本文選題：食管癌 + 吸煙飲酒　； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：研究背景江蘇省泰興市位于我國的蘇北食管癌高發(fā)區(qū),經(jīng)濟(jì)發(fā)展居江蘇省中等水平,食管癌發(fā)病率遠(yuǎn)高于全國平均水平,對患者及其家庭帶來沉重的精神損失和經(jīng)濟(jì)負(fù)擔(dān),造成人力和社會資源的巨大損耗。研究該地食管癌,對當(dāng)?shù)氐娜嗣窠】岛蜕鐣l(fā)展具有十分重要的意義。食管癌的確切病因還不是很清楚,但普遍認(rèn)為食管癌是多因素、多基因、多階段的復(fù)雜的發(fā)生發(fā)展過程,許多因素比如亞硝胺的攝入、不良的生活或飲食習(xí)慣等,都和食管癌的發(fā)生有關(guān)。第一部分吸煙飲酒與食管鱗癌發(fā)生之間的關(guān)系：在過去的幾十年間,大量證據(jù)顯示,吸煙和飲酒是食管癌發(fā)生的主要危險因素。且在西方國家吸煙、飲酒和食管癌之間存在著密切的相關(guān),但是先前在亞洲的研究結(jié)果顯示,他們之間存在著比較弱的相關(guān)甚至不存在相關(guān),在中國地區(qū)的相關(guān)研究更是少。第二部分幽門螺桿菌與食管癌發(fā)生之間的meta分析,先前國內(nèi)外研究對此問題并沒有得到準(zhǔn)確的結(jié)果,以便為以后的實驗室工作提供依據(jù),我們對這個問題進(jìn)行了總結(jié)和meta分析。研究目的探究泰興地區(qū)吸煙、飲酒與食管鱗癌的發(fā)生之間有沒有相關(guān)性,為當(dāng)?shù)馗呶Ｈ巳旱暮Y查提供理論依據(jù)；收集國內(nèi)外有關(guān)幽門螺桿菌與食管癌發(fā)生之間的研究,通過meta分析進(jìn)行結(jié)果合并,為下一步實驗室的分子流行病學(xué)研究打下基礎(chǔ)。研究方法1.采用以人群為基礎(chǔ)的病例-對照研究,在泰興市四家主要醫(yī)院收集食管癌新發(fā)病例,在泰興市常駐人口中隨機(jī)抽取對照,配比因素為年齡和性別,對符合入選標(biāo)準(zhǔn)的研究對象進(jìn)行面對面調(diào)查,收集吸煙飲酒相關(guān)的信息,并應(yīng)用非條件Logistic回歸分析分別探討吸煙飲酒與食管鱗癌發(fā)病的關(guān)系,并進(jìn)行交互作用分析。所有分析采用SAS 9.1完成。2.收集國內(nèi)外所有關(guān)于幽門螺桿菌與食管癌發(fā)生危險性之間的研究,提取相應(yīng)的數(shù)據(jù)和信息,通過合并OR值,得到比較有說服力的結(jié)果。所有分析采用STATA完成。研究結(jié)果1.吸煙、飲酒與食管鱗癌關(guān)系的研究1.1一般情況本研究共納入分析的病例組人數(shù)為612人,對照組人數(shù)為770人,其中病例組中男女性別之比為2.29：1,略高于該地區(qū)食管癌發(fā)病的性別比(1.93：1)。1.2吸煙與食管鱗癌之間的關(guān)系(1)吸煙與否在食管癌病例組和對照組中無統(tǒng)計學(xué)差異。(2)開始吸煙的年齡較小會增大食管鱗癌發(fā)病的風(fēng)險,OR值為1.71(1.09-2.68),所得的p值為0.0138。(3)隨著吸煙強(qiáng)度的增大,食管鱗癌發(fā)生的風(fēng)險也增大,0R值為1.56(1.10-2.22),p值為0.0054。而對于累積吸煙量,調(diào)整0R值為1.61(1.06-2.44),所得的線性趨勢檢驗結(jié)果為0.0050。1.3飲酒與食管鱗癌之間的關(guān)系飲酒與食管鱗癌的發(fā)生有較強(qiáng)程度的關(guān)聯(lián),調(diào)整后的OR值為2.26(1.68-3.04)。(1)食管鱗癌發(fā)病的風(fēng)險隨初始飲酒年齡的減小而呈上升趨勢,p0.0001。(2)食管鱗癌的發(fā)病風(fēng)險也隨著飲酒年限的增加呈上升趨勢,并且具有統(tǒng)計學(xué)意義00.0001)。(3)隨著飲酒強(qiáng)度的增大,OR值呈上升的趨勢,且具有統(tǒng)計學(xué)意義(p0.0001)。1.4交互作用吸煙與飲酒之間交互作用的分析。吸煙喝酒組與不吸煙喝酒組相比,得到了有統(tǒng)計學(xué)意義的0R值1.81(1.18-2.78)。說明吸煙和飲酒對食管鱗癌的發(fā)生之間存在交互作用。2.幽門螺桿菌與食管癌發(fā)病關(guān)系的meta分析2.1一般情況入選的28個研究中,累計參與人數(shù)為10285人,其中病例3269人,對照7016人。在28篇入選文獻(xiàn)中,其中有23篇為英文文獻(xiàn)和5篇為中文文獻(xiàn)。同時在入選研究中,有9篇是關(guān)于食管腺癌的,15篇是關(guān)于食管鱗癌的,4篇文章是食管鱗癌和腺癌的內(nèi)容都有涉及。入選文獻(xiàn)中,有13篇文獻(xiàn)的研究人群是亞洲人,其余15篇是非亞洲人。2.2合并OR值食管腺癌與幽門螺桿菌感染之間的合并OR值為0.57(95% CI0.44-0.73),食管腺癌與cagA陽性的幽門螺桿菌感染之間的合并的OR值為0.64(95% CI0.52-0.79),說明幽門螺桿菌和cagA陽性的幽門螺桿菌的存在均是食管腺癌發(fā)生的保護(hù)性因素。食管鱗癌與幽門螺桿菌感染之間的合并的0R值為1.16(95% CI0.83-1.60),食管鱗癌與cagA陽性的幽門螺桿菌感染之間的合并的0R值為0.97(95% CI0.79-1.19),幽門螺桿菌的感染與食管鱗癌的發(fā)生之間沒有得到有統(tǒng)計學(xué)意義的結(jié)果。結(jié)論1.吸煙與否與食管鱗癌的發(fā)生之間沒有得到有統(tǒng)計學(xué)意義的結(jié)果,但是隨著吸煙強(qiáng)度的增大,其危險性就得以顯現(xiàn)。2.飲酒是食管鱗癌發(fā)生的危險性因素。3.幽門螺桿菌/cagA陽性的幽門螺桿菌感染是食管腺癌發(fā)生的保護(hù)性因素。4.幽門螺桿菌/cagA陽性的幽門螺桿菌感染與食管鱗癌的發(fā)生之間,并沒有得到有統(tǒng)計學(xué)意義的結(jié)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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 Deng-Chyang Wu;Fang-Jung Yu;Jaw-Yuan Wang;Chao-Hung Kuo;Sheau-Fang Yang;Ming-Tsang Wu;;Association between Helicobacter pylori seropositivity and digestive tract cancers[J];World Journal of Gastroenterology;2009年43期

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本文編號：1787930