吸烟饮酒以及幽门螺杆菌感染与食管癌发病关系的研究

发布时间：2018-04-22 16:04

本文选题：食管癌 + 吸烟饮酒　；参考：《山东大学》2015年硕士论文

【摘要】：研究背景江苏省泰兴市位于我国的苏北食管癌高发区,经济发展居江苏省中等水平,食管癌发病率远高于全国平均水平,对患者及其家庭带来沉重的精神损失和经济负担,造成人力和社会资源的巨大损耗。研究该地食管癌,对当地的人民健康和社会发展具有十分重要的意义。食管癌的确切病因还不是很清楚,但普遍认为食管癌是多因素、多基因、多阶段的复杂的发生发展过程,许多因素比如亚硝胺的摄入、不良的生活或饮食习惯等,都和食管癌的发生有关。第一部分吸烟饮酒与食管鳞癌发生之间的关系：在过去的几十年间,大量证据显示,吸烟和饮酒是食管癌发生的主要危险因素。且在西方国家吸烟、饮酒和食管癌之间存在着密切的相关,但是先前在亚洲的研究结果显示,他们之间存在着比较弱的相关甚至不存在相关,在中国地区的相关研究更是少。第二部分幽门螺杆菌与食管癌发生之间的meta分析,先前国内外研究对此问题并没有得到准确的结果,以便为以后的实验室工作提供依据,我们对这个问题进行了总结和meta分析。研究目的探究泰兴地区吸烟、饮酒与食管鳞癌的发生之间有没有相关性,为当地高危人群的筛查提供理论依据；收集国内外有关幽门螺杆菌与食管癌发生之间的研究,通过meta分析进行结果合并,为下一步实验室的分子流行病学研究打下基础。研究方法1.采用以人群为基础的病例-对照研究,在泰兴市四家主要医院收集食管癌新发病例,在泰兴市常驻人口中随机抽取对照,配比因素为年龄和性别,对符合入选标准的研究对象进行面对面调查,收集吸烟饮酒相关的信息,并应用非条件Logistic回归分析分别探讨吸烟饮酒与食管鳞癌发病的关系,并进行交互作用分析。所有分析采用SAS 9.1完成。2.收集国内外所有关于幽门螺杆菌与食管癌发生危险性之间的研究,提取相应的数据和信息,通过合并OR值,得到比较有说服力的结果。所有分析采用STATA完成。研究结果1.吸烟、饮酒与食管鳞癌关系的研究1.1一般情况本研究共纳入分析的病例组人数为612人,对照组人数为770人,其中病例组中男女性别之比为2.29：1,略高于该地区食管癌发病的性别比(1.93：1)。1.2吸烟与食管鳞癌之间的关系(1)吸烟与否在食管癌病例组和对照组中无统计学差异。(2)开始吸烟的年龄较小会增大食管鳞癌发病的风险,OR值为1.71(1.09-2.68),所得的p值为0.0138。(3)随着吸烟强度的增大,食管鳞癌发生的风险也增大,0R值为1.56(1.10-2.22),p值为0.0054。而对于累积吸烟量,调整0R值为1.61(1.06-2.44),所得的线性趋势检验结果为0.0050。1.3饮酒与食管鳞癌之间的关系饮酒与食管鳞癌的发生有较强程度的关联,调整后的OR值为2.26(1.68-3.04)。(1)食管鳞癌发病的风险随初始饮酒年龄的减小而呈上升趋势,p0.0001。(2)食管鳞癌的发病风险也随着饮酒年限的增加呈上升趋势,并且具有统计学意义00.0001)。(3)随着饮酒强度的增大,OR值呈上升的趋势,且具有统计学意义(p0.0001)。1.4交互作用吸烟与饮酒之间交互作用的分析。吸烟喝酒组与不吸烟喝酒组相比,得到了有统计学意义的0R值1.81(1.18-2.78)。说明吸烟和饮酒对食管鳞癌的发生之间存在交互作用。2.幽门螺杆菌与食管癌发病关系的meta分析2.1一般情况入选的28个研究中,累计参与人数为10285人,其中病例3269人,对照7016人。在28篇入选文献中,其中有23篇为英文文献和5篇为中文文献。同时在入选研究中,有9篇是关于食管腺癌的,15篇是关于食管鳞癌的,4篇文章是食管鳞癌和腺癌的内容都有涉及。入选文献中,有13篇文献的研究人群是亚洲人,其余15篇是非亚洲人。2.2合并OR值食管腺癌与幽门螺杆菌感染之间的合并OR值为0.57(95% CI0.44-0.73),食管腺癌与cagA阳性的幽门螺杆菌感染之间的合并的OR值为0.64(95% CI0.52-0.79),说明幽门螺杆菌和cagA阳性的幽门螺杆菌的存在均是食管腺癌发生的保护性因素。食管鳞癌与幽门螺杆菌感染之间的合并的0R值为1.16(95% CI0.83-1.60),食管鳞癌与cagA阳性的幽门螺杆菌感染之间的合并的0R值为0.97(95% CI0.79-1.19),幽门螺杆菌的感染与食管鳞癌的发生之间没有得到有统计学意义的结果。结论1.吸烟与否与食管鳞癌的发生之间没有得到有统计学意义的结果,但是随着吸烟强度的增大,其危险性就得以显现。2.饮酒是食管鳞癌发生的危险性因素。3.幽门螺杆菌/cagA阳性的幽门螺杆菌感染是食管腺癌发生的保护性因素。4.幽门螺杆菌/cagA阳性的幽门螺杆菌感染与食管鳞癌的发生之间,并没有得到有统计学意义的结果。
[Abstract]:Background the Taixing city of Jiangsu province is located in the high incidence area of esophageal cancer in Northern Jiangsu Province. The economic development is in the middle level of Jiangsu province. The incidence of esophageal cancer is far higher than the national average. It brings heavy mental loss and economic burden to the patients and their families and causes great loss of human and social resources. People's health and social development are of great significance. The exact cause of esophageal cancer is not clear, but it is generally believed that esophageal cancer is a multi factor, multi gene, multi stage complex development process, many factors such as nitrosamines intake, bad life or eating habits, are related to the occurrence of esophageal cancer. The relationship between smoking and esophageal squamous cell carcinogenesis: over the past few decades, a large number of evidence shows that smoking and drinking are the major risk factors for the occurrence of esophageal cancer. There is a close correlation between smoking, drinking and esophageal cancer in the western countries, but previous studies in Asia showed that there was a weak relationship between them. The related research is not even related, the related research in China is less. Second the analysis of meta between Helicobacter pylori and the occurrence of cancer of the esophagus. The previous domestic and foreign studies have not obtained the accurate results in order to provide the basis for the future laboratory work. We have made a summary and meta analysis of this problem. Objective to explore the correlation between smoking, drinking and the occurrence of esophageal squamous cell carcinoma in Taixing, to provide a theoretical basis for the screening of high risk population in the local area, and to collect the study on the occurrence of Helicobacter pylori and esophageal cancer at home and abroad, and to combine the results through meta analysis to lay the basis for the molecular epidemiological study in the next laboratory. Research method 1. a case control study based on population was used to collect new cases of esophageal cancer in four main hospitals in Taixing. The control was randomly selected from the resident population of Taixing. The ratio factors were age and sex. The relationship between smoking and drinking and the incidence of esophageal squamous cell carcinoma was analyzed with non conditional Logistic regression analysis, and the interaction analysis was carried out. All the analyses used SAS 9.1 to complete.2. collection of all the studies on the risk of Helicobacter pylori and esophageal cancer at home and abroad, to extract corresponding data and information, and to get the comparison by combining the OR value. Results of persuasiveness. All analysis was completed by STATA. Results 1. smoking, drinking and esophageal squamous cell carcinoma were studied in 1.1 cases. The total number of cases in the case group was 612 and the control group was 770, of which the sex ratio of men and women in the case group was 2.29:1, slightly higher than the sex ratio of esophageal cancer in the area (1.93: 1) the relationship between.1.2 smoking and esophageal squamous cell carcinoma (1) smoking was not statistically significant in the cases of esophageal cancer and in the control group. (2) the risk of the onset of esophageal squamous cell carcinoma was increased by the younger age of smoking, and the value of OR was 1.71 (1.09-2.68). The value of the income was 0.0138. (3) with the increase of smoking intensity, the risk of squamous carcinoma of the esophagus increased, and the value of 0R was increased. The risk of esophageal squamous cell carcinoma increased, and the value of the esophageal squamous cell carcinoma increased, and the 0R value was increased. For 1.56 (1.10-2.22), the p value was 0.0054. and the cumulative smoking volume, the adjusted 0R value was 1.61 (1.06-2.44). The result of linear trend test was that the relationship between drinking and esophageal squamous cell carcinoma was strongly associated with the occurrence of esophageal squamous cell carcinoma, and the adjusted OR value was 2.26 (1.68-3.04). (1) the risk of esophageal squamous cell carcinoma was associated with the initial risk. The decrease in initial drinking age showed an upward trend, p0.0001. (2) the risk of esophageal squamous cell carcinoma increased with the increase of drinking years, and was statistically significant 0.0001. (3) with the increase of alcohol consumption, the OR value increased, and was statistically significant (P0.0001).1.4 interaction between smoking and drinking alcohol interaction. A statistically significant 0R value of 1.81 (1.18-2.78) was obtained in the smoking and drinking group compared with the non smoking group. It showed that the interaction between smoking and drinking on the occurrence of esophageal squamous cell carcinoma was the meta analysis of the relationship between.2. Helicobacter pylori and the incidence of esophageal cancer. In the 28 studies, the total number of participants was 10285. Of the 3269 cases, 7016 of them were compared. Among the 28 articles, 23 were in English and 5 were Chinese. In the study, 9 were about esophageal adenocarcinoma, 15 were on esophageal squamous cell carcinoma, and 4 articles were related to the contents of esophageal squamous cell carcinoma and adenocarcinoma. Among the selected literature, there were 13 literature research crowds. The other 15 were non Asian.2.2 combined with OR value of adenocarcinoma of the esophagus and Helicobacter pylori infection, the OR value was 0.57 (95% CI0.44-0.73), and the OR value of the combination between the esophageal adenocarcinoma and the cagA positive Helicobacter pylori infection was 0.64 (95% CI0.52-0.79), indicating that the presence of Helicobacter pylori and cagA positive Helicobacter pylori are all Protective factors for the occurrence of esophageal adenocarcinoma. The 0R value of the combination of esophageal squamous cell carcinoma and Helicobacter pylori infection was 1.16 (95% CI0.83-1.60), and the 0R value of the combination between the esophageal squamous cell carcinoma and the cagA positive Helicobacter pylori infection was 0.97 (95% CI0.79-1.19), and there was no statistical significance between the Helicobacter pylori infection and the occurrence of esophageal squamous cell carcinoma. Conclusion 1. smoking or not and the occurrence of esophageal squamous cell carcinoma is not statistically significant, but with the increase of smoking intensity, the risk of.2. drinking is a risk factor for esophageal squamous cell carcinoma.3. Helicobacter pylori /cagA positive Helicobacter pylori infection is the protection of the occurrence of esophageal adenocarcinoma. Factors.4. Helicobacter pylori /cagA positive Helicobacter pylori infection and esophageal squamous cell carcinomas were not statistically significant.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

【参考文献】