PDF(Pubmed)
Abstract：
The cause of Paget\'s disease of bone (PDB) is unknown. It emerged as a distinct entity in Britain in the late nineteenth century when it was prevalent, and florid presentation not uncommon. Epidemiological surveys in the 1970s showed that Britain had a substantially higher prevalence of PDB than any other country. Studies in the late twentieth and early twenty-first centuries have documented an unexplained change in presentation, with a greatly reduced prevalence and less severe disease than formerly. The emergence of PDB in Britain coincided with rapid industrialization which, in turn, was driven by the use of coal for energy. In the home, bituminous coal was customarily burnt on an open hearth for heating. Using data on coal production, population size, and estimates of domestic use, the estimated exposure to domestic coal burning rose threefold in Britain during the nineteenth century and began to fall after 1900. This pattern fits well with the decline in PDB documented from death certification and prevalence surveys. Colonists moving from Britain to North America, Australia and New Zealand established coal mines and also used coal for domestic heating. PDB was found in these settler populations, but was largely absent from people indigenous to these lands. In all parts of the world PDB prevalence has fallen as the burning of coal in open hearths for domestic heating has reduced. The nature of the putative factor in coal that could initiate PDB is unknown, but possible candidates include both organic and inorganic constituents of bituminous coal.
摘要：
Paget骨病（PDB）的病因尚不清楚。它在19世纪后期盛行时在英国成为一个独特的实体，花哨的演讲并不少见。1970年代的流行病学调查显示，英国的PDB患病率远高于其他任何国家。20世纪末和21世纪初的研究记录了一种无法解释的表述变化，患病率大大降低，疾病比以前严重。英国PDB的出现与快速工业化同时发生，反过来,是由煤炭作为能源的使用驱动的。在家里,烟煤通常在平炉上燃烧加热。利用煤炭产量数据，人口规模，以及国内使用的估计，在19世纪，英国国内燃煤的估计暴露量增加了三倍，1900年后开始下降。这种模式与死亡证明和患病率调查记录的PDB下降非常吻合。殖民者从英国迁往北美,澳大利亚和新西兰建立了煤矿，并将煤炭用于家庭取暖。在这些定居者中发现了PDB，但这些土地上的土著人基本上不存在。在世界所有地区，PDB的流行率都在下降，因为用于家庭取暖的平炉中的煤炭燃烧减少了。煤中可能引发PDB的推定因素的性质尚不清楚，但可能的候选者包括烟煤的有机和无机成分。
