可吸入颗粒物对食管癌死亡率及临床病理学特征影响的研究

发布时间：2018-06-22 20:33

本文选题：可吸入颗粒物 + 食管癌　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景近来,国际癌症研究机构工作组将室外空气污染以及室外空气污染中的颗粒物,定义为1类致癌物质。在中国,N02、S02以及可吸入颗粒物(PM10)是应用比较广泛的指标。PM10指空气动力学当量直径≤10微米的颗粒物。PM10可以悬浮于空气中,是一类大小、组成及来源各异的极小的颗粒与液滴的混合物。目前,世界上对于空气污染尤其是PM10及细颗粒物(PM2.5)对于肺癌的影响的研究非常之多,这些研究主要集中在欧美等发达国家。然而,空气污染,尤其是将空气污染的指标细化后,与其他恶性肿瘤联系起来的研究较少,且结论尚不一致。食管癌在我国的发病率及死亡率都较高。然而,不论是在我国还是在世界范围内,食管癌的发病率和死亡率都有明显的地域差异,这说明环境因素可能在食管癌发生发展中起到了重要的作用。关于空气污染与食管癌的流行病学研究,目前尚未得出统一的结论,且主要集中在职业危害层面,对空气污染的定义也不甚明确。而且,目前尚没有针对PM10与食管癌死亡率以及临床病理学特征关系的研究。中国作为空气污染严重的发展中国家以及食管癌高发国,研究空气污染尤其是PM10与食管癌的关系,具有深远意义。研究目的研究空气污染,包括PM10、S02、NO2与山东省食管癌患者死亡率的关系,以及PM10是否会影响食管鳞癌患者发病伊始的临床病理学特征。研究方法本研究主要分两个部分对空气污染,尤其是PM10与食管癌的关系进行研究。第一部分为横断面生态学研究,主要是从全省水平来看空气污染与食管癌死亡率之间的关系。我们将从山东省环保厅获取的山东17地市2009-2014年六年间PM10、SO2、NO2的年平均值,再分别计算平均值,来代表一个城市的空气污染水平,即市级PM10、SO2、NO2平均浓度。再用市级PM10、SO2、NO2平均浓度作为横坐标,以山东省疾病预防控制中心提供的2015年山东17地市的食管癌标化死亡率作为纵坐标做散点图,并进行双变量相关分析及假设检验。因为吸烟是影响食管癌死亡率的重要的危险因素,为了进一步探寻在纳入吸烟这个危险因素以后,这三种空气污染物是否仍然与食管癌死亡率相关,以及,这三种空气污染物,尤其是PM10是否仍然可以作为独立危险因素影响食管癌的死亡率,我们进一步进行了多元线性回归分析。第二部分进行的是临床病理学特征分析。主要是看暴露于不同污染水平PM10浓度是否会影响食管鳞癌患者发病伊始的临床病理学特征。这一部分将符合要求的食管鳞癌的患者1255例,按照其久居城市的PM10市级平均浓度,分成高PM10污染水平组以及低PM10污染水平组。我们将吸烟状态作为分层标准,进行亚组分析,以此来纳入吸烟这个最强烈的混杂因素。我们进一步对两组患者的临床病理学特征进行的统计学分析。这些临床病理学特征包括,人口统计学特征(性别,诊断年龄);以及临床特征和病理特征(肿瘤位置,T分期,N分期,分化程度,TNM分期,脉管-淋巴管癌栓,以及肿瘤大小)。结果横断面生态学研究部分,在线性相关研究中,PM10浓度(p=0.046)以及NO2浓度(p=0.03),与食管癌的标化死亡率均显示出有统计学意义的相关关系。当引入吸烟这个危险因素进行多元线性回归分析时,PM10仍然作为一项可以升高食管癌标化死亡率的独立危险因素。由此也说明,在我们最初研究的三项空气污染指标中,PM10是与食管癌关系最为密切的一项指标。本研究的第二部分临床病理学特征分析中,吸烟状态作为最强烈的混杂因素被引入进而控制偏倚。在高PM10污染水平组与低PM10污染水平组两组患者的临床病理学特征分析中,进行亚组分析之后,两组患者的性别分布有显著的统计学差异(p=0.02)。女性患者在高PM10污染水平组中所占的比例高于其在低PM10污染水平组所占的比例。这可能说明高污染暴露组的女性患者更易罹患食管癌。而能代表肿瘤恶性程度的这些病理学指标,如T分期,N分期,分化程度,TNM分期,脉管-淋巴管癌栓,以及肿瘤大小,两组患者均没有表现出具有统计学意义的差异。结论本研究虽然得到了 PM10与食管癌相关的阳性结论,然而也存在一定的局限性以及不可控制的偏倚。PM10显然不是食管癌的唯一致癌因素,甚至与吸烟饮酒以及不良饮食习惯相比,PM10短期的致癌作用可能显得不那么明显。然而,本研究可能为恶性肿瘤的预防与控制提供了全新的思路,控制空气污染,可能是减轻当前以及今后肿瘤高负荷的可行之路。
[Abstract]:Recently, the working group of the International Cancer Research Institute defines the particles in outdoor air pollution and outdoor air pollution as 1 types of carcinogens. In China, N02, S02, and inhalable particulate matter (PM10) are widely used as an indicator of the application of.PM10 to particles with aerodynamic diameter less than 10 microns that can be suspended in the air. In gas, it is a mixture of small particles and droplets of different sizes, composition and origin. At present, there are many studies on the effects of air pollution, especially PM10 and fine particles (PM2.5) on lung cancer. These studies are mainly concentrated in developed countries such as Europe and America. However, air pollution, especially the index of air pollution. After refining, there are few studies associated with other malignant tumors, and the conclusions are not consistent. The incidence and mortality of esophageal cancer in our country are high. However, both in China and in the world, the incidence and mortality of esophageal cancer have obvious regional differences, which suggests that environmental factors may be in the development of esophageal cancer. The epidemiological study on air pollution and esophageal cancer has not yet reached a unified conclusion, mainly focused on the occupational hazard level, and the definition of air pollution is not clear. Moreover, there is no study on the relationship between PM10 and the mortality of esophageal cancer and the characteristics of clinicopathological characteristics. It is of profound significance to study the relationship between air pollution, especially PM10 and esophageal cancer, in developing countries with severe air pollution and high incidence of esophageal cancer. The purpose of this study is to study the relationship between air pollution, including PM10, S02, NO2 and the mortality of esophageal cancer in Shandong, and whether PM10 affects the clinicopathology of the onset of esophageal squamous cell carcinoma. The study method is mainly divided into two parts to study the relationship between air pollution, especially the relationship between PM10 and esophageal cancer. The first part is the cross-sectional ecology study, mainly from the level of the province, the relationship between air pollution and the mortality of esophageal cancer. We will get the 17 city of Shandong from the environmental protection department of Shandong province for 2009-2014 years six. The annual mean values of PM10, SO2 and NO2 were calculated to represent the air pollution level of a city, namely, the municipal level of PM10, SO2, and NO2. Then the municipal level PM10, SO2, and NO2 mean concentration was used as a horizontal coordinate, and the standardized mortality rate of esophageal cancer in the 17 city of Shandong in 2015 was taken as the ordinate by the Shandong Center for Disease Control and prevention. Scatter plot, bivariate correlation analysis and hypothesis testing. Smoking is an important risk factor for esophageal cancer mortality. To further explore whether these three air pollutants are still associated with esophageal cancer mortality after the risk of smoking, and whether these three air pollutants, especially PM10, still remain. However, as an independent risk factor that affects the mortality of esophageal cancer, we have further carried out multiple linear regression analysis. The second part carries out the analysis of the clinicopathological features of the esophagus. It is mainly to see whether the exposure to PM10 concentrations at different levels of pollution will affect the clinical pathological features of the onset of esophageal squamous cell carcinoma. 1255 cases of the required esophageal squamous cell carcinoma were divided into high PM10 level and low PM10 level groups according to the average city level of PM10 level in the city. We used smoking status as a stratification standard for subgroup analysis in order to incorporate the strongest mix factor of smoking. We further studied the clinical disease of two groups of patients. Statistical analysis of the characteristics of science. These clinicopathological features include demographic characteristics (sex, diagnostic age), and clinical features and pathological features (tumor location, T staging, N staging, differentiation, TNM staging, vascular lymphangiocarcinoma thrombus, and tumor size). In the study, PM10 concentration (p=0.046) and NO2 concentration (p=0.03) have a statistically significant correlation with the standardized mortality rate of esophageal cancer. When multiple linear regression analysis of the risk factors for smoking is introduced, PM10 is still an independent risk factor to increase the standardized mortality rate of esophageal cancer. Of the first three air pollution indicators studied, PM10 is one of the most closely related indicators of esophageal cancer. In the second part of this study, smoking status was introduced as the strongest confounding factor to control bias. In the high PM10 level group and the low PM10 level group, the clinicopathology of the two groups After subgroup analysis, there was a significant statistical difference between the two groups of patients (p=0.02). The proportion of women in the high PM10 level was higher than that in the low PM10 level. This may indicate that the female patients in the high pollution exposure group are more likely to suffer from esophageal cancer. These pathological indexes, such as T staging, N staging, differentiation, TNM staging, vascular lymphangiocarcinoma thrombus, and tumor size, were not statistically significant in the two groups. Conclusion this study has obtained positive conclusions associated with PM10 and esophageal cancer, but there are some limitations as well as not The controlled bias.PM10 is obviously not the only cause of cancer in the esophagus. Even compared with smoking and drinking and bad eating habits, the short term carcinogenesis of PM10 may appear less obvious. However, this study may provide a new way of thinking for the prevention and control of malignant tumors. Control of air pollution may be a reduction in current and present times. A feasible way for high post tumor load.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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