【作者】 王猛；

【导师】 高晓虹；

【作者基本信息】 大连医科大学 ， 流行病与卫生统计学， 2008， 硕士

【摘要】 目的:通过对大连市原发性肺癌相关危险因素的调查分析,探讨影响原发性肺癌发病的相关因素,为原发性肺癌的预防和控制提供依据。方法:采用1:1配对的病例对照研究,所有研究对象均来自2007年3月~2008年3月间,在大连市内多家综合性医院住院,并且在大连市区居住10年及以上的病人。病例选择新入院的经病理诊断确诊为原发性肺癌患者200例;同时在同期住院的非肿瘤、非呼吸道疾病的患者中选择对照200例。匹配条件为:同性别、年龄±3岁。使用统一设计的调查表,由经过培训的调查员对研究对象本人进行面对面的调查。调查表的内容主要包括:一般情况、职业暴露史、生活居住环境、生活行为方式、疾病史、家族史、饮食习惯及社会心理因素等。所获资料采用Excel2003表建立数据库,并采用SPSS13.0和SAS8.2统计软件进行分析,单因素分析主要根据资料的类型采用χ2检验和单因素条件Logistic回归分析,并采用多因素条件Logistic回归模型进行多因素分析。结果:1.一般状况对文化程度、婚姻状况、血型、家庭居住地区、家庭收入及生活费的支出、十年前人均居住面积等7个因素分别进行分析后,仅发现十年前人均居住面积与肺癌的发生有统计学联系。2.职业史研究发现职业有毒有害物质暴露可增加患肺癌的危险性( OR=9.625,OR95%CI=4.647~19.934),进一步分析发现工作环境中接触石棉、苯、金属粉末和粉尘与肺癌发生具有关联性。3.饮食习惯在饮食习惯方面十年前较多摄入新鲜绿叶蔬菜、水果、鱼类及生蒜为肺癌的保护因素,而十年前较多食用贝类食品、熏制食品及动物油脂为肺癌的危险因素。4.生活环境和生活行为方式十年前居住地周围有排污工厂、工作场所及居住地周围有高压设备、大型装修史、烹饪时油烟较多、经常感觉烟雾刺激、使用燃煤是肺癌的可疑危险因素。吸烟史和熬夜史可增加发生肺癌的危险性( OR=7.375, OR95%CI=3.524~15.433; OR=1.793,OR95%CI=1.138~2.824)。两组在被动吸烟史(OR=1.292,OR95%CI=0.758~2.201)、饮酒史(OR=1.379,OR95%CI=0.855~2.225)、饮茶史(OR=1.367,OR95%CI=0.853~2.189)等方面未发现差异有统计学意义。5.疾病史与家族史本研究发现胸部放射线检查史、癌症家族史是肺癌发生的危险因素,而感冒是肺癌发生的保护因素。进一步分析感冒频次,结果显示,每年感冒1~2次可降低肺癌发生的危险性,而每年感冒3次及以上则可增加发生肺癌的危险性。6.社会心理因素经历过负性事件、经常感到有压力、处事态度悲观、经常爱生闷气、情绪调节能力差、婚姻生活不和谐、精神长期处于压抑状态等为肺癌发生的危险因素,而愿意与他人沟通则是肺癌的保护因素(OR=0.475,OR95%CI=0.306~0.740)。7.多因素分析多因素条件logistic回归分析结果显示,工作中接触有毒有害物质、近十年有大型装修、十年前居住地周围有高压设备、有胸部放射线检查史、精神长期处于压抑状态、经常食用动物油脂、大量吸烟及肿瘤家族史是肺癌发生的危险因素,而常食生蒜是肺癌发生的保护因素。结论:大连市肺癌的发生是多种危险因素综合作用的结果,提示对肺癌的预防和控制应采取综合措施。更多还原

【Abstract】 Objective: To investigate the risk factors of Primary Lung Cancer and to provide better scientific basis for prevention of Primary Lung Cancer in Dalian.Methods: A 1:1 matched case-control study was carried out in Dalian including 200 cases and 200 controls in synthesize hospital of Dalian from March, 2007 to March, 2008. Cases and controls were requested must have lived in Dalian more than 10 years. Cases were chosen from in hospital patients who had diagnosed lung cancer in pathology nearly one or two years. According to the principle of 1:1 matched case-control study, controls were paired to cases with same sex, younger or older 3 years old, and controls must be patients with non-cancer and non- respiratory disease in the same period. The main contents of questionnaire included that general state of health, occupation, inhabited environment, life behavior, the history of disease, the family history of cancer, dietary habits, and psychological factor et.al. Data were input to the computer by the software of EXCEL 2003 and analyzed with Chi-square test, and the conditional Logistic regression by the softwares of SPSS 13.0 or SAS 8.2, then calculated the Odds Ratio and the 95% confidence. Results:1. There were no statistics difference between cases and controls in the aspect that educational level,marital status, blood type, the area of the family residence, family income and living expenses, and so on, but there were difference in the facet of per capita living space.2. There were difference in the facet that touching poisonous or noxious substance(OR=9.625,OR95%CI=4.647~19.934). With a develop- ped investgation, we found that asbestos, benzene, metallizer and dust were risk factors with primary lung cancer.3. In the dietary factor, eating fresh vegetables with green leaves, fresh fruit, fish, and garlic were protective factors, while seashell, smoked food, and animal fat were risk factors with primary lung cancer.4. Through reviewing the inhabited environment, we found that there were s significant difference between cases and controls in the aspect of whether the pollutional factory exist near the inhabited address, apparatus of high voltage around the workplace,apparatus of high voltage around the family residence, whether decorating the house during the near ten years, much more smog while cooking, smog irritating throat, using coal as the fuel. There were no statistics difference between the two group in the aspect of well water(OR=1.410, OR95%CI=0.936~2.126) and water from the water tank of the building (OR=, OR95%CI=0.398~6.974). Through investigating the behavior, we found that there were significant difference between the two groups in the aspect of smoking (OR=7.375), staying up late or all night (OR=1.793), and there were no statistical difference in the aspect of passive smoking(OR=1.292, OR95% CI=0.758~2.201), drinking alcoholic beverages(OR=1.379, OR95%CI= 0.855~2.225), drinking tea(OR=1.367, OR95%=0.853~2.189) between the two groups.5. There were statistical difference between the two groups in the aspect that the history of common cold, the history of checking chest in radioactive ray and the family history of cancer (OR=19.333).6. Through investigating the social psychic factor, we found that there were statistics difference between the two group in the aspect of experiencing the negative events, feeling pressure frequently, pessimistic way of handling affairs, Sulk, bad ability to regulate mood, disharmonious marriage life, having the experience of pressure during a long time. Good ability to communicate with others was the protective factor of lung cancer(OR=0.475,OR95%CI=0.306~0.740).According the multiple conditional logistic regression, there were significant difference between primary lung cancer and the factors include that touching poisonous or noxious substance, whether decorating the house during the near ten years, apparatus of high voltage around the family residence, the history of checking chest in radiation, having the experience of pressure during a long time, eating garlic, animal fat, Average smoking amount, and the family history of cancer. Except eating garlic is the protective factor, the others are the risk factors of primary lung cancer.Conclusion: The emergence of lung cancer is the result that many kinds of dangerous factors act on together, in Dalian. So, we should take the comprehensive measure to prevent lung cancer and reduce the morbidity .更多还原