临饮水类型与结直肠癌发病率关系的前瞻性队列研究  

Association of Drinking Water Source and Colorectal Cancer Incidence: A Prospect Cohort Study

作　　者：陈坤[1] 俞维萍[1] 马新源[2] 姚开颜[2] 郑树[3] 蒋沁婷[1] 

机构地区：[1]浙江大学公共卫生学院流行病与卫生统计学教研室,浙江杭州310031 [2]嘉善县肿瘤防治所,浙江嘉善314100 [3]浙江大学医学院肿瘤研究所,浙江杭州310009

出　　处：《癌症》2004年第5期550-554,共5页Chinese Journal of Cancer

基　　金：国家自然科学基金项目(No.30170828)~~

摘　　要：背景及目的:以往的研究认为,饮用河水、池塘水等易被污染的地表水,其结直肠癌发病率明显高于其他水源,但少见直接基于人年发病率的前瞻性队列研究,本研究旨在通过调查队列人群,探讨不同饮水类型与结直肠癌发病的关系。方法:以浙江嘉善县1989年5月～1990年4月期间,参加结直肠癌筛检的10个乡镇30岁及以上人群共64115人为研究队列,按不同饮水类型建立5组不同的暴露人群,通过肿瘤登记、肠癌报卡和死亡登记等系统对队列进行随访,观察结直肠癌发病及人群死亡截尾情况。随访11年后,以个人为单位计算人年,分析不同饮水类型的结肠、直肠癌人时发病率,并应用Poisson回归估计调整人群特征及吸烟等混杂因素后的相对危险度(RR)。结果:长期饮用自来水、河水、泯沟水、混和水和井水者结直肠癌人时发病率依次增高,分别为29.61/10万、32.67/10万、33.45/10万、40.87/10万和58.67/10万;以发病率最低的饮用自来水者为参照,只有饮用井水者与之有显著性差异(P<0.05)。多因素Poisson回归调整混杂因素后,也只有饮用井水与结肠癌、直肠癌和结直肠癌发病有显著性相关,RR值分别为1.741(95%CI1.001～3.029)、2.228(95%CI1.432～3.466)和2.022(95%CI1.432～2.854)。结论:长期饮用井水是嘉善地区结直肠癌发病的危险因素,尤其是对直肠?BACHGROUND &OBJECTIVE: The pollution of drinking water, for example river and pool, has long been recognized to be associated with an increased risk of colorectal cancer (CRC) in previous epidemiological studies. There is little prospect cohort study with person years directly on the relative risks of different sources of drinking water for CRC. METHODS: From May 1989 to April 1990, a screening for CRC was carried out among residents aged 30 and over 30 years in 10 villages and towns of Jiashan in China. A total of 64115 residents who participated the screening were classified into 5 cohorts by the source of drinking water and were followed up for CRC incidence through a tumor reporting system including a rapid reporting system of CRC Registry and for death instance through Death Registration of Jiashan. After 11 years of follow up, person years calculated with every cohort member, the incidence densities of CRC with different sources of drinking water were analyzed respectively. Poisson regression was used to control potential confounding variables including demography variables and smoke history and to attain crude and adjusted relative risks based on person years. RESULTS: A trend was seen toward increasing incidence rates of colorectal cancer from municipal, river, channel, mixed water to well source in turn as shown as 29.61, 32.67, 33.45, 40.87, 58.67 per 100,000 inhabitants, and only the role in risk of well water was marked different from municipal water (P< 0.05). After adjusted the confounding variables by multi Poisson regression, we found the significant risk of drinking well water for colon cancer, rectal cancer, and colorectal cancer. The relative risks were 1.741 (95%CI 1.001 3.029), 2.228 (95%CI 1.432 3.466), and 2.022 (95%CI 1.432 2.854), respectively. CONCLUSION: Drinking well water long is a risk factor for colorectal cancer in Jianshan, especially for rectal cancer.

关 键 词：饮水类型 结直肠癌 发病率 前瞻性 队列分析 

分 类 号：R735.3[医药卫生—肿瘤]