戶外工作者的AMD風險比較高


  【24drs.com】對於戶外工作者而言,有個壞消息,長時間在太陽下工作,老年性黃斑部病變(AMD)的風險可能會增加。
  
  研究者在4月的Retina期刊發表一篇文章指出,退休人員中,相較於在太陽下工作時間較少,或沒有在太陽下工作者,曾在太陽下工作的經歷與初期或後期AMD的風險呈現劑量相關的增加趨勢。
  
  德國Cologne大學醫院眼科Tina Schick醫師等人寫道,年輕時的陽光曝曬情況,對於數十年後發生嚴重眼科疾病有所影響。研究結果也指出,本病的誘發事件在形態學徵兆變明顯前多年即發生。
  
  研究對象是參與「European Genetic Database (EUGENDA)」研究的3,701名患者,除了標準的人口統計學資料與抽菸史,作者們還收集了有關職業類型、虹膜顏色、目前與過去(退休前)的陽光曝曬,每天少於8小時或者每天大於8小時等資料,很少到戶外者則被視為對照組。
  
  作者們使用眼底照相術將AMD進行分期,他們定義初期AMD為出現10個以上的小玻璃膜疣及色素改變,或者是在「Early Treatment Diabetic Retinopathy Study」研究的方格表中,發現中等或較大的玻璃膜疣;他們定義後期AMD為,中央窩下區域病變的AMD且/或至少一眼有脈絡膜新血管生成。
  
  研究對象平均年齡72.20 ± 8.71歲,其中2,186名女性(59.1%),初期AMD者有752人(20.3%),後期AMD者有1179人(31.9%),其他1,770人(47.8%)沒有AMD。
  
  過去的太陽曝曬情況與初期AMD有顯著關係(戶外小於8小時:勝算比[OR], 5.05 [95%信賴區間(CI), 1.19 - 21.47;P = .03];戶外≧8小時:OR, 6.32 [95% CI, 1.45 - 27.50;P = .01])。曾曝曬於太陽的情況越高,也和後期AMD有關(<8小時:OR, 0.92 [95% CI, 0.48 - 1.78;P = .81];≧8 小時:OR, 2.65 [95% CI, 1.34 - 5.24;P = .005])。
  
  校正年齡、性別、抽菸史之後,曾曝曬於太陽的情況越高者依舊和初期AMD(<8小時:OR, 4.94 [95% CI, 1.14 - 21.34;P = .03];≧8小時:OR, 5.54 [95% CI, 1.25 - 24.58;P = .02])與後期AMD (<8小時:OR, 1.14 [95% CI, 0.53 - 2.45;P = .74];≧8小時:OR, 2.77 [95% CI, 1.25 - 6.16;P = .01])有顯著關聯。
  
  當研究者根據工作地點、而非太陽曝曬情況分析資料時,作者們發現,相較於室內工作,戶外工作與後期AMD有顯著關聯(OR, 2.70;95% CI, 2.09 - 3.49;P = 1.31 × 10-13)。校正年齡、性別、抽菸史之後,此關聯依舊存在(OR, 2.57;95% CI, 1.89 - 3.48;P = 1.58 × 10-9)。
  
  有關校正分析,除了在太陽下的時間,AMD的風險與目前的太陽曝曬、虹膜顏色、特定職業類型並無顯著關聯。
  
  作者們結論指出,這些研究結果認為,對於AMD而言,以前的太陽曝曬情況和戶外工作是重要的環境風險因素。考量太陽曝曬對於白內障和皮膚癌也是風險因素,他們提出警告,應盡早開始戴太陽眼鏡和有帽沿的帽子,以使陽光曝曬最小化等預防措施,以防後來發生AMD與其他疾病。
  
  資料來源:http://www.24drs.com/
  
  Native link:AMD Risk Higher Among Outdoor Workers

AMD Risk Higher Among Outdoor Workers

By Norra MacReady
Medscape Medical News

Some cloudy news for people who work outdoors: long hours in the sun may increase the risk for age-related macular degeneration (AMD).

Compared with little or no time spent working in the sun, past but not current sun exposure showed a dose-related increase in the risk for early and late AMD among retirees, researchers report in an article published in the April issue of Retina.

"[S]unlight exposure at younger age has an influence on the development of a severe eye disease...decades later," write Tina Schick, MD, from the Department of Ophthalmology, University Hospital of Cologne, Germany, and colleagues. "The results also demonstrate that the predisposing events for the disease take place many years before morphological signs become apparent."

The researchers studied 3701 people participating in the European Genetic Database (EUGENDA). In addition to standard demographic data and smoking history, the authors collected information on occupation type, iris color, and current and past (preretirement) sun exposure: either less than 8 hours daily or 8 or more hours daily. People who rarely went outside served as the reference group.

The authors used fundus photographs to stage the AMD. They defined early AMD as the presence of 10 or more small drusen and pigmentary changes, or intermediate or large drusen on the Early Treatment Diabetic Retinopathy Study grid; they defined late AMD as AMD with subfoveal geographic atrophy and/or choroidal neovascularization in at least one eye.

The group had a mean age of 72.20 ± 8.71 years and included 2186 women (59.1%). Early AMD was seen in 752 individuals (20.3%), and late AMD in 1179 (31.9%). The remaining 1770 (47.8%) participants had no AMD.

Past sun exposure showed a significant association with early AMD (<8 hours outdoors: odds ratio [OR], 5.05 [95% confidence interval (CI), 1.19 - 21.47; P = .03]; ?8 or more hours outdoors: OR, 6.32 [95% CI, 1.45 - 27.50; P = .01]). Higher past sun exposure was also associated with late AMD (<8 hours: OR, 0.92 [95% CI, 0.48 - 1.78; P = .81]; ?8 or more hours: OR, 2.65 [95% CI, 1.34 - 5.24; P = .005]).

After adjustment for age, sex, and smoking history, greater past sun exposure remained significantly associated with early (<8 hours: OR, 4.94 [95% CI, 1.14 - 21.34; P = .03]; ?8 or more hours: OR, 5.54 [95% CI, 1.25 - 24.58; P = .02]) and late (<8 hours: OR, 1.14 [95% CI, 0.53 - 2.45; P = .74]; ?8 or more hours: OR, 2.77 [95% CI, 1.25 - 6.16; P = .01]) AMD.

When they analyzed the data according to work location, rather than sun exposure, the authors found a highly significant association between outside work (compared with inside work) and late AMD (OR, 2.70; 95% CI, 2.09 - 3.49; P = 1.31 × 10?13). This association persisted after adjustment for age, sex, and smoking history (OR, 2.57; 95% CI, 1.89 - 3.48; P = 1.58 × 10?9).

On adjusted analysis, the risk for AMD was not significantly associated with current sun exposure, iris color, or specific occupation type, other than the amount of time spent in the sun.

These findings suggest that "past sunlight exposure and outside working [are] important environmental risk factors for AMD," the authors conclude. Considering that sunlight exposure is also a risk factor for conditions such as cataracts and skin cancer, they warn that "preventive measures, for example wearing sunglasses and brimmed hats to minimize sunlight exposure, should start early to prevent development of AMD and other diseases later in life."

The authors have disclosed no relevant financial relationships.

Retina. 2016;36:787-790.

    
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