【作者】 黄欣欣；

【导师】 蔡琳；

【作者基本信息】 福建医科大学 ， 流行病与卫生统计学， 2007， 硕士

【摘要】 [目的]探讨食管癌、贲门癌、非贲门胃癌发生的危险因素；研究DNA损伤修复基因XPA、XRCC3多态性对食管癌、贲门癌、非贲门胃癌易感性的关系及基因与环境因素联合作用对食管癌、贲门癌、非贲门胃癌的影响；为上消化道常见恶性肿瘤的病因研究提供线索；为采取有效的防治措施提供科学依据。[方法]采用分子流行病学与病例—对照研究的方法。食管癌病例来自厦门市同安区及翔安区区级以上医院确诊的食管癌新发病例(150例)，对照选择与病例在年龄、性别、居住地频率匹配的当地社区居民(402例)。贲门癌病例来自福州五大医院确诊的贲门癌新发病例(145例)，按性别及年龄进行成组配对，选择非贲门部胃癌(146例)及非肿瘤的病例对照(180例)。采用统一编制的调查表，由经过培训的调查员以面访的形式进行流行病学调查。每个研究对象抽取静脉血5ml，应用DNA zol试剂法提取血凝块中的基因组DNA。应用PCR-RFLP方法检测基因多态性。采用Epi Data软件录入数据，SPSS 14.0软件进行统计分析。[结果]1．食管癌的危险因素有：烧饭时烟雾较多、不按时吃饭、进食速度快、饮食嗜咸、常用油炸等烹饪方法、粮食霉变、吸烟、饮酒、性格忧郁、食管炎症状、肿瘤家族史；食管癌的保护因素有：粮食存放在楼上、粮食翻晒、使用冰箱、饮茶、鲜地瓜、猪肉、鸡蛋、新鲜蔬菜。贲门癌的危险因素有：吸烟、饮酒、不按时吃饭、胃病史(包括胃溃疡、慢性胃炎)、一级亲属肿瘤史；贲门癌的保护因素有：新鲜水果、新鲜蔬菜、家禽、牛奶、自来水。非贲门胃癌的危险因素有：吸烟、饮酒、进食速度快、胃病史(包括胃溃疡、慢性胃炎)、一级亲属肿瘤史；非贲门胃癌的保护因素有：新鲜水果、牛奶。2．吸烟与饮酒联合作用，可增大食管癌、贲门癌、非贲门胃癌发生的危险性。3．XPA A23G及XRCC3 Thr241Met基因多态与食管癌及贲门癌有关，XPAA23G、XRCC3 Thr241Met基因联合作用与食管癌、贲门癌、非贲门胃癌有关。4．XRCC3多态、XPA与XRCC3联合作用可修饰吸烟、饮酒、饮茶、新鲜蔬菜与食管癌的关系；XRCC3多态可修饰饮酒与贲门癌及吸烟与非贲门胃癌的关系。[结论]1．食管癌、贲门癌、非贲门胃癌有相同及不同的危险／保护因素，某些因素对不同部位癌症的作用程度存在差别。2．XPA A23G和XRCC3 Thr241Met基因联合作用与食管癌、贲门癌、非贲门胃癌有关。吸烟等环境因素与遗传易感基因在食管癌、贲门癌、非贲门胃癌的发生上具有联合作用。更多还原

【Abstract】 [Objective]Searching for the risk factors of esophageal, cardia and non-cardia gastric cancer; To study the association between genetic polymorphisms of XPA, XRCC3 and susceptibilities to esophageal, cardia and non-cardia gastric cancer, and to explore the gene-environmental joint action in etiology of esophageal, cardia and non-cardia gastric cancer. This will be the foundation for further revealing the cause of common upper gastrointestinal caners and preventing the carcinoma.[Methods]Molecular epidemiology and case-control study were conducted. The esophageal cancer group (150) consisted of all patients who were diagnosed with primary esophageal cancer from Tongan and Xiangan hospital. Based on a rolling-match of recruitment, population controls (402) matched frequently by gender, age (±5 years), habitation were recruited. The cardia gastric cancer group (145) consisted of all patients who were diagnosed with primary gastric cardia cancer and were from five hospitals in Fuzhou. Based on a rolling-match of recruitment, non-cardia gastric cancer (146) and controls (180) without tumor were matched frequently by gender, age (±3 years) were recruited. A structured questionnaire was administered face to face to all subjects. About 5ml of blood was collected from cases and controls, genomic DNA was isolated from the coagulated blood using DNA zol reagent. The polymorphisms of XPA and XRCC3 were investigated by PCR-RFLP. Questionnaire data was entered by Epi Dada software. Use SPSS 14.0 for Windows to analysis the data.[Results]1. Awfully smoke when cooking, diet irregularly, eating faster, eating salt food, cooking method such as dry in oil frequently, eating mildewed food, tobacco smoking, alcohol drinking, depression, esophagitis symptom, family cancer history were the risk factors of esophageal cancer; while food storaging above, food tedding, using refrigerator, tea consumption, fresh sweet potato, pork and eggs, fresh vegetables were the protective factors of esophageal cancer. Tobacco smoking, alcohol drinking, diet irregularly, history of stomach ailment (including gastrelcoma and chronic gastritis), cancer history of first degree relative were the risk factors of cardia gastric cancer; while fresh fruits, fresh vegetables, fowl, milk, tap water were the protective factors of cardia gastric cancer.Tobacco smoking, alcohol drinking, eating faster, history of stomach ailment (including gastrelcoma and chronic gastritis), cancer history of first degree relative were the risk factors of non-cardia gastric cancer; while fresh fruits, milk were the protective factors of non-cardia gastric cancer.2. There were joint effects between smoking and alcohol drinking, which accreted the risk factor of esophageal, cardia and non-cardia gastric cancer.3. The XPA, XRCC3 variated genotype were the risk factors of esophageal and cardia gastric cancer. The joint effects of XPA and XRCC3 were the risk factors of esophageal, cardia and non-cardia gastric cancer.4. There were combined effects between the joint effects of XPA, XRCC3 and tobacco smoking, alcohol drinking, tea consumption, fresh vegetables on esophageal cancer; between XRCC3 and tobacco smoking on non-cardia gastric cancer.[Conclusions]1. Esophageal, cardia and non-cardia gastric cancer had common and different risk/protective factors.2. The joint action of XPA and XRCC3 were the risk factor of esophageal, cardia and non-cardia gastric cancer. There were joint action between environmental factors such as smoking and XPA, XRCC3 on esophageal, cardia and non-cardia gastric cancer.更多还原