胰腺癌相关危险因素研究及高危评分模型的建立  

Establishment of a risk model based on study of risk factors for pancreatic cancer

作　　者：陆星华[1] 王丽[2] 李辉[2] 钱家鸣[1] 邓瑞雪[1] 周璐[1] 

机构地区：[1]中国协和医科大学中国医学科学院北京协和医院消化科,北京100730 [2]中国协和医科大学中国医学科学院基础研究所流行病教研组

出　　处：《中华消化杂志》2005年第9期515-520,共6页Chinese Journal of Digestion

基　　金：卫生部直属单位临床科室重点项目(20010102)

摘　　要：目的探索胰腺癌相关危险因素,建立胰腺癌高危评分模型.方法采用病例对照研究,收集2002年1月至2004年4月胰腺癌患者119例,正常对照238名.对所有研究对象进行流行病学问卷调查,通过两组比较确定胰腺癌相关危险因素.选择相关危险因素和症状进行多元Logistic回归分析,计算各变量的权重分数,建立高危评分模型.结果高剂量吸烟(＞17包年)人群发生胰腺癌的风险增加(OR 1.98;95%CI 1.11～3.49),尤其是男性高剂量吸烟者(OR 2.11;95%CI 1.18～3.78);饮酒对胰腺癌的危险性主要表现在高剂量饮酒中(OR 3.681;95% CI 1.604～8.443).胰腺癌患者中以肉食为主者占31.03%,而对照组中仅为7.61%(P＜0.0001);有糖尿病史的胰腺癌患者占18.49%,而对照组仅为5.77%(P=0.0003),胰腺癌组中患糖尿病时间中位数为0.5年,对照组为4年;临床症状中厌食、上腹痛、腹胀、黄疸及体重下降两组间差异有统计学意义.根据高危评分模型对两组进行评分,胰腺癌组和对照组平均分分别为80.6(95% CI 74.9～86.3)和7.4(95% CI 6.0～8.7),P＜0.001.初步确定≥45分为胰腺癌高危人群筛查界值.结论高剂量吸烟、高剂量饮酒、肉食、糖尿病史为汉族人群的胰腺癌相关危险因素.该评分模型可用于胰腺癌高危人群的初筛,可能有助于发现早期胰腺癌患者,但还需进一步验证.Objective To investigate the risk factor for pancreatic cancer and establisha risk model for Han population. Methods Our population-based case control study was carried out in Beijing from January 2002 to April 2004. One hundred and ninteen patients with pancreatic cancer and 238 healthy controls completed the questionnaire which was used for the risk factor analysis. Logistic regression analysis was used to calculate odds ratios （ORs） , 95% confidence intervals （CIs） and β, which were further used to establish the risk model. Results According to the study, people who have smoked more than 17 pack years had a higher risk to develop pancreatic cancer compared to non smokers or light smok ers （no more than 17 pack years） （OR 1.98; 95%CI 1. 11～3.49,）. More importantly, heavy smokers in men had increased risk for developing pancreatic cancer （OR 2. 11 ： 95 %CI 1. 18～3.78） than women. Heavy alcohol drinkers （〉20 cup-years） were found to have increased risk for pancreatic cancer （OR 3. 681; 95%CI 1. 604～8. 443）. Daily diet with high meat intake was also linked to pancreatic cancer. About 18.49% of the pancreatic cancer patients had diabetes mellitus compared to the control group of 5.77% （P=0.0003）. Typical symptoms of pancreatic cancer were anorexia, upper abdominal pain, bloating, jaundice and weight loss. The high risk score of the two groups were 80.6 （95% CI 74.9～86.3） and 7.4（95% CI 6.0～8.7） （P〈0.001）,respectively. A score above 45 were set as the cut-off value of high risk screening of pancreatic cancer. Conclusion High-dose smoking, high dose drinking, high meat diet and diabetes were major risk factors for pancreatic cancer in Han population. This high risk model is an easy method for primary screening of pancreatic cancer. It may be helpful for detecting early pancreatic cancers, but further validation is needed.

关 键 词：胰腺癌 危险因素 高危模型 

分 类 号：R735.9[医药卫生—肿瘤]