基于大型数据库链接后队列的结直肠癌危险因素巢式病例对照研究  

A Nested Case-control Study of Risk Factors for Colorectal Cancer Based on a Large Database Linked Cohort

作　　者：臧钊平 孙可欣 张梅[3] 郑荣寿 赵艳芳[3] 张思维 张笑[3] 王丽敏[3] 魏文强 刘芬 ZANG Zhao-ping;SUN Ke-xin;ZHANG Mei;ZHENG Rong-shou;ZHAO Yan-fang;ZHANG Si-wei;ZHANG Xiao;WANG Li-min;WEI Wen-qiang;LIU Fen(School of Public Health,Beijing Municipal Key Laboratory of Clinical Epidemiology,Capital Medical University,Beijing 100069,China;National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;National Center for Chronic and Non-Communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100081,China)

机构地区：[1]首都医科大学公共卫生学院,北京市临床流行病学重点实验室,北京100069 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院,北京100021 [3]中国疾病预防控制中心慢性非传染性疾病预防控制中心,北京100081

出　　处：《中国肿瘤》2023年第3期226-233,共8页China Cancer

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-061)。

摘　　要：[目的]探讨我国结直肠癌发病相关影响因素及多种因素联合暴露与结直肠癌发病风险的关联。[方法]基于中国慢性病及其危险因素监测项目数据与中国肿瘤登记数据链接、匹配后的数据库开展巢式病例对照研究。共纳入结直肠癌病例755例,1∶4匹配对照共3 004例。采用条件Logistic回归模型计算各因素与结直肠癌发病风险的比值比(OR)和95%置信区间(CI),并基于弗明汉风险评分函数计算每个个体不同因素联合暴露评分。[结果]在校正多种混杂因素后,目前吸烟(OR=1.765,95%CI:1.408~2.211)、目前饮酒(OR=1.370,95%CI:1.122~1.674)、日均静坐时长超过4 h(OR=1.843,95%CI:1.382~2.456)、体质指数(body mass index,BMI)为超重(OR=1.241,95%CI:1.027~1.501)或肥胖(OR=1.564,95%CI:1.217~2.009)、每天吃红肉类食物(OR=1.445,95%CI:1.185~1.763)、不经常吃蔬菜(OR=1.650,95%CI:1.196~2.278)、患有高血压(OR=1.634,95%CI:1.350~1.978)和糖尿病(OR=1.749,95%CI:1.389~2.204)以及有癌症家族史(OR=1.880,95%CI:1.324~2.668)为结直肠癌发病危险因素。联合暴露评分结果显示,最高四分位数组发生结直肠癌的风险为第一四分位数组的4.186倍(95%CI:3.192~5.490)。[结论]目前吸烟、饮酒者、久坐、超重或肥胖且有不良饮食习惯者以及患有高血压、糖尿病、有癌症家族史者是结直肠癌的高危人群,应重点关注。此外,上述多种危险因素联合作用会更为显著地增加结直肠癌发病风险。[Purpose] To investigate the influential factors associated with the development of colo-rectal cancer in China and the association between combined exposure to multiple factors and the risk of colorectal cancer development. [Methods] A nested case-control study was conducted based on data from the Chinese Chronic Disease and its Risk Factors Surveillance Program and a database matched with the linked Chinese cancer registry data. A total of 755 colorectal cancer cases and 3 004 matched control cases(at a ratio of 1∶4) were included. Conditional Logistic regression models were used to calculate the odds ratio(OR) and 95% confidence interval(CI) of each factor to the risk of colorectal cancer, and the combined exposure scores of different factors were calculated for each individual based on the Framingham risk score function. [Results] After correcting for multiple confounders, current smoking(OR=1.765, 95%CI: 1.408~2.211), current alcohol consumption(OR=1.370, 95%CI: 1.122~1.674), average daily sedentary time >4 h(OR=1.843,95%CI: 1.382~2.456), and overweight(OR= 1.241, 95%CI: 1.027~1.501) or obese(OR=1.564,95%CI: 1.217~2.009), daily consumption of red meat(OR=1.445, 95%CI: 1.185~1.763), less vegetable consumption(OR =1.650, 95% CI: 1.196 ~2.278), hypertension(OR =1.634, 95% CI:1.350~1.978), diabetes(OR=1.749, 95%CI: 1.389~2.204), and family history of cancer(OR=1.880, 95%CI: 1.324~2.668) were risk factors for colorectal cancer development. The results of the combined exposure score showed that the risk of colorectal cancer in the highest quartile group was 4.186 folds(95%CI: 3.192~5.490) higher than that in the first quartile group. [Conclusion]Current smokers, alcohol drinkers, people who are sedentariness, overweight or obese and have poor dietary habits, as well as people with hypertension, diabetes and family history of cancer are high-risk groups for colorectal cancer and should be given priority attention. In addition, the combined effect of multiple risk factors mentioned above could significantly increa

关 键 词：结直肠癌 巢式病例对照 危险因素 

分 类 号：R73-31[医药卫生—肿瘤] R735[医药卫生—临床医学]