【摘要】：目的:卵巢癌是繼子宮內(nèi)膜癌和宮頸癌發(fā)病率居第三位的婦科惡性腫瘤,對(duì)婦女的健康構(gòu)成了嚴(yán)重的威脅。由于卵巢癌發(fā)病隱匿,早期缺乏典型的癥狀,導(dǎo)致大多數(shù)卵巢癌患者確診時(shí)已為晚期,治療效果和預(yù)后極差,其死亡率居?jì)D科腫瘤之首。盡管諸如年齡、家族史等卵巢癌發(fā)病的危險(xiǎn)因素已經(jīng)得到公認(rèn),但是卵巢癌的發(fā)病原因還沒有完全被闡釋清楚。因?yàn)閷?duì)卵巢癌還沒有成熟有效的普查手段,所以能夠識(shí)別其危險(xiǎn)因素就顯得尤為重要。有研究表明,超重和肥胖也可能是卵巢癌的危險(xiǎn)因素之一,但是目前不同的流行病學(xué)研究間的結(jié)論并不一致。而且,超重,肥胖與卵巢癌的關(guān)聯(lián)是否會(huì)受絕經(jīng)與否的影響,現(xiàn)在爭(zhēng)議還很大。為了更新現(xiàn)有的知識(shí),并進(jìn)一步探討超重、肥胖與卵巢癌的關(guān)聯(lián),以及二者的關(guān)聯(lián)是否會(huì)受不同絕經(jīng)狀況的影響,本研究對(duì)已發(fā)表的觀察性研究進(jìn)行了meta分析。方法:1文獻(xiàn)搜集及檢索策略。檢索數(shù)據(jù)庫(kù)PubMed,EMBASE和中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、相關(guān)期刊論文(CNKI)、維普期刊數(shù)據(jù)庫(kù)(VIP),萬方數(shù)據(jù)庫(kù)上于2016年12月以前已發(fā)表的關(guān)于超重、肥胖與卵巢癌關(guān)聯(lián)的文獻(xiàn)。英文檢索詞為(“BMI”or“body mass index”or“overweight”or“obesity”)and(“ovarian cancer”or“ovarian neoplasm”or“ovarian carcinoma”),中文檢索詞為“體質(zhì)指數(shù)”或“超重、肥胖”和“卵巢癌”。相關(guān)文章的參考文獻(xiàn)也進(jìn)行了查閱來搜檢文獻(xiàn)。2文獻(xiàn)的納入與排除標(biāo)準(zhǔn)。文獻(xiàn)符合以下條件被納入:1)研究設(shè)計(jì)為觀察性研究(隊(duì)列研究或病例對(duì)照研究);2)探討超重、肥胖與卵巢癌的關(guān)聯(lián),并且以體質(zhì)指數(shù)(BMI)來明確地定義超重和肥胖;3)文章提供了相應(yīng)的風(fēng)險(xiǎn)效應(yīng)值。兩名研究者獨(dú)立評(píng)估合格的已納入文獻(xiàn)。如遇分歧通過討論解決。排除標(biāo)準(zhǔn):1)綜述或系統(tǒng)評(píng)價(jià)以及meta分析;2)無法獲得風(fēng)險(xiǎn)效應(yīng)值;3)重復(fù)的數(shù)據(jù);4)摘要和未發(fā)表的報(bào)道。3納入文獻(xiàn)的質(zhì)量評(píng)價(jià)。對(duì)預(yù)納入的文獻(xiàn)運(yùn)用九分newcastle-ottawascale(nos)量表進(jìn)行評(píng)價(jià),文獻(xiàn)評(píng)分若大于等于六顆星,則可認(rèn)為是高質(zhì)量研究可以被納入。4提取數(shù)據(jù)。每篇文獻(xiàn)中提取如下信息:第一作者姓名,文章發(fā)表年份,原始國(guó)別,研究的時(shí)間,研究的名稱,暴露的測(cè)量,研究人群的年齡和數(shù)目,病例和對(duì)照人群的來源,病例的絕經(jīng)情況以及肥胖與oc關(guān)聯(lián)的風(fēng)險(xiǎn)效應(yīng)值。5統(tǒng)計(jì)學(xué)分析。采用stata12.0(statacorp,collegestation,tx,usa)軟件進(jìn)行數(shù)據(jù)分析。用合并rr值和95%可信區(qū)間(ci)評(píng)估所有研究中超重、肥胖與卵巢癌的關(guān)聯(lián)強(qiáng)度。q檢驗(yàn)統(tǒng)計(jì)量和i2測(cè)量值來檢驗(yàn)和量化納入文獻(xiàn)的異質(zhì)性,并且按照文章發(fā)表年份進(jìn)行累積meta分析,觀察肥胖和卵巢癌關(guān)聯(lián)隨時(shí)間推移的變化趨勢(shì)。egger’s檢驗(yàn)和begg’s檢驗(yàn)評(píng)估漏斗圖的對(duì)稱性來評(píng)價(jià)潛在的發(fā)表偏倚。進(jìn)行敏感性分析來驗(yàn)證結(jié)果的穩(wěn)定性。結(jié)果:1文獻(xiàn)搜索結(jié)果:經(jīng)過初步篩選共獲得70篇文獻(xiàn),使用上述檢索策略,排除41篇不合格文獻(xiàn),最終有29篇文獻(xiàn)被納入。其中,16篇為隊(duì)列研究,13篇為病例對(duì)照研究。2文獻(xiàn)的質(zhì)量評(píng)價(jià)結(jié)果:對(duì)預(yù)納入的29篇研究均進(jìn)行了質(zhì)量評(píng)價(jià),結(jié)果顯示,文獻(xiàn)評(píng)分均大于等于六顆星,所有研究都可以被納入。3超重、肥胖和卵巢癌關(guān)聯(lián)的結(jié)果:與正常體重組(bmi=18.5 24.9kg/m2)相比較,超重組和oc發(fā)生的風(fēng)險(xiǎn)之間有統(tǒng)計(jì)學(xué)差異(rr=1.07,95%ci:1.03 1.12),涉及到28篇文獻(xiàn);同樣,與正常體重組(bmi=18.5 24.9kg/m2)相比較,肥胖組和oc發(fā)生的風(fēng)險(xiǎn)之間也具有統(tǒng)計(jì)學(xué)差異(rr=1.27,95%ci:1.15 1.40),涉及到27篇文獻(xiàn)。累積meta分析結(jié)果顯示,不論是體重超重組還是肥胖組,關(guān)聯(lián)的趨勢(shì)趨于穩(wěn)定,風(fēng)險(xiǎn)效應(yīng)值的可信區(qū)間不斷縮小。4不同亞組的分析結(jié)果:不論是隊(duì)列研究還是病例對(duì)照研究,自我報(bào)告的研究還是測(cè)量的研究,體重增加均可以增加oc發(fā)生的風(fēng)險(xiǎn),合并效應(yīng)值具有統(tǒng)計(jì)學(xué)意義。按照研究地點(diǎn)分層:在體重為超重時(shí),美洲的研究(rr=1.05,95%ci:0.96 1.41)和歐洲的研究(rr=1.05,0.99 1.11),增加的體重與OC發(fā)生風(fēng)險(xiǎn)的關(guān)聯(lián),均無統(tǒng)計(jì)學(xué)意義。但亞洲的研究(RR=1.05,95%CI:0.96 1.41)和大洋洲的研究(RR=1.05,95%CI:0.96 1.41),增加的體重與OC發(fā)生風(fēng)險(xiǎn)的關(guān)聯(lián),均有統(tǒng)計(jì)學(xué)意義;在體重為肥胖時(shí),結(jié)果與超重相反,美洲的研究(RR=1.32,95%CI:1.20 1.45)和歐洲的研究(RR=1.21,1.05 1.40),增加的體重與OC發(fā)生風(fēng)險(xiǎn)的關(guān)聯(lián),均有統(tǒng)計(jì)學(xué)意義。但亞洲的研究(RR=1.23,95%CI:0.52 2.90)和大洋洲的研究(RR=1.22,95%CI:0.52 2.86),增加的體重與OC發(fā)生風(fēng)險(xiǎn)的關(guān)聯(lián),均無統(tǒng)計(jì)學(xué)意義。當(dāng)按照絕經(jīng)狀況分層:在體重為超重時(shí),不論是絕經(jīng)前(RR=1.16,95%CI:0.95 1.41)還是絕經(jīng)后(RR=1.01,0.90 1.14),增加的體重與OC發(fā)生風(fēng)險(xiǎn)的關(guān)聯(lián),均無統(tǒng)計(jì)學(xué)意義。但在體重為肥胖時(shí),風(fēng)險(xiǎn)僅在絕經(jīng)前的女性中有統(tǒng)計(jì)學(xué)意義(RR=1.38,95%CI:1.10 1.72),在絕經(jīng)后女性中卻沒有統(tǒng)計(jì)學(xué)意義(RR=0.97,95%CI:0.73 1.29)。5發(fā)表偏倚和敏感性分析的結(jié)果:分別用Egger’s檢驗(yàn)和Begg’s檢驗(yàn)兩種方法對(duì)“超重”組和“肥胖”組應(yīng)用進(jìn)行檢驗(yàn),Egger’s檢驗(yàn)結(jié)果為(P=0.198和0.179),Begg’s檢驗(yàn)結(jié)果為(P=0.650和0.404),P值均0.05,故認(rèn)為不存在明顯的發(fā)表偏倚。刪除掉任何一篇納入的文獻(xiàn),剩余文獻(xiàn)的合并RR值沒有明顯的變化,驗(yàn)證了結(jié)果的穩(wěn)健性。結(jié)論:過分增長(zhǎng)的體重會(huì)增加卵巢癌的發(fā)生風(fēng)險(xiǎn),而且肥胖程度嚴(yán)重的女性表現(xiàn)出更強(qiáng)的風(fēng)險(xiǎn)效果。但是,這種風(fēng)險(xiǎn)僅在絕經(jīng)前的女性中有統(tǒng)計(jì)學(xué)意義,在絕經(jīng)后女性中卻沒有統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: Ovarian cancer is the third gynecologic malignant tumor following the incidence of endometrial carcinoma and cervical cancer, which poses a serious threat to the health of women. Due to the insidious and early absence of typical symptoms in the patients with ovarian cancer, most of the patients with ovarian cancer have been diagnosed with a late stage, a poor treatment and a poor prognosis, and the mortality rate is the first in the gynecological tumors. Although the risk factors such as age, family history and other ovarian cancer have been recognized, the cause of ovarian cancer is not fully explained. Because there is no mature and effective means of screening for ovarian cancer, it is particularly important to be able to identify its risk factors. Studies have shown that overweight and obesity may also be one of the risk factors for ovarian cancer, but the conclusions of the current epidemiological studies are not consistent. Also, whether the association of overweight, obesity and ovarian cancer is affected by the menopause is still large. In order to update the existing knowledge and to further explore the association between overweight, obesity and ovarian cancer, and whether their association is affected by different menopausal conditions, this study has made a meta-analysis of the published observational studies. Methods:1 Literature collection and retrieval strategy. The search database PubMed, EMBASE and the Chinese Biomedical Literature Database (CBM), the Chinese Journal Full-text Database (CNKI), the Vip Journal Database (VIP), and the Wanfang database, published in December 2016, have been published on the association of overweight, obesity and ovarian cancer. The Chinese search term is" body mass index "or overweight, obesity" and "ovarian cancer". References of the related articles have also been reviewed for the search of the literature. The inclusion and exclusion criteria of the literature. The literature was included in the following conditions:1) the study was designed as an observational study (cohort study or case-controlled study);2) to investigate the association of overweight, obesity with ovarian cancer, and to clearly define overweight and obesity with a body mass index (BMI); 3) The article provides the corresponding risk effect value. Two of the investigator's independent assessments were included in the literature. If the differences are resolved through discussion. Exclusion criteria:1) review or system evaluation and meta-analysis;2) no risk-effect value;3) duplicate data;4) summary and unpublished reports.3-quality evaluation of the literature. The pre-included literature was evaluated using a nine-point newcastle-bottom-bottom (nos) scale and the literature score, if greater than or equal to six, can be considered to be a high-quality study that can be included in.4 to extract data. The following information was extracted in each document: the first author's name, the year of publication, the original country, the time of the study, the name of the study, the measurement of the exposure, the age and number of the study population, the case and the source of the control population, Postmenopausal status of the case and the value of the risk effects associated with the obesity and the c.5 statistical analysis. Data analysis was performed using the stata12.0 (statacorp, collegation, tx, usa) software. The association between overweight, obesity and ovarian cancer in all studies was assessed with the combined rr value and the 95% confidence interval (ci). Q-test statistics and i2-measured values were used to test and quantify the heterogeneity of the inclusion in the literature, and the cumulative meta-analysis was performed in the year published to observe the trend of the association of obesity and ovarian cancer over time. The egger's test and the begg's test evaluate the symmetry of the funnel diagram to evaluate potential published bias. Sensitivity analysis was performed to verify the stability of the results. Results:1 Literature search results:70 articles were obtained through preliminary screening,41 non-conforming articles were excluded by using the above-mentioned search strategy, and 29 articles were included. Of these,16 were cohort studies and 13 were case-control studies. The results of the quality evaluation of the literature: The evaluation of the quality of the pre-included 29 studies results in a literature score of greater than or equal to six stars, all of which could be included in.3 Overweight, The correlation between obesity and ovarian cancer: There was a statistically significant difference between the risk of superrecombination and the oc (r = 1.07,95% ci: 1.03.12) compared to normal body recombination (bmi = 18.5 24.9 kg/ m2), involving 28 articles; similarly, compared to normal body recombination (bmi = 18.5 24.9 kg/ m2), There was also a statistical difference between the risk between the obesity group and the oc (r = 1.27,95% ci: 1.15 1.40), involving 27 articles. The cumulative meta-analysis showed that the correlation trend was stable and the confidence interval of the risk-effect value decreased continuously, both in the body weight and in the obese group. The results of the analysis in the different subgroups: whether the cohort study was a case-controlled study, the self-reported study or the measurement, Weight gain can increase the risk of oc occurrence and the combined effect value is of statistical significance. Stratification according to the study site: when the body weight was overweight, studies in the Americas (rr = 1.05,95% ci: 0.96 1.41) and European studies (rr = 1.05, 0.99.11), increased body weight and the risk of OC occurrence were not statistically significant. However, studies in Asia (RR = 1.05,95% CI: 0.96 1.41) and Oceania (RR = 1.05,95% CI: 0.96 1.41), increased body weight and the risk of OC occurrence were statistically significant; in the case of obesity, the results were in contrast to overweight, in the Americas (RR = 1.32,95% CI: 1.20 1.45) and in Europe (RR = 1.21, 1.05. 1.40), The increased body weight was associated with the risk of OC occurrence, all of which were statistically significant. However, studies in Asia (RR = 1.23,95% CI: 0.52 2.90) and Oceania (RR = 1.22,95% CI: 0.52 2.86), increased body weight and the risk of OC occurrence were not statistically significant. The increased body weight was not statistically significant when the body weight was overweight, either before or after menopause (RR = 1.16,95% CI: 0.95 1.41) or after menopause (RR = 1.01, 0.90.14). However, in the case of obesity, the risk was only statistically significant in pre-menopausal women (RR = 1.38,95% CI: 1.10 1.72), with no statistical significance in postmenopausal women (RR = 0.97,95% CI: 0.73 1.29). The results of Egger's test were (P = 0.198 and 0.179). The results of the test were (P = 0.198 and 0.179), and the results of the Beg's test were (P = 0.650 and 0.404). There was no significant change in the combined RR values of the remaining literature, and the robustness of the results was verified. Conclusion: The excessive increase of body weight will increase the risk of ovarian cancer, and the most obese women show a stronger risk. However, this risk is only statistically significant in pre-menopausal women, but there is no statistical significance in postmenopausal women.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.31;R589.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 徐赫男;;從中國(guó)居民營(yíng)養(yǎng)與慢性病狀況報(bào)告看到了什么[J];糖尿病天地(臨床);2016年04期

，

本文編號(hào)：2506595