【作者】 林菁； 曹裕杰； 何宝昌； 张诗蕾；

【机构】 福建医科大学公共卫生学院流行病与卫生统计学系； 福建医科大学附属第一医院；

【摘要】 目的:探讨口腔卫生状况与口腔癌发病风险的关联。方法:采用病例-对照研究方法,病例组为2016年10月至2019年1月在福建医科大学附属第一医院经病理学诊断的口腔癌新发病例215例,对照组为同期选取的社区健康人群358例。应用非条件logistic回归模型估算各项口腔卫生指标与口腔癌的调整OR(95%CI)值,选取有统计学意义的指标构建口腔卫生指数模型。采用多因素logistic回归模型分析口腔卫生指数与口腔癌发病的关联,并进一步按吸烟状况、饮酒状况、饮茶状况进行分层分析和联合交互作用分析。最后分析口腔卫生状况与不同部位口腔癌的关系。结果:牙齿缺失数(<5颗和≥5颗)、佩戴假牙及戴假牙年限(<10年和≥10年)、复发性口腔溃疡和使用漱口水均可显著增加口腔癌的发病风险(P<0.001),其调整OR(95%CI)值分别为2.42(1.50-3.90),7.35(4.43-12.18),2.11(1.29-3.47),2.85(1.74-4.68),10.58(4.50-24.88),4.12(1.82-9.30);多因素logistic回归模型结果显示,口腔卫生指数与口腔癌存在关联,分值越高,发病风险越高(Ptrend<0.001);口腔卫生指数得分1-2、3-6分的OR(95%CI)值分别为3.79(2.35,6.12)、7.43(4.46,12.40)。分层分析结果显示,无论是非吸烟者还是吸烟者,非饮酒者还是饮酒者,非饮茶者还是饮茶者中,不良口腔卫生状况均可增加其口腔癌的发病风险(P<0.001);吸烟、饮酒、饮茶与口腔卫生综合指数均有相乘交互作用;口腔卫生状况在口腔癌不同部位发病风险存在差异,不良口腔卫生状况对舌癌发病风险增加较为显著,其调整OR(95%CI)值为4.64(2.28-9.44)。结论:口腔卫生对口腔癌发病具有一定影响,尤其在吸烟、饮酒者中风险更大,同时在口腔癌患者的不同部位中,不良口腔卫生状况可以增加舌癌的发病风险。更多还原

【Abstract】 Objective:To investigate the relationship between oral hygiene and risk of oral cancer.Methods:A case-control study were performed between October 2010 and January 2019 including 215 oral cancer cases in the first affiliated Hospital of Fujian Medical University with pathologically confirmed and 358 community controls.The odds ratio(OR) and 95% confidence interval(95%CI) of various oral hygiene related variables and risk of oral cancer were analyzed by using the unconditioned logistic regression model and construction of oral hygiene index model by selecting statistically significant indexes.Multivariate logistic regression model was used to examine the effect of oral hygiene index model on oral cancer and to assess multiplicative interactions between oral hygiene index model and smoking,drinking,drinking tea.We also stratified by smoking,drinking,drinking tea to explore possible difference in association between subgroups.Finally,the relationship between oral health status and oral cancer in different parts was analyzed.Results:Teeth lost(<5 and ≥5),dentures wearing and the number of years of wearing dentures(<10 and ≥10),recurrent dental ulceration and using of mouthwash all significantly increased the risk of oral cancer.The adjusted OR(95%CI) were 2.42(1.50-3.90),7.35(4.43-12.18),2.11(1.29-3.47),2.85(1.74-4.68),10.58(4.50-24.88),4.12(1.82-9.30),respectively.Multivariate logistic regression showed that the oral hygiene index was associated with risk of oral cancer.The higher the score,the higher risk was observed.The adjusted OR(95%CI) of oral hygiene index scores(score 1-2,score 3-6) were 3.79(2.35,6.12)、7.43(4.46,12.40),respectively.Smoking or drinking alcohol or drinking tea and oral health composite index all have multiple interaction(Ptrend<0.001).The results of stratified analysis showed that poor oral hygiene increased the risk of oral cancer among non-smokers and smokers,non-drinkers and drinkers,nontea consumers and tea consumers(P<0.001).Smoking,drinking,tea drinking and oral hygiene index had multiplicative interaction.Oral health status was different in different parts of oral cancer,and poor oral hygiene significantly increased the risk of tongue cancer.The adjusted OR(95%CI) value was 4.64(2.28-9.44).Conclusions:Oral hygiene has a certain impact on the incidence of oral cancer,especially in smokers and drinkers.At the same time,in different sites of patients with oral cancer,poor oral hygiene can increase the risk of tongue cancer.更多还原