本文關鍵詞： 惡性腫瘤 發(fā)病率 五氯酚 環(huán)境暴露　出處：《安徽醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的 了解血吸蟲流行區(qū)中五氯酚（pentachlorophol，PCP）污染區(qū)的惡性腫瘤發(fā)病情況及特征，并結(jié)合該地區(qū)水源水五氯酚的殘留情況，以社區(qū)人群為基礎，通過生態(tài)學研究的方法，分析和探討五氯酚長期低劑量暴露與惡性腫瘤發(fā)病的風險性關系。 方法 根據(jù)2009~2012年某市國家腫瘤登記系統(tǒng)中各類惡性腫瘤的發(fā)病數(shù)據(jù)，以及該市范圍內(nèi)各社區(qū)衛(wèi)生服務中心和社區(qū)衛(wèi)生室等隨訪獲得的腫瘤發(fā)病資料，按性別、發(fā)病部位、發(fā)病年齡等分類，統(tǒng)計分析腫瘤的粗發(fā)病率、標化發(fā)病率及年齡別發(fā)病率等指標。 采用固相萃取-氣相色譜串聯(lián)質(zhì)譜法測定該市每個水廠水樣中五氯酚殘留量，估計該地區(qū)范圍內(nèi)社區(qū)人群的五氯酚暴露水平，并以四分位區(qū)間劃分低、中、高三個暴露等級。采用內(nèi)對照形式，以低暴露區(qū)為參照，計算不同五氯酚暴露區(qū)惡性腫瘤的粗發(fā)病率、標化發(fā)病率，統(tǒng)計分析不同暴露區(qū)惡性腫瘤發(fā)病的標化發(fā)病率比，比較不同五氯酚暴露水平惡性腫瘤發(fā)病的風險性。 結(jié)果 2009~2012年共報告惡性腫瘤新發(fā)病例6750例，年平均粗發(fā)病率為233.10/10萬（男性為298.14/10萬，女性為165.20/10萬），年平均標化發(fā)病率為123.77/10萬（男性為147.78/10萬，女性為93.03/10萬），男性發(fā)病率高于女性。50歲以上人群惡性腫瘤發(fā)病有上升趨勢，70歲以后為惡性腫瘤好發(fā)年齡段。全人群惡性腫瘤發(fā)病順位前五位分別為胃癌、肺癌、食管癌、結(jié)直腸癌、肝癌。消化道癌和肺癌為該市的好發(fā)腫瘤，胃癌在男性和女性腫瘤發(fā)病均位于首位。 運用固相萃取-氣相色譜串聯(lián)質(zhì)譜法測定地表水中五氯酚含量，五氯酚在0.1～1000μg/L濃度范圍內(nèi)線性關系良好，其相關系數(shù)為0.9996，若取水樣100ml，按此方法，最低檢測質(zhì)量濃度為1.0ng/L，方法平均回收率在91.9～109.0%，RSD均小于5％。所采水廠水樣共27份，均有五氯酚檢出，測定含量為11.21~684.00ng/L。 高暴露區(qū)惡性腫瘤發(fā)病率高于其他兩個暴露區(qū)。與低暴露區(qū)相比，中暴露區(qū)合計所有腫瘤的發(fā)病風險比SRR為1.05，95%CI=1.01~1.10，高暴露區(qū)合計所有腫瘤的SRR為1.67，95%CI=1.60~1.74。隨著暴露等級的增加，大部分腫瘤發(fā)病風險有所上升。其中男性白血�。ㄖ械缺┞禨RR=3.95，高暴露SRR=18.83）、腦瘤（中等暴露SRR=2.04，高暴露SRR=4.90）和女性惡性淋巴瘤（中等暴露SRR=9.03，高暴露SRR=35.05）、食管癌（中等暴露SRR=1.05，高暴露SRR=3.60）的發(fā)病風險較高。此外高暴露區(qū)各年齡組發(fā)病風險比均高于中暴露區(qū)，隨著年齡的增長，除肺癌和肝癌外，高暴露區(qū)惡性淋巴瘤、消化道癌和乳腺癌發(fā)病風險均有所上升。 結(jié)論 消化道癌和肺癌為研究地區(qū)的好發(fā)腫瘤，胃癌應作為該市監(jiān)測和控制的重點。中老年人群是惡性腫瘤的高危人群，應加強該人群的預防保健工作。 SPE-GC/MS/MS法測定地表水中五氯酚，，方法操作方便，回收率高，在實際應用中效果良好，適用于水中痕量PCP的定性、定量分析。 長期低劑量五氯酚暴露與血液腫瘤、消化系統(tǒng)腫瘤、神經(jīng)系統(tǒng)腫瘤發(fā)病可能相關，特別是與惡性淋巴瘤、白血病、食管癌發(fā)病可能存在的一定相關性，五氯酚長期低劑量的環(huán)境污染健康風險不可忽視。
[Abstract]:Purpose To understand the incidence and characteristics of malignant tumors in the contaminated areas of PCP in the epidemic area of Schistosoma japonicum , and to analyze and discuss the risk - related relationship between the long - term exposure of PCP and the onset of malignant tumor based on community population . method According to the incidence data of all kinds of malignant tumors in the national tumor registration system from 2009 to 2012 , and the data of cancer incidence obtained from the follow - up of community health service centers and community health centers in the city , the indexes such as the sex , the incidence part , the age of the onset and the like are classified , and the indexes such as the gross incidence rate , the standardized incidence rate and the age of the tumor are statistically analyzed . Using solid - phase extraction - gas chromatography tandem mass spectrometry , the levels of PCP residues in each water sample of the city were determined , and the levels of PCP exposure in the community population were estimated . Results In 2009 ~ 2012 , 6750 new cases of malignant tumor were reported . The average annual average incidence rate was 233 . 10 / 100 000 ( male : 298.14 / 100 000 , female : 165.20 / 100000 ) . The incidence of malignant tumor was 123.77 / 100 000 ( male 147.78 / 100000 , female 93.03 / 100000 ) . The incidence of malignant tumor in the whole population was higher than that of female . The first five of the patients with malignant tumor were gastric cancer , lung cancer , esophageal cancer , colorectal cancer , liver cancer , digestive tract cancer and lung cancer . The linear relationship of PCP in surface water was determined by solid - phase extraction - gas chromatography tandem mass spectrometry . The correlation coefficient was 0.9996 . The correlation coefficient was 0.9996 . If 100 ml of water sample was taken , the average recovery was 91.9 锝

本文編號：1542145