济南市部分区县农村居民食管癌危险因素病例对照研究
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摘要
目的中国食管癌发病人数占世界总发病人数的50%,并具有发病年龄更低的特点。2006年原卫生部在全国启动了食管癌早诊早治项目,山东省作为首批加入该项目的省份,承担了较多项目任务。本研究探讨2013-2016年济南市部分区县农村居民食管癌发病的危险因素,为进一步开展食管癌防治工作提供依据。方法采用病例对照研究设计1∶2匹配病例组和对照组,选取2013-2016年山东省食管癌早诊早治项目组中济南市部分区县农村地区病理确诊为食管癌的278例患者作为病例组,选择同期同一项目组符合入组条件的556名正常人为对照组。分别对病例组和对照组进行问卷调查,调查内容包括一般情况,吸烟、饮酒情况,新鲜蔬菜、新鲜水果、肉蛋奶类、豆类食品、腌晒食品、油炸食品、烫热食品和霉变食品摄入等。采用Epidata 3.1软件对危险因素调查表进行录入,建立数据库,采用SPSS 19.0COXREG命令拟合条件Logistic模型,对相关变量进行单因素Logistic分析,筛选出有统计学意义的变量后,进一步行多因素Logistic分析,计算各危险因素的比值比(odds ratio,OR)及95%可信区间(confiden ceinterval,CI)。结果单因素分析显示,病例组和对照组在吸烟、饮酒、饮茶,以及经常食用新鲜水果、肉蛋奶类、豆类食品、腌晒食品和霉变食品上的差异有统计学意义,P<0.001。多因素分析显示,饮酒者发生食管癌的风险是不饮酒者的2.6倍(OR=2.556,95%CI=1.619～4.037),经常食用霉变食品者罹患食管癌风险是不经常食用霉变食品者的3.4倍(OR=3.439,95%CI=1.625～7.276);经常食用新鲜水果(OR=0.518,95%CI=0.350～0.768)和豆类食品(OR=0.384,95%CI=0.269～0.548)是食管癌的保护因素。结论饮酒和经常食用霉变食品是食管癌发生的危险因素,经常食用新鲜水果和豆类食品能有效预防食管癌的发生。
OBJECTIVE The incidence of esophageal cancer in China which were characterized by a lower age of onset accounts for 50%of the total number of cases in the world.In 2006,the Ministry of Health launched the Early Diagnosis and Therapy of Cancer in China.As one of the first province to join the project,Shandong Province took on many project tasks.This study aimed to explore the risk factors of esophageal cancer in rural areas of some districts and counties in Jinan City from 2013 to 2016,to provide a strategy for further prevention and treatment of esophageal cancer.METHODS A casecontrol study was conducted to design 1∶2 matched case group and a control group.Total of 278 patients with pathological diagnosis of esophageal cancer in the rural areas of Jinan City from 2013 to 2016 were selected as case groups,and 556 eligible persons were selected as the case control group.Questionnaires were surveyed for case and control groups by using specially designed questionnaires.The survey included general conditions,smoking and drinking,fresh vegetables,fresh fruits,meat and eggs,legumes,pickled foods,fried foods,Hot food,moldy food intake,etc.The risk data questionnaire was entered using epidata software and the database was established.The conditional logistic model was fitted with the SPSS19.0 software COXREG command.The single-factor logistic analysis was performed on the relevant variables.After screening the statistically significant variables,further multivariate logistic analysis was performed.Estimated odds ratio(OR)of risk factors and 95%confidence interval(CI).RESULTS There was a statistically significant difference between the case group and the control group in smoking,drinking,drinking tea,regular consumption of fresh fruits,meat and eggs,legumes,pickled foods and mildewed foods(P<0.001).Multivariate analysis showed that the risk of esophageal cancer in drinkers was 2.6 times higher than that of non-drinkers(OR=2.556,95%CI=1.619-4.037).The risk of esophageal cancer was 3.4 times higher than that of people who often consumed mildewed food(OR=3.439,95%CI=1.625-7.276).Fresh fruit(OR=0.518,95%CI=0.350-0.768)and legumes(OR=0.384,95%CI=0.269-0.548)were protective factors for esophageal cancer.CONCLUSIONS Drinking alcohol and frequently consumption of mildew foods are risk factors for esophageal cancer.Frequently consumption of fresh fruits and legumes can effectively prevent the occurrence of esophageal cancer.
OBJECTIVE The incidence of esophageal cancer in China which were characterized by a lower age of onset accounts for 50%of the total number of cases in the world.In 2006,the Ministry of Health launched the Early Diagnosis and Therapy of Cancer in China.As one of the first province to join the project,Shandong Province took on many project tasks.This study aimed to explore the risk factors of esophageal cancer in rural areas of some districts and counties in Jinan City from 2013 to 2016,to provide a strategy for further prevention and treatment of esophageal cancer.METHODS A casecontrol study was conducted to design 1∶2 matched case group and a control group.Total of 278 patients with pathological diagnosis of esophageal cancer in the rural areas of Jinan City from 2013 to 2016 were selected as case groups,and 556 eligible persons were selected as the case control group.Questionnaires were surveyed for case and control groups by using specially designed questionnaires.The survey included general conditions,smoking and drinking,fresh vegetables,fresh fruits,meat and eggs,legumes,pickled foods,fried foods,Hot food,moldy food intake,etc.The risk data questionnaire was entered using epidata software and the database was established.The conditional logistic model was fitted with the SPSS19.0 software COXREG command.The single-factor logistic analysis was performed on the relevant variables.After screening the statistically significant variables,further multivariate logistic analysis was performed.Estimated odds ratio(OR)of risk factors and 95%confidence interval(CI).RESULTS There was a statistically significant difference between the case group and the control group in smoking,drinking,drinking tea,regular consumption of fresh fruits,meat and eggs,legumes,pickled foods and mildewed foods(P<0.001).Multivariate analysis showed that the risk of esophageal cancer in drinkers was 2.6 times higher than that of non-drinkers(OR=2.556,95%CI=1.619-4.037).The risk of esophageal cancer was 3.4 times higher than that of people who often consumed mildewed food(OR=3.439,95%CI=1.625-7.276).Fresh fruit(OR=0.518,95%CI=0.350-0.768)and legumes(OR=0.384,95%CI=0.269-0.548)were protective factors for esophageal cancer.CONCLUSIONS Drinking alcohol and frequently consumption of mildew foods are risk factors for esophageal cancer.Frequently consumption of fresh fruits and legumes can effectively prevent the occurrence of esophageal cancer.
引文
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[2]陈万青,李贺,孙可欣,等.2014年中国恶性肿瘤发病与死亡分析[J].中华肿瘤杂志,2018,40(1):5-13.
[3]付振涛,徐爱强,赵滢,等.2013年山东省恶性肿瘤发病与死亡分析[J].中华肿瘤防治杂志,2017,24(18):1261-1266.
[4]刘海燕,陈军贤,赵秋枫,等.杭州地区食管癌发病危险因素分析[J].中国公共卫生,2014,30(6):842-844.
[5]赫捷,邵康.中国食管癌流行病学现状、诊疗现状及未来对策[J].中国癌症杂志,2011,21(7):501-504.
[6]潘媛,张丽娟,潘恩春,等.淮安市居民早期食管癌危险因素的病例对照研究[J].江苏预防医学,2017,28(5):515-517.
[7]杨建洲,纪爱芳,魏武,等.山西东南部贲门癌危险因素病例对照研究[J].中国公共卫生,2012,28(8):1035-1037.
[8] Wheeler JB,Reed CE.Epidemiology of esophageal cancer[J].Surg Clin N Am,2012,92(5):1077-1087.
[9] Xie TP,Zhao YF,Chen LQ,et al.Long-term exposure to sodium nitrite and risk of esophageal carcinoma:a cohort study for 30years[J].Dis Esoph,2011,24(1):30-32.
[10] Wu Y,Fan Y,Jiang Y,et al.Analysis of risk factors associated with precancerous lesion of gastric cancer in patients from eastern China:A comparative study[J].J Cancer Res Ther,2013,9(2):205-209.
[11] Vingeliene S,Chan DSM,Aune D,et al.An update of the WCRF/AICR systematic literature review on esophageal and gastric cancers and citrus fruits intake[J].Cancer Cause Control,2016,27(7):837-851.
[12] Duell EJ,Lujan-Barroso L,Llivina C,et al.Vitamin C transporter gene(SLC23A1and SLC23A2)polymorphisms,plasma vitamin C levels,and gastric cancer risk in the EPIC cohort[J].Genrs Nutr,2013,8(6):549-560.
[13]徐汉友.食管癌高中低发区居民钼日食入量的研究[J].中华预防医学杂志,1999,33(4):237.
[14]罗贤懋,胡国刚,魏慧娟,等.钼在食管癌病因、发病及预防中的作用(摘要)[J].医学研究杂志,1990,19(1):28.