食管癌高发地区人群危险因素的调查研究

摘要

Objective To explore the risk factors of esophageal cancer ( EC ) in a high - risk area in China. Methods In this case -control study, 311 patients with pathologically confirmed EC from Linzhou ( formerly known as Linxian, an EC high - risk area in China ), Henan Province from December 2010 to December 2011 were enrolled as the case group, and 625 healthy subjects who received gastroscopic screening in Wuan and Handan in Hebei Province were enrolled as the control group. The general data and EC - related risk factors were compared between these two groups. Results The mean age was ( 59. 6 ±8. 0 ) years old in the case group and ( 50. 8 ± 7. 3 ) years in the control group （ t = 11. 823, P < 0. 001 ). Although the male/female ratio was not significantly different between these two groups ( P > 0. 05 ), the marital status and education background showed significant differences ( P <0. 001 ). There were too much missing data of drinking information in this study, so we did not make further analysis. The rates of smoking, consumption of fresh fruit, meat and eggs, beans, onion and garlic, and pickled food, and family history of cancer were significantly different between these two groups ( P < 0. 05 ), although the rates of consumption of fried foods, hot food, and moldy food were not significantly different. Logistic regression analysis slunved that the risk of EC in smokers was 1. 7 times of that in the non - smokers, 1. 7 times in individuals who consumed pickled foods regularly than those who did not regularly consume the pickled food, and 2. 5 times in patients with a family history than those without a family history. Regular consumption of fresh fruit, meat and eggs, beans, onion, and garlic were the protective factors of EC. After the age was adjusted, the smoking status, regular consumption of fresh fruit, meat and eggs, beans foods, and pickled foods, and family history of EC were found to be the independent factors of EC. Further analysis showed that regular consumption of pickled food interacted with age [ OR = 1. 0, 95% CI ( 1. 00, 1. 01 ), P = 0. 006 ]. Conclusion EC is the outcomes of multiple factors including food, lifestyle and social factors in susceptible individuals. Early diagnosis and treatment is critical for improving the prognosis of EC. Healthy diets and lifestyles should be promoted among high - risk populations.%目的 探讨食管癌高发地区人群危险因素,为食管癌防治措施的制定提供依据.方法 选择2010年12月-2011年12月在河南省林州市(林县)姚村医院首次经病理学检查确诊的食管鳞状细胞癌患者311例为病例组,选择同期在河北省武安市和邯郸市经胃镜筛查正常者625例为对照组.调查两组研究对象一般情况,吸烟、饮酒情况,新鲜水果、肉蛋奶类、豆类食品、葱蒜、腌晒食品、油炸食品、烫热食品、霉变食品摄入情况及食管癌家族史等.对食管癌发病的相关因素先进行单因素分析,差异有统计学意义的因素再采用多因素非条件Logistic回归分析,计算其比值比(OR)及95%可信区间(95%CI).结果 病例组平均年龄为(59.6±8.0)岁,对照组为(50.8±7.3)岁,差异有统计学意义(t=17.823,P＜0.001);两组性别构成比较,差异无统计学意义(P＞0.05);两组婚姻状况、受教育程度比较,差异均有统计学意义(P＜0.001).因两组研究对象饮酒资料数据缺失较多而未进一步比较分析.两组吸烟率,新鲜水果、肉蛋奶类、豆类食品、葱蒜、腌晒食品经常食用率及家族史阳性率比较,差异均有统计学意义(P＜0.05);两组油炸食品、烫热食品及霉变食品经常食用率比较,差异均无统计学意义(P＞0.05).非条件Logistic回归分析发现,吸烟者发生食管癌的风险是不吸烟者的1.7倍,经常食用腌晒食品者是不经常食用腌晒食品者的1.5倍,有家族史者是无家族史者的2.5倍;经常食用新鲜水果、肉蛋奶类、豆类食品及葱蒜是食管癌的保护因素.校正年龄因素后发现,吸烟,经常食用新鲜水果、肉蛋奶类、豆类食品、腌晒食品及家族史是食管癌的独立影响因素.进一步分析发现,经常食用腌晒食品与年龄有交互作用[OR=1.0,95%CI(1.00,1.01),P=0.006].结论 食管癌是饮食因素、生活习惯、社会因素等对具有不同遗传体质的个体长期反复作用的结果,应积极推进食管癌的早诊、早治工作,加强卫生宣教,普及食管癌危险因素知识及防治方法,大力宣传戒烟,倡导健康饮食及生活方式.