饮水等三大环境危险因素与肝癌--泰兴市肝癌病例对照研究  

The drinking water and three environmental risk factors for hepatocellular carcinoma in Taixing by case-control study

作　　者：俞顺章[1] 穆丽娜[1] 蔡琳[2] 陈传炜[1] 卫国荣[1] 周学富 丁保国 常军 曹巍[4] Eric Hurwitz Janet Sinsheimer Barbara Visscher 姜庆五[1] 张作风[4] 

机构地区：[1]复旦大学预防医学研究所,上海200032 [2]福建医科大学流行病学教研组,福州350001 [3]泰兴市疾病控制中心,泰兴225400 [4]美国加州大学洛山矶分校流行病学教研组,CA90095-1772,USA

出　　处：《复旦学报（医学版）》2008年第1期31-38,共8页Fudan University Journal of Medical Sciences

基　　金：教育部全国优秀博士学位论文专项资金项目(200157)

摘　　要：目的通过泰兴肝癌环境病例对照研究,搞清肝癌环境危险因素,进一步证实饮水等与肝癌的关系,从而采取预防措施。方法选择以人群为基础的病例对照调查方法,通过问卷、采血,测定对两种病毒的感染、黄曲霉毒素(AFB1)摄入后白蛋白加合物和机体内基因检测,并进行统计分析,以判断当地肝癌主要危险因素。结果HBsAg比数比(OR)=5.68(95%可信限CI3.80-8.51),丙型肝炎OR=4.19(95%CI1.72-10.22),两种肝炎均为肝癌危险因素,但以乙型肝炎为主。居民摄入霉变食物OR=2.25(95%CI1.39-3.64)。1/2病例和1/3对照有饮生水习惯,经常饮生水者OR=4.60(95%CI1.30-16.30)。肝癌家族史OR=2.99(95%CI1.78-5.01)。吸烟和饮酒未达到危险水平。多吃蔬菜和水果有保护作用OR=0.58(95%CI0.38-0.89)。摄取霉变食物或AFB1加合物,饮生水与HBsAg有联合作用。肝癌与存在基因MTHFR anyT,并同时具有三大环境因素者(摄取霉变食物,饮生水与HBsAg)有明显的联合作用,OR由22跃升到72倍。IFNA17亦与HB-sAg和AFB1加合物有联合作用。结论泰兴肝癌与三大环境因素(HBsAg、摄取霉变食物,饮生水)有密切关系。两种基因的多态,尤其MTHFR anyT值得关注。管水、改粮和防肝炎仍然是预防肝癌的重要措施。Objective Using population-base case-control study, to find the main risk factors of hepatocellular carcinoma（HCC） in Taixing, and to explain the role of drinking water for HCC. Methods The study included 204 HCC cases and 415 healthy controls. After questioanaire, collection of blood samples, detection of two viruses and investigated AFB1 albumin adduct, as well as detected gene polymorphisms of MTHFR, IFNA17 and CYP2C1, the main risk factors of HCC could be confirmed. Results The adjusted OR of HBsAg was 5.68 （95 % CI 3.80 - 8. 51）, anti-HCV OR was 4.19（95%CI 1.72-10.22）, anyway, HBV is more important. The OR of people intaked moldy food was 2.25（95%CI 1.39-3.64）. The half of cases and 1/3 of controls drinking raw water and OR of often drinking group was 4.60（95%CI 1.30-16.30）. The OR of family HCC history was 2.99（95%CI 1.78-5.01）. Intake more fruits and vegetables will reduce OR（OR = 0.58, 95 %CI 0. 38-0. 89）. There were conjugated effect between HBsAg and intake of moldy food, AFB1 albumin adduct, and drinking raw water. When people got MTHFR any T biomarkers and exposed with three main environmental factors （HBsAg, intake of moldy food and drinking raw water）, the ORs were increased from 22 to 72 times. Conclusions The three main evironmental factors （HBsAg, intake of moldy food and drinking raw water） related with HCC in Taixing, especially people with MTHFR 677 any T markers. three motoes of HCC prevention, including control of water, change of corn and prevention of hepatitis are still important.

关 键 词：肝癌 肝炎病毒 黄曲霉毒素 饮水 亚甲基四氢叶酸还原酶 

分 类 号：R735.7[医药卫生—肿瘤]