中国人群胃癌发病影响因素的Meta分析  

A meta-analysis of factors influencing the development of gastric cancer in Chinese populations

作　　者：杨丹丹 姚学成 张昕涵 唐梦龄 王建炳 金明娟[1,4] 陈坤 YANG Dandan;YAO Xuecheng;ZHANG Xinhan;TANG Mengling;WANG Jianbing;JIN Mingjuan;CHEN Kun(School of Medicine,Zhejiang University,Hangzhou,Zhejiang 310058,China;The Fourth Hospital Affiliated to Zhejiang University School of Medicine,Jinhua,Zhejiang 322000,China;The Children's Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou,Zhejiang 310005,China;The Second Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou,Zhejiang 310003,China)

机构地区：[1]浙江大学医学院,浙江杭州310058 [2]浙江大学医学院附属第四医院,浙江金华322000 [3]浙江大学医学院附属儿童医院,浙江杭州310005 [4]浙江大学医学院附属第二医院,浙江杭州310003

出　　处：《预防医学》2022年第6期561-570,共10页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：浙江大学空气污染与健康研究中心2015年项目(H20151885)。

摘　　要：目的探讨中国人群胃癌发病的影响因素,为建立中国人群胃癌发病预测模型提供依据。方法检索中国知网、万方数据知识服务平台、维普中文期刊服务平台、PubMed、Web ofScience和Embase等中英文数据库,收集建库至2021年9月30日发表的中国人群胃癌发病影响因素的病例对照和队列研究文献,采用R 4.1.0软件进行Meta分析;采用逐篇剔除法进行敏感性分析;采用Egger回归法和剪补法评价发表偏倚。结果检索文献5301篇,最终纳入分析116篇,包括103项病例对照研究和13项队列研究,样本量约323万人。收集胃癌发病影响因素45个,其中7个因素的文献数<4篇,仅进行定性描述;38个因素进行Meta分析。Meta分析结果显示,消化道疾病史(合并OR=4.85,95%CI:3.74~6.29)、幽门螺杆菌(Hp)感染(合并OR=3.18,95%CI:2.35~4.32)、暴饮暴食(合并OR=2.88,95%CI:2.09~3.97)、肿瘤家族史(合并OR=2.78,95%CI:2.17~3.56)等21个因素是胃癌发病的危险因素;蔬菜摄入(合并OR=0.48,95%CI:0.38~0.61)、饮茶(合并OR=0.55,95%CI:0.47~0.64)、使用阿司匹林(合并OR=0.53,95%CI:0.31~0.92)、使用他汀类药物(合并OR=0.59,95%CI:0.44~0.80)等10个因素是胃癌发病的保护因素。常吃霉变食物、白肉摄入、偏好辣食和使用磺酰脲类药物的敏感性分析结果不稳健。经济收入高、糖尿病、使用他汀类药物、饮酒、饮茶和白肉摄入经剪补法修正后仍提示存在发表偏倚。结论胃癌发病与消化道疾病史、Hp感染史、肿瘤家族史和不良饮食习惯等有关,在建立中国人群胃癌发病预测模型时可考虑纳入相关因素。Objective To investigate the factors influencing the development of gastric cancer in Chinese populations,so as provide insights into creating a model for predicting gastric cancer incidence among Chinese populations.Methods The case-control and cohort studies pertaining to factors affecting the development of gastric cancer were retrieved in electronic Chinese and English databases,including CNKI,Wanfang Data,VIP,PubMed,Web of Science and Embase from their inception until September 30,2021.A meta-analysis was performed using R package version 4.1.0.Sensitivi⁃ty analysis was performed using the“leave-one-out”evaluation procedure,and the publication bias was evaluated using the Egger regression test and the trim-and-fill procedure.Results A total of 5301 publications were screened and 116 eligible studies were included in the final analysis,including 103 case-control studies and 13 cohort studies,which covered approximately 3.23 million study subjects.A total of 45 factors affecting the development of gastric can⁃cer were collected,and there were less than 4 publications reporting 7 factors,which were only qualitatively described.There were 38 factors included in the final meta-analysis.A total of 21 factors were identified as risk factors of gastric cancer,including a history of gastrointestinal diseases(pooled OR=4.85,95%CI:3.74-6.29),H.pylori infection(pooled OR=3.18,95%CI:2.35-4.32),binge eating and drinking(pooled OR=2.88,95%CI:2.09-3.97)and a family history of tu⁃mors(pooled OR=2.78,95%CI:2.17-3.56),and 10 factors as protective factors,including vegetable intake(pooled OR=0.48,95%CI:0.38-0.61),tea consumption(pooled OR=0.55,95%CI:0.47-0.64),administration of aspirin(pooled OR=0.53,95%CI:0.31-0.92)and administration of statins(pooled OR=0.59,95%CI:0.44-0.80).Sensitivity analyses of eat⁃ing moldy food frequently,white meat intake,favoring spicy food and administration of sulfonylureas were not robust.Following correction with the trim-and-fill procedure,there was still a publication bias pertaining

关 键 词：胃癌 影响因素 META分析 中国人群 

分 类 号：R735.2[医药卫生—肿瘤]