【摘要】 目的探讨吸烟和不同体质指数(BMI)水平对肺癌发病的影响。方法1974、1979和1980年,经统一培训的调查人员采用问卷形式对北京首都钢铁公司5137名年龄≥18岁男性工人进行心血管疾病基线调查,于1982、1987、1993和2001年随访,采用Cox比例风险回归模型分析吸烟和不同BM I水平与肺癌发病的关系。结果以1974、1979和1980年资料作为基线,进入队列950、1163和3024人,共5137人。以肺癌发病作为观察终点,共随访了103715人.a,实际随访4986人,失访151人,每个观察对象平均随访20.8a,随访率97.06%。此期间发生肺癌106人,其中97人已死亡,肺癌发病率为102.2/10万人.a。肺癌组年龄、吸烟率、饮酒率均高于非肺癌组,BM I低于非肺癌组,差别有统计学意义(P<0.05)。调整了年龄等因素后,大量吸烟可增加患肺癌的相对危险度(RR),差别有统计学意义(P<0.01)。随着BM I的增加,肺癌发病率逐渐降低。调整年龄等因素后,吸烟工人中的肺癌发病RR随BM I升高顺序依次为1.00,0.57和0.33;剔除随访5a新发的10名肺癌患者后,吸烟工人的肺癌发病RR依次为1.00,0.52和0.33,均呈随BM I增加而发病危险降低的趋势,但差别无统计学意义(P>0.05)。工人按吸烟与否和不同BM I分组,经调整年龄、饮酒情况后,以吸烟+低体重组为参照,不吸烟+正常体重组、不吸烟+超重和肥胖组、吸烟+正常体重组与吸烟+超重和肥胖组肺癌发病R R分别为0.25(95%CI:0.08～0.84,P<0.05),0.16(95%CI:0.04～0.74,P<0.05),0.45(95%CI:0.46～1.24,P>0.05)和0.23(95%CI:0.07～0.77,P<0.05)。结论吸烟和低体重人群增加肺癌发病危险,戒烟和保持正常体重是预防肺癌的重要措施。更多还原

【Abstract】 Objective To assess the effect of smoking and body mass index(BMI) on lung cancer incidence density in male workers.Methods Risk factors of cardiovascular diseases in baseline were surveyed in 1974,1979 and 1980 for 5 137 men aged more than 18 years old from Beijing Capital Steel and Iron Company.Follow-up was carried out to 2001;all diseases were identified by uniform standard.Cox proportional hazards model was used to analyze the relationship between smoking,BMI and lung cancer.Results During mean follow-ups of 20.8 years,106 cases of lung cancer occurred.The crude incident rates of lung cancer were 102.2 cases per 100 000 person-years.After adjustment for age,BMI and other established risk factors,cigarettes consumption of greater than 20 cigarettes/day versus no smoking was associated with a relative risk of lung cancer of 3.45(95% confidence interval(CI): 1.58～7.53).In categories of BMI of less than 18.5(underweight),18.5～24.9(normal weight) and more than 25 kg/m2(overweight and obesity),adjusting for age and other covariables,all workers and smoking workers both showed decreasing tendencies in relative risks of lung cancer in higher BMI groups.The pattern was similar after excluding the early 5-year lung cancer patients.Grouping in smoking and BMI levels,compared with underweight smokers,the relative risks for lung cancer of normal-weight nonsmokers and nonsmokers with overweight and obesity,as well as smokers with overweight and obesity were 0.25(95% CI: 0.08～0.84),0.16(95% CI: 0.04～0.74) and 0.23(95% CI: 0.07～0.77),respectively.Smokers with underweight had higher risk for lung cancer.Conclusion Smoking and underweight increased the risk of lung cancer.Keeping normal weight and giving up tobacco were important for the prevention of lung cancer.更多还原