本文選題：可吸入顆粒物 + 食管癌��； 參考：《山東大學》2017年碩士論文

【摘要】：研究背景近來,國際癌癥研究機構工作組將室外空氣污染以及室外空氣污染中的顆粒物,定義為1類致癌物質。在中國,N02、S02以及可吸入顆粒物(PM10)是應用比較廣泛的指標。PM10指空氣動力學當量直徑≤10微米的顆粒物。PM10可以懸浮于空氣中,是一類大小、組成及來源各異的極小的顆粒與液滴的混合物。目前,世界上對于空氣污染尤其是PM10及細顆粒物(PM2.5)對于肺癌的影響的研究非常之多,這些研究主要集中在歐美等發(fā)達國家。然而,空氣污染,尤其是將空氣污染的指標細化后,與其他惡性腫瘤聯(lián)系起來的研究較少,且結論尚不一致。食管癌在我國的發(fā)病率及死亡率都較高。然而,不論是在我國還是在世界范圍內,食管癌的發(fā)病率和死亡率都有明顯的地域差異,這說明環(huán)境因素可能在食管癌發(fā)生發(fā)展中起到了重要的作用。關于空氣污染與食管癌的流行病學研究,目前尚未得出統(tǒng)一的結論,且主要集中在職業(yè)危害層面,對空氣污染的定義也不甚明確。而且,目前尚沒有針對PM10與食管癌死亡率以及臨床病理學特征關系的研究。中國作為空氣污染嚴重的發(fā)展中國家以及食管癌高發(fā)國,研究空氣污染尤其是PM10與食管癌的關系,具有深遠意義。研究目的研究空氣污染,包括PM10、S02、NO2與山東省食管癌患者死亡率的關系,以及PM10是否會影響食管鱗癌患者發(fā)病伊始的臨床病理學特征。研究方法本研究主要分兩個部分對空氣污染,尤其是PM10與食管癌的關系進行研究。第一部分為橫斷面生態(tài)學研究,主要是從全省水平來看空氣污染與食管癌死亡率之間的關系。我們將從山東省環(huán)保廳獲取的山東17地市2009-2014年六年間PM10、SO2、NO2的年平均值,再分別計算平均值,來代表一個城市的空氣污染水平,即市級PM10、SO2、NO2平均濃度。再用市級PM10、SO2、NO2平均濃度作為橫坐標,以山東省疾病預防控制中心提供的2015年山東17地市的食管癌標化死亡率作為縱坐標做散點圖,并進行雙變量相關分析及假設檢驗。因為吸煙是影響食管癌死亡率的重要的危險因素,為了進一步探尋在納入吸煙這個危險因素以后,這三種空氣污染物是否仍然與食管癌死亡率相關,以及,這三種空氣污染物,尤其是PM10是否仍然可以作為獨立危險因素影響食管癌的死亡率,我們進一步進行了多元線性回歸分析。第二部分進行的是臨床病理學特征分析。主要是看暴露于不同污染水平PM10濃度是否會影響食管鱗癌患者發(fā)病伊始的臨床病理學特征。這一部分將符合要求的食管鱗癌的患者1255例,按照其久居城市的PM10市級平均濃度,分成高PM10污染水平組以及低PM10污染水平組。我們將吸煙狀態(tài)作為分層標準,進行亞組分析,以此來納入吸煙這個最強烈的混雜因素。我們進一步對兩組患者的臨床病理學特征進行的統(tǒng)計學分析。這些臨床病理學特征包括,人口統(tǒng)計學特征(性別,診斷年齡);以及臨床特征和病理特征(腫瘤位置,T分期,N分期,分化程度,TNM分期,脈管-淋巴管癌栓,以及腫瘤大小)。結果橫斷面生態(tài)學研究部分,在線性相關研究中,PM10濃度(p=0.046)以及NO2濃度(p=0.03),與食管癌的標化死亡率均顯示出有統(tǒng)計學意義的相關關系。當引入吸煙這個危險因素進行多元線性回歸分析時,PM10仍然作為一項可以升高食管癌標化死亡率的獨立危險因素。由此也說明,在我們最初研究的三項空氣污染指標中,PM10是與食管癌關系最為密切的一項指標。本研究的第二部分臨床病理學特征分析中,吸煙狀態(tài)作為最強烈的混雜因素被引入進而控制偏倚。在高PM10污染水平組與低PM10污染水平組兩組患者的臨床病理學特征分析中,進行亞組分析之后,兩組患者的性別分布有顯著的統(tǒng)計學差異(p=0.02)。女性患者在高PM10污染水平組中所占的比例高于其在低PM10污染水平組所占的比例。這可能說明高污染暴露組的女性患者更易罹患食管癌。而能代表腫瘤惡性程度的這些病理學指標,如T分期,N分期,分化程度,TNM分期,脈管-淋巴管癌栓,以及腫瘤大小,兩組患者均沒有表現(xiàn)出具有統(tǒng)計學意義的差異。結論本研究雖然得到了 PM10與食管癌相關的陽性結論,然而也存在一定的局限性以及不可控制的偏倚。PM10顯然不是食管癌的唯一致癌因素,甚至與吸煙飲酒以及不良飲食習慣相比,PM10短期的致癌作用可能顯得不那么明顯。然而,本研究可能為惡性腫瘤的預防與控制提供了全新的思路,控制空氣污染,可能是減輕當前以及今后腫瘤高負荷的可行之路。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1

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本文編號：2054148