宣威地区肺癌危险因素系统分析与综合预防策略的研究  

Risk factors of lung cancer and relevant comprehensive preventive strategy——a cohort study in Xuanwei, Yunnan Province, China

作　　者：王登忠[1] 何兴舟[2] 刘韵源[3] 杨儒道[4] 

机构地区：[1]卫生部艾滋病预防与控制中心,北京100050 [2]中国预防医学科学院环境卫生与卫生工程研究所 [3]中国医学科学院肿瘤研究所 [4]云南省卫生防疫站

出　　处：《中华医学杂志》2001年第14期876-880,共5页National Medical Journal of China

摘　　要：目的　系统分析宣威地区肺癌的危险因素 ,提出综合预防策略。方法　利用双向队列研究资料 ,应用COX模型和危险状态分析理论进行分析。研究人群为 42 434人 ,随访 2 1年 ,共观察793 10 0 .7人年。结果　室内燃煤空气污染是宣威地区肺癌高发的主要原因 ,改炉改灶措施可以明显降低肺癌死亡率 ,但其效果需实施一段时期以后方可显现出来。吸烟是宣威男性肺癌的一个重要危险因素 ,并有可能上升为主要危险因素。男性队列中各危险因素危险性的大小依次为生活燃料、肺癌家族史、慢性支气管炎病史和吸烟 ;女性队列中为生活燃料、肺癌家族史和慢性支气管炎病史 ;危险状态分类模型可有效确定肺癌高危人群和高危个体。结论　宣威地区肺癌的综合预防策略为一级预防为主 ,并分 3步走 :(1)进一步降低室内空气污染程度 ;(2 )加强和实施戒烟措施 ;(3)Objective To systematically analyze the risk factors of lung cancer in Xuanwei, Yunnan Province, an area with a high prevalence of lung cancer, and in view of the above to propose a comprehensive preventive strategy. Methods A cohort study of 42 434 Xuanwei farmers who were born 1917 195,and still alive on 1 st January 1976 was carried out from 1992 to1996 with a follow up time of 21 years. The data collection was done in two steps. A retrospective cohort study was conducted in the form of questionnaire survey in 1992 to understand the health situation of the interviewees from 1 st January 1976 to 31 st December 1991. In the second stage, a prospective cohort study was conducted to review the death records of the interviewees from 1 st January 1992 to 31 st December 1996. The data thus collected were analyzed by the Mantel Haezel analysis method, COX model and risk state analysis method. Results Indoor air pollution caused by biturminous coal burning is the major risk factor of lung cancer in Xuanwei. Stove improvement decreased the lung cancer mortality rate in both male and female subjects, but its beneficial can be recognized at least 10 years after. Smoking is another important risk factor of lung cancer in males in Xuanwei. In course of a long time since stove improvement smoking will become the major risk factor of lung cancer. The risky factors can be arranged in sequence of riskiness from high to low as bituminous coal burning, family history of lung cancer, personal history of chronic bronchitis, and smoking in males; and bituminous coal burning, family history of lung cancer, and personal history of chronic bronchitis in fermales. The risk state classification model established upon the basis of risk state analysis can be used in identifying effectively high risk population quantitatively for local administrators of health as well as for local residents. Conclusion According to the comprehensive strategy for lung cancer control in Xuanwei, priority should be given to p

关 键 词：肺肿瘤 流行病学研究 预防医学 危险因素 肺癌 宣威地区 

分 类 号：R734.2[医药卫生—肿瘤]