本文關(guān)鍵詞：面向農(nóng)村的兩階段多腫瘤風(fēng)險評估模型前期研究　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 乳腺癌 宮頸癌 危險因素 篩查 風(fēng)險評估模型

【摘要】：目的本研究目的在于通過系統(tǒng)的文獻(xiàn)復(fù)習(xí)、基于醫(yī)院與基于社區(qū)的病例對照研究,設(shè)計(jì)出一套適合農(nóng)村的兩階段多腫瘤風(fēng)險評估模型,實(shí)現(xiàn)將有限的衛(wèi)生人力物力資源運(yùn)用到真正需要的腫瘤高危人群中去的目的,提高基層腫瘤篩查的執(zhí)行力與效果。方法調(diào)查開始前,通過系統(tǒng)文獻(xiàn)復(fù)習(xí)法找出影響中國人群腫瘤發(fā)病的主要影響因素,運(yùn)用Stata12.0分析軟件計(jì)算各影響因素的合并優(yōu)勢比。自2013年11月至今開展基于醫(yī)院的病例對照研究,在合肥五家醫(yī)院腫瘤科挑選來自安徽六安農(nóng)村地區(qū)的原發(fā)目標(biāo)腫瘤患者作為病例,在六安市金安、裕安區(qū)、壽縣和舒城農(nóng)村地區(qū)挑選年齡與病例相差不超過三歲的健康人群作為對照,采用1:3的配對設(shè)計(jì)方法,進(jìn)行一對一現(xiàn)場“網(wǎng)絡(luò)化”問卷;基于社區(qū)的病例對照研究采用相同的標(biāo)準(zhǔn)在安徽農(nóng)村18個干預(yù)村與18個延遲干預(yù)村中利用網(wǎng)絡(luò)化輔助工具收集數(shù)據(jù);前期研究的數(shù)據(jù)分析階段主要采用SPSS17.0軟件對自變量進(jìn)行描述性分析、t檢驗(yàn)、卡方檢驗(yàn)、單因素Logistic回歸和多因素條件Logistic回歸分析;調(diào)查全程實(shí)施質(zhì)量控制,并嚴(yán)格遵循倫理學(xué)規(guī)定,與研究對象簽署知情同意書。結(jié)果 本課題初步評估問卷包含“快速”與“詳細(xì)”風(fēng)險評估兩部分,快速風(fēng)險評估由涉及191個影響因素的13類問題組成,詳細(xì)風(fēng)險評估由936個問題構(gòu)成且只呈現(xiàn)快速風(fēng)險評估中陽性影響因素的具體問題;本前期研究共納入有效乳腺癌病例115例,宮頸癌病例104例,乳腺癌對照345例,宮頸癌對照312例,病例對照組的年齡、文化程度分布無統(tǒng)計(jì)學(xué)差異。數(shù)據(jù)分析結(jié)果顯示:六安農(nóng)村地區(qū)女性乳腺癌的危險因素主要有乳腺腫塊(OR 16.036;95%CI 7.333-35.068)、乳腺增生(OR 2.601;95%CI 1.124-6.020)、人工流產(chǎn)(OR 3.115;95%CI 1.538-6.309)、長期口服避孕藥(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),保護(hù)因素為輸卵管結(jié)扎(OR 0.298;95%CI 0.165-0.506)和常吃大蒜(OR 0.507;95%CI 0.297-0.866);宮頸癌的危險因素為陰道異常出血(OR82.129;95%CI 19.266-350.100)、下腹痛或下墜感(OR 5.268;95%CI 1.388-19.900)、白帶反復(fù)異常(OR 3.304;95%CI 1.415-7.714)、宮頸囊腫(OR 27.451;95%CI1.522-495.262)、人工流產(chǎn)(OR 3.319;95%CI 1.881-5.859)、常吃辛辣食品(OR3.296;95%CI 1.366-7.954),保護(hù)因素為輸卵管結(jié)扎(OR 0.218;95%CI0.069-0.693)。本研究建立的乳腺癌風(fēng)險評估模型一曲線下面積為0.875,模型二曲線下面積為0.799;宮頸癌風(fēng)險評估模型一曲線下面積為0.886,模型二為0.763。結(jié)論 六安農(nóng)村地區(qū)女性乳腺癌發(fā)病的危險因素包括乳腺腫塊、乳腺增生、長期避孕藥是,保護(hù)因素為大蒜。宮頸癌的危險因素包括陰道異常出血、白帶反復(fù)異常、下腹痛或下墜感、宮頸囊腫、月經(jīng)初潮早。人工流產(chǎn)和常吃辛辣食品是“兩癌”的共同危險因素,輸卵管結(jié)扎是“兩癌”的共同保護(hù)因素。通過篩選影響因素建立的“兩癌”風(fēng)險評估模型具有一定準(zhǔn)確性。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R73-31

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