摘要：Objectives. We investigated whether US Army Gulf War veterans who were potentially exposed to nerve agents during the March 1991 weapons demolitions at Khamisiyah, Iraq, are at increased risk of cause-specific mortality. Methods. The cause-specific mortality of 100487 exposed US Army Gulf War veterans was compared with that of 224980 unexposed US Army Gulf War veterans. Exposure was determined with the Department of Defense 2000 plume model. Relative risk estimates were derived from Cox proportional hazards models. Results. The risks of most disease-related mortality were similar for exposed and unexposed veterans. However, exposed veterans had an increased risk of brain cancer deaths (relative risk [RR]=1.94; 95% confidence interval [CI]=1.12, 3.34). The risk of brain cancer death was larger among those exposed 2 or more days than those exposed 1 day when both were compared separately to all unexposed veterans (RR=3.26; 95% CI=1.33, 7.96; RR=1.72; 95% CI=0.95,3.10, respectively). Conclusions. Exposure to chemical munitions at Khamisiyah may be associated with an increased risk of brain cancer death. Additional research is required to confirm this finding. On March 4 and 10, 1991, combat engineer and explosive ordnance disposal units of the US Army XVIII Corps destroyed 2 large Iraqi weapons caches at Khamisiyah, Iraq. In October 1991, March 1992, May 1992, and May 1998, representatives from the United Nations Special Commission inspected Khamisiyah and detected the existence of sarin and cyclosarin in both intact and damaged rockets in the bunker and pit. Military personnel who were possibly exposed to chemical warfare agents at Khamisiyah were identified by environmental and climatological modeling of the plume dispersion. Sarin is a toxic nerve agent produced for chemical warfare. Sarin can be inhaled or absorbed via the mucous membranes, skin, or eyes, and at sufficient dosage it can cause convulsions and death. 1 Acute sarin exposure produces a well-characterized acute cholinergic reaction, and doses sufficient to produce an acute reaction have been associated with persistent health effects such as fatigue, vision problems, and headaches. 1 There is no evidence that sarin is carcinogenic. 2 Several studies have examined cause-specific mortality risks associated with Gulf War service by comparing the mortality of all Gulf War veterans to that of veterans who served in the military during the period of the Gulf War but did not serve in the Persian Gulf region. 3 – 5 Although reporting that Gulf War veterans were at increased risk for traumatic deaths, the studies did not find any increased risk of disease-related deaths. One of these studies assessed cause-specific mortality among Gulf War veterans who were considered exposed to nerve gas on the basis of the 1997 plume model. 4 When the mortality of 48281 Gulf War veterans who were exposed to nerve gas at Khamisiyah was compared with that of 573621 Gulf War veterans who were not exposed, there was no increased risk in either overall or cause-specific mortality among exposed veterans. Another study using the same exposure model found no unusual morbidity among exposed troops. 6 To determine whether adverse health are outcomes associated with exposure to chemical agents released at Khamisiyah, we compared the mortality of all exposed US Army Gulf War veterans to that of unexposed US Army Gulf War veterans, using the 2000 plume model to assess potential for exposure.
