depending on the level of exposure (r = 0.297–0.423; statistically insignificant due to the small sample size: n = 8). It is concluded that for mortality from CVD after irradiation, the threshold value of 0.5 Gy established by UNSCEAR and ICRP and confirmed in the present pooled analysis should be strictly adhered to. Due to the lack of effects of low doses, it is inappropriate to raise the issue of low dose effects in the context of these pathologies.
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来源期刊
Medical Radiology and Radiation Safety
Medical Radiology and Radiation Safety Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
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