合肥市消化道癌筛查结果及影响因素分析

发布时间：2017-12-26 21:28

本文关键词：合肥市消化道癌筛查结果及影响因素分析　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1)分析合肥市消化道(上消化道和结直肠)癌筛查结果,了解合肥市居民消化道健康状况以及消化道癌前病变的分布和严重程度;2)分析消化道各部位病变的影响因素,为探索各部位病变发展规律和癌变可能性提供依据。方法采用整群抽样方法在安徽省合肥市选择7个区,从每个区中随机选取2-3个街道,对入选街道中40-70岁符合纳入标准的居民通过问卷调查初步筛选出癌症高危人群,然后对高危人群进行临床癌症筛查并再次进行慢性病问卷调查。数据录入采用EpiData3.1软件进行实时双录入和逻辑校验,结果分析使用SPSS17.0软件进行。通过描述性分析、卡方检验、单向有序秩和检验和logistic回归分析进行消化道各部位影响因素分析。结果1)既完成上消化道镜检又完成慢性病调查的有1277人。食管病变检出率随年龄增大而升高,40-49岁组检出率13.0%,50-59岁组18.4%,60-70岁21.2%。男性(21.2%)食管病变率高于女性(15.0%)。贲门部和胃底部病变检出率在年龄、性别、文化程度和体质指数各组间分布均无统计学差异。胃体病变检出率随年龄增长逐渐增加,40-49岁组、50-59岁组及60-70岁组病变检出率分别为23.2%、31.2%和32.1%。胃角部病变检出率男性为女性的2倍(男性为17.2%,女性为8.2%)。幽门部病变检出率在不同体质指数组间有统计学差异,体质指数正常、超重及肥胖组的检出率分别为9.38%、5.08%及9.40%。2)食管病变发生率最高的为糜烂,发生率为9.33%,其次为充血和粗糙或不规则,发生率分别为5.41%和2.43%。在贲门部,病变发生例数最多的为糜烂,其次为贲门息肉、肿物和充血。胃底部和胃体部病变发生率前3位为充血、息肉和水肿。胃角部前3位病变为充血、水肿和糜烂。胃窦部最常见病变为充血,发生率高达88.89%。幽门部常见病变为胆汁附着。3)食管、贲门和胃底部病变得分最高4分,得分最多集中在1分。胃体、胃角、胃窦部最高得分5分。幽门部病变最高得分3分。4)贲门部病变得分与糖尿病患病率之间有统计学关联,但并不表现明显趋势,胃底病变得分与既往经常胃痛之间有统计学关联,但并无明显趋势,胃体病变得分与高血脂、经常失眠多梦和胃息肉有统计学联系,胃角部病变得分与既往有胃溃疡史和肝炎史有统计学关联,得分越高,既往有溃疡史所占比例越高,但肝炎患病率与得分无明显趋势,胃窦部病变得分与高血压、高血脂和既往溃疡史之间有统计学差异,十二指肠部得分与既往胃炎和溃疡史之间有统计学关联。5)食道病变得分与经常吃油炸食品、重盐、经常饮酒、经常抽烟有统计学关联,得0分者中危险因素发生率均低于有得分者。胃体部病变得分与经常饮酒具有统计学意义,且随着病变得分越高,经常饮酒率逐渐升高。胃角部病变得分与经常吸烟、经常饮酒有统计学联系。胃窦部病变得分与经常抽烟、饮酒、饮茶具有统计学意义。十二指肠病变得分与经常饮食不规律有关。6)既完成结直肠镜检又完成慢性病问卷调查的有370人,结果发现左半结肠和直肠最易发生病变,且随着年龄和体质指数增加,病变发生率增加。7)结果表明年龄、体质指数、自报既往高血压史、肠息肉史和既往经常便秘是结直肠病变的危险因素。结论1)在上消化道,食管和胃窦部最易发生病变,可视为上消化癌筛查的重点部位,且这些病变受多种既往病史和饮食行为习惯影响,通过既往病史和饮食行为习惯问卷调查初筛高危人群可行。2)在结直肠部,左半结肠和直肠最易发生病变,可视为肠镜检查的重点部位,通过既往疾病/症状史、饮食行为习惯与结直肠病变关系分析,提示通过既往病史初筛结直肠高危人群比较可信,但多种饮食行为习惯在结直肠癌筛查中的作用尚不明确。
[Abstract]:1) analysis of Hefei city in the digestive tract (upper gastrointestinal and colorectal cancer screening results), understand the Hefei city residents health status and distribution of digestive tract gastrointestinal precancerous lesions and severity; 2) analysis of gastrointestinal lesions of the effects of various factors, provide the basis for exploring the possibility of each part of the law of development and malignant lesions. Methods by cluster sampling method, 7 District in Anhui city of Hefei Province, were randomly selected from each district of 2-3 street, on the street in the selected 40-70 years in accordance with the inclusion criteria of residents by questionnaire survey screened cancer high-risk groups, and clinical cancer screening for high-risk patients and chronic disease questionnaire again. The data entry uses EpiData3.1 software for real-time double entry and logical verification, and the results are analyzed using SPSS17.0 software. The influence factors of various parts of the digestive tract were analyzed by descriptive analysis, chi square test, unidirectional order rank sum test and logistic regression analysis. Results 1) there were 1277 people who completed both the upper gastrointestinal endoscopy and the chronic disease investigation. The detection rate of esophageal lesions increased with age. The detection rate in the 40-49 year old group was 13%, the 50-59 year old group was 18.4%, and the 60-70 year old was 21.2%. The rate of esophageal lesion in men (21.2%) was higher than that of women (15%). There was no significant difference in the distribution of age, sex, educational level and body mass index between the cardia and the fundus of the stomach. The detection rate of gastric body lesions increased gradually with age. The detection rates of pathological changes in 40-49 year old group, 50-59 year old group and 60-70 year old group were 23.2%, 31.2% and 32.1%, respectively. The rate of detection of lesions in the angle of the stomach was 2 times as high as that of women (17.2% for men and 8.2% for women). The detection rate of pyloric lesions was statistically different among different body mass index groups. The detection rates of body mass index in normal, overweight and obesity groups were 9.38%, 5.08% and 9.40%, respectively. 2) the highest incidence of esophageal lesions was erosions, the incidence of which was 9.33%, followed by hyperemia, rough or irregular, and the incidence of 5.41% and 2.43%, respectively. In the cardia, the most of the cases were erosions, followed by cardia polyps, swelling and hyperemia. The first 3 were hyperemia, polyps and edema in the top of the gastric and gastric body lesions. The first 3 lesions of the horns of the stomach were hyperemia, edema and erosion. The most common lesion of the gastric antrum was hyperemia, and the incidence was up to 88.89%. The common lesion of the pylorus is bile attachment. 3) the highest score of the esophagus, the cardia and the bottom of the stomach was 4 points, with a score of 1 points at most. The highest score was 5 points in the stomach body, the angle of the stomach and the sinus of the stomach. The highest score of pylorus lesion was 3 points. 4) cardia lesions score and the prevalence of diabetes association was observed between, but not obvious trend between gastric lesion score was significantly associated with previous often stomach pain, but there is no obvious trend, there was correlation in gastric body lesion score and high blood lipids, often insomnia and gastric polyp and gastric lesions and the scores of the corner with a history of gastric ulcer history and the history of hepatitis was associated with higher scores, previous ulcer history proportion is higher, but the prevalence rate of hepatitis had no obvious trend and score, there was significant difference between gastric lesion score and hypertension, previous ulcer history, there was a correlation between the duodenum and previous scoring gastritis and ulcer history. 5) esophageal lesions score and often eat fried food, salt, often drinking, smoking was significantly associated, rates were lower than the score were risk factors in the 0 points. The score of gastric body lesion and regular drinking had statistical significance. With the higher score of the lesion, the frequent drinking rate increased gradually. The score of gastric corner lesions was associated with frequent smoking and frequent drinking. The score of the lesion of the gastric antrum was statistically significant to smoking, drinking and drinking tea. The score of duodenal disease is related to irregular diet. 6) 370 patients who completed both colorectal examination and chronic disease questionnaire were found to be most susceptible to lesions in the left colon and rectum, and increased with age and body mass index. 7) the results showed that age, body mass index, history of self reporting hypertension, history of intestinal polyps, and previous frequent constipation were risk factors for colorectal lesions. Conclusion 1) in the upper gastrointestinal tract, esophageal and gastric antrum are most susceptible to lesions, which can be regarded as the key part of the upper digestive tract cancer screening. These lesions are influenced by many past medical history and eating habits. Through the past medical history and eating habits and habits questionnaire, it is feasible to screen high-risk groups. 2) in colorectal, left colon and rectum were most prone to disease, colonoscopy can be regarded as the key part of the relationship between disease symptoms / history, eating habits and colorectal lesions analysis, prompted by a history of colorectal screening high-risk groups more credible, but a variety of eating habits in the role of screening for colorectal cancer it is not clear.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

【参考文献】