面向农村的两阶段多肿瘤风险评估模型前期研究

发布时间：2018-01-13 10:35

本文关键词：面向农村的两阶段多肿瘤风险评估模型前期研究　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的本研究目的在于通过系统的文献复习、基于医院与基于社区的病例对照研究,设计出一套适合农村的两阶段多肿瘤风险评估模型,实现将有限的卫生人力物力资源运用到真正需要的肿瘤高危人群中去的目的,提高基层肿瘤筛查的执行力与效果。方法调查开始前,通过系统文献复习法找出影响中国人群肿瘤发病的主要影响因素,运用Stata12.0分析软件计算各影响因素的合并优势比。自2013年11月至今开展基于医院的病例对照研究,在合肥五家医院肿瘤科挑选来自安徽六安农村地区的原发目标肿瘤患者作为病例,在六安市金安、裕安区、寿县和舒城农村地区挑选年龄与病例相差不超过三岁的健康人群作为对照,采用1:3的配对设计方法,进行一对一现场“网络化”问卷;基于社区的病例对照研究采用相同的标准在安徽农村18个干预村与18个延迟干预村中利用网络化辅助工具收集数据;前期研究的数据分析阶段主要采用SPSS17.0软件对自变量进行描述性分析、t检验、卡方检验、单因素Logistic回归和多因素条件Logistic回归分析;调查全程实施质量控制,并严格遵循伦理学规定,与研究对象签署知情同意书。结果本课题初步评估问卷包含“快速”与“详细”风险评估两部分,快速风险评估由涉及191个影响因素的13类问题组成,详细风险评估由936个问题构成且只呈现快速风险评估中阳性影响因素的具体问题;本前期研究共纳入有效乳腺癌病例115例,宫颈癌病例104例,乳腺癌对照345例,宫颈癌对照312例,病例对照组的年龄、文化程度分布无统计学差异。数据分析结果显示:六安农村地区女性乳腺癌的危险因素主要有乳腺肿块(OR 16.036;95%CI 7.333-35.068)、乳腺增生(OR 2.601;95%CI 1.124-6.020)、人工流产(OR 3.115;95%CI 1.538-6.309)、长期口服避孕药(OR 2.988;95%CI 1.087-8.212)以及常吃辛辣食品(OR 2.698;95%CI 1.535-4.740),保护因素为输卵管结扎(OR 0.298;95%CI 0.165-0.506)和常吃大蒜(OR 0.507;95%CI 0.297-0.866);宫颈癌的危险因素为阴道异常出血(OR82.129;95%CI 19.266-350.100)、下腹痛或下坠感(OR 5.268;95%CI 1.388-19.900)、白带反复异常(OR 3.304;95%CI 1.415-7.714)、宫颈囊肿(OR 27.451;95%CI1.522-495.262)、人工流产(OR 3.319;95%CI 1.881-5.859)、常吃辛辣食品(OR3.296;95%CI 1.366-7.954),保护因素为输卵管结扎(OR 0.218;95%CI0.069-0.693)。本研究建立的乳腺癌风险评估模型一曲线下面积为0.875,模型二曲线下面积为0.799;宫颈癌风险评估模型一曲线下面积为0.886,模型二为0.763。结论六安农村地区女性乳腺癌发病的危险因素包括乳腺肿块、乳腺增生、长期避孕药是,保护因素为大蒜。宫颈癌的危险因素包括阴道异常出血、白带反复异常、下腹痛或下坠感、宫颈囊肿、月经初潮早。人工流产和常吃辛辣食品是“两癌”的共同危险因素,输卵管结扎是“两癌”的共同保护因素。通过筛选影响因素建立的“两癌”风险评估模型具有一定准确性。
[Abstract]:Objective the purpose of this study is through literature review, based on the community and hospital based case-control study, a set of suitable rural two phase tumor risk assessment model design, implementation will use the health manpower resource is limited to cancer risk population really need to go to improve the implementation and effect of grassroots cancer screening methods. Before the investigation began, through systematic literature review method to find out main factors affecting Chinese cancer incidence, using Stata12.0 analysis software to calculate the combined advantages of various factors. Since November 2013 to carry out the research on the control of hospital based on the selected from rural Anhui, Lu'an's primary goal in cancer patients as cases oncology department of five hospitals in Hefei, in the city of Lu'an, Jinan, Yu'an District, in rural areas of Shouxian County and Shucheng are not over age and case selection A three year old healthy people as control, using the method of matching design of 1:3, one of the "network" questionnaire; community case-control study using the same standard in the 18 intervention and 18 village of Anhui rural village delayed intervention network use auxiliary tools to collect data based on the data analysis of the early stage of the study; SPSS17.0 software mainly uses descriptive analysis, independent t test, chi square test, single factor Logistic regression analysis and multivariate conditional Logistic regression; investigation of the full implementation of quality control, and strictly follow the ethics regulations, signed informed consent and the study results of this paper. A preliminary assessment questionnaire containing "fast" and "details" the two part of the risk assessment, risk evaluation consists of 13 kinds of problems involving 191 factors, detailed risk assessment consists of 936 questions and is fast The positive effects of specific problems in risk assessment factors; the previous study included 115 breast cancer patients were effective, 104 cases of cervical cancer, breast cancer in 345 cases, 312 cases of cervical cancer control, case control group age, culture level. No significant differences in the distribution of the results of data analysis showed that the risk factors of female breast cancer in rural areas Lu'an is the main area of breast masses (OR 16.036; 95%CI 7.333-35.068), breast hyperplasia (OR 2.601; 95%CI 1.124-6.020), artificial abortion (OR 3.115; 95%CI 1.538-6.309), long-term oral contraceptives (OR 2.988; 95%CI 1.087-8.212) and eat spicy food (OR 2.698; 95%CI, 1.535-4.740) were protective factors of tubal ligation (OR 0.298; 95%CI 0.165-0.506) and eat garlic (OR 0.507; 95%CI 0.297-0.866); cervical cancer risk factors for abnormal vaginal bleeding (OR82.129; 95%CI 19.266-350.100), lower abdominal pain or tenesmus (OR 5.268; 9 5%CI 1.388-19.900), abnormal leucorrhea repeated (OR 3.304; 95%CI 1.415-7.714), cervical cyst (OR 27.451; 95%CI1.522-495.262), artificial abortion (OR 3.319; 95%CI 1.881-5.859), eat spicy food (OR3.296; 95%CI, 1.366-7.954) were protective factors of tubal Guan Jiezha (OR 0.218; 95%CI0.069-0.693). This study established the evaluation of breast cancer a model of risk area under the curve was 0.875, the area under the curve of two for model 0.799; to assess the risk of cervical cancer in a model area under the curve was 0.886, the risk factors of 0.763. model for the conclusion of Lu'an rural area female breast cancer including breast lumps, breast hyperplasia, long-term prophylactic, protective factors for garlic. Risk factors of cervical cancer including abnormal vaginal bleeding, recurrent abdominal pain or abnormal leucorrhea, tenesmus, cervical cyst, early menarche. Artificial abortion and eat spicy food is "common danger two" cancer Factors, tubal ligation is a common protective factor for "two cancer". The "two cancer" risk assessment model, established by screening the influencing factors, has a certain accuracy.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R73-31

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