应用病例对照研究方法确定肝癌筛检间隔

文中介绍了筛检研究中确定筛检间隔的病例对照研究设计方法。应用此方法从前瞻性肝癌筛检资料中进行再抽样组成１：４匹配的病例对照，考察了阴性筛检后不同时间对肝癌死亡和发病的保护效应。结果表明在调整了肝病史和肝癌家族史后，这种保护效应在肝癌高危人群中自阴性筛检后一年半左右基本消失，由此建议其筛检的时间间隔以一年左右为宜。     

胃癌个体危险度及人群筛检数量化评价的研究

目的：建立胃癌个体危险度判定及人群筛检的数量化模型。方法：在人群为基础的胃癌危险因素病例对照研究的基础上筛选出有统计学意义变化，应用概率论、模糊数学等原理和方法对胃癌危险因素和保护因素数量化，建立用于个体胃癌危险度测量和人群筛检的数量化评价方法（数学模型）。采用两种不同的加权系数计算方法，分别确定该数量化方法的判别阈值为0．20和0．17，对63例胃癌患者和693名正常人进行实际判别。结果：灵敏度和特异度均分别达到69％和63％左右，加权系数计算方法不同并不影响实际判别效果。结论：建立的胃癌个体危险度及人群筛检的数量化模型灵敏度和特异度尚理想；方法简便、易行、经济，有利于获得满意的受检率；可用于个体和群体（社区）的胃癌危险度测定。     

谷胱甘肽硫转移酶基因GSTM1及GSTT1缺失与肺癌发病关系的研究

在我国肺癌高发区云南省宣威市进行了一次１：１配对的以人群为基础的病例对照研究,共收集８６例新发肺癌病人,并选择８６例与病例相同性别、相同燃料品种,年龄相差２岁以内的宣威居民作为对照。     

膳食,体力活动与大肠癌：病例对照研究

１９８８～１９８９年以大连市市区部分病理学确诊的大肠癌病例１２９例（结肠癌５０例，直肠癌７９例）及其１：１匹配的邻居对照为对象，用病例对照法研究大肠癌的危险因素。用条件ｌｏｇｉｓｔｉｃ回归模型，分析各因素与疾病危险性的联系。分析结果：饱和脂肪摄入及久坐工作或生活方式是最重要的危险因素，体力活动与膳食纤维摄入是最重要的保护因素，对结肠癌的作用尤其明显。     

北京市乳腺癌危险因素病例对照研究

目的：探索北京地区乳腺癌的主要危险因素。方法：采用１：１配对的病例对照研究方法，共押取３５０对样本，进行了多变量的筛检分析。结果：精神、心理因素和良性乳腺疾病史是生物效应较强的主要危险因素，而产后哺乳及常吃玉米为乳腺癌的保护因子。结论：此次研究结果与因内其它城市相关研究结果基本一致，但亦存在一定的地区性差异。     

肝癌高发区HBV感染与肝癌关系的流行病学研究

目的：为了探讨同安县原发性肝癌高发的主要危险因素。方法：应用流行病学调查研究的方法，开展了１：２配对的ＰＨＣ危险因素病例－对照，ＥＬＩＳＡ法的高危人群筛检，ＨＢＶ感染与ＰＨＣ关系的前瞻性研究。结果：ＨＢｓＡｇ携带率病例组高于对照组，抗－ＨＢｓ阳性率病例组低于对照组；ＨＢｓＡｇ携带率病例组高对对照组，抗－ＨＢｓ阳性率病例组低于对照组；ＨＢＳａＧ，ＡＦＰ阳性率男性高于女性，抗－ＨＢｓ阳性率男性低于女性     

饮食因素与慢性消化道疾病关系的病例对照研究

饮食因素与慢性消化道疾病关系的病例对照研究肖梦兰，许秀举，李丰，张虹，李美仙我们对包头市４００例慢性消化道病例作了１：１配比病例对照研究。１．对象与方法：选自包头市４所市级综合医院１９９１年以来经纤维食管胃镜检查确诊的４００例馒性消化道病人（慢性食管...     

临床流行病学 第六讲 诊断性试验研究

一、研究设计：进行诊断试验研究的基本方法是与诊断该病的金标准作官法和同步的比较。1．确立黄金标准（goldstandard）：是指公认的标准的诊断方法，它包括病理学检查（组织活俭和尸体解剖）、外科手术发现、特殊的影像诊断（如用冠状动脉造影诊断冠心病等）以及长期随访临床观察所获得的结论。2．选择研究对象：包括两组，一组是被金标准确诊的病例组，另一组是经金标准证实无该病的人群，即对照组。若研究目的是评价临床诊断价值，对照可来自其他病例，尤其是易与该病混淆的其他病例；若研究目的是评价筛检试验价值，对照应选自筛检人群…     

南四湖区域人群肝癌危险因素的病例－对照研究

对南四湖区域人群肝癌危险因素的病例－对照研究病例９５例，对照９５例。条件Ｌｏｇｉｓｔｉｃ回归分析表明：饮用湖水、作业接触湖水、饮酒和吃鱼为该区肝癌的危险因素，其比值比（ＯＲ）分别为６．５５，３．２４，１．８６，２．５５。对吸烟、用盐量、接触霉变食物、性格、家族肿瘤史和肝炎病史因素的研究结果揭示，可能与该区肝癌发病无关。     

产后出血危险因素病例对照研究

为了研究影响产后出血的危险因素，于１９９１年１０月至１９９２年１月在湖北省随州市进行了一次１：２配比的病例对照研究，以经阴道分娩，出血量达到或超过５００ｍｌ者作为“病例”，以出血量低于２００ｍｌ者作为“对照”。研究对象包括１０９例“病例”和２１８例“对照”，全部在市级医院分娩。利用ＳＡＳ软件采用单因素分析、多元逐步回归分析和多元条件Ｌｏｇｉｓｔｉｃ回归分析估计各危险因素的大小。结果表明：第三产程延长、人均收入低、未进行产前检查、孕期情绪差、劳动强度大、流产史等是影响产后出血的重要因素。     

Colorectal cancer among Chinese restaurant waiters

To investigate whether Chinese restaurant waiters in Hong Kong had an increased risk of dying from colorectal cancer, we linked the records of deceased union members to the mortality information for the general population between 1986 and 1995. A case-control analysis among the deceased was performed with 346 deceased waiters and 306 deceased male kitchen workers. Waiters were found to have a significantly higher mortality odds ratio [(MOR) 2.29; 95% confidence interval (CI) = 1.47-3.56] of colorectal cancer when compared with the general population. The MOR (1.45; 95% CI = 0.71-2.93) was increased, but not significantly, when compared with the kitchen workers. The study suggested that waiters in Hong Kong Chinese restaurants are at a higher risk of dying from colorectal cancer. An unhealthy diet associated with their job is a possible explanation, and interventions should be initiated.     

An analytical method for assessing patterns of familial aggregation in case-control studies.

This paper describes an analytical method that is used to assess patterns of disease aggregation within family based on family history information collected in case-control studies. In such a study, cases and controls are thought of as probands whose relatives are identified, and relatives' phenotypes and other covariates such as age, sex, and genealogical relationship with the probands are recorded. By modeling the dependence of relatives' phenotypes on case-control status and other covariates, this method yields adjusted odds ratios that quantify familial aggregation. The estimated standard errors are obtained for statistical inference since the method acknowledges the potential correlations between relatives' phenotypes by using the estimating equations technique. In population-based case-control studies, the estimates and statistical inferences are generalizable to the general population. To illustrate this method, we analyzed a case-control study of colorectal cancer involving 5,190 relatives of 792 cases and 4,478 relatives of 680 population-based controls conducted in Hawaii. Although detailed results will be presented elsewhere, the colorectal cancer was found to aggregate within family with an odds ratio of 2.74 (95% confidence interval (CI): 1.78-4.21). Among parents, the odds ratio for familial aggregation was 2.38 (95% CI: 1.25-4.54). The corresponding value for siblings was 3.09 (95% CI: 1.87-5.11). It was also found that the odds ratio increases from about 2.00 for relatives of the probands who were 50 years or older to 7.66 and 12.84 for relatives of the probands who were between 40 and 50 years and under 40 years, respectively, suggesting that the familial aggregation of colorectal cancer decreases as probands' age increases.     

基于筛检人群的大肠癌危险因素病例-对照研究

本文应用在大肠癌高发区——浙江省嘉善县进行序贯筛检人群大肠癌的数据库,对检出的41例大肠癌病例和筛检对象中的正常人作1:5配比的病例-对照分析.结果显示:男性中的嗜食肥肉、慢性腹泻史和粘液血便史的相对危险度(OR)分别为2.86、3.70和13.26,P<0.05;女性中的慢性腹泻史、粘液血便史和家族癌肿史的OR分别为7.29、25.0和6.55,P<0.05.     

Interim within-season estimate of the effectiveness of trivalent inactivated influenza vaccine--Marshfield, Wisconsin, 2007-08 influenza season

During clinical trials, the efficacy of vaccination with inactivated influenza vaccines for the prevention of serologically confirmed influenza infection has been estimated as high as 70%-90% among healthier adults. However, the effectiveness of annual influenza vaccination typically is lower during those influenza seasons when a suboptimal match between the vaccine strains and circulating influenza strains is observed. For example, in a 4-year randomized study of influenza vaccine among healthy persons aged 1-65 years, the predominant strain was drifted from the vaccine strain in 2 of the 4 years. Inactivated vaccine effectiveness (VE) against culture-confirmed influenza ranged from 71% to 79% when the vaccine and circulating strains were suboptimally matched to 74% to 79% when the matches were well matched. In contrast, a 2-year study of inactivated influenza vaccine among healthy adults aged 18-64 years found no measurable VE during a year when a poorly matched strain circulated, but found VE of 86% against laboratory-confirmed influenza during the following year when the vaccine and circulating strains were well matched. Although laboratory data on the antigenic characteristics of circulating influenza viruses compared with vaccine strains are available during influenza seasons, estimates of VE usually have not been made until months after the conclusion of the season. This report summarizes interim results of a 2008 case-control study to estimate the effectiveness of trivalent inactivated influenza vaccine for prevention of medically attended, laboratory-confirmed influenza during the 2007-08 influenza season, when most circulating influenza A (H3N2) and B viruses were suboptimally matched to the vaccine strains. Despite the suboptimal match between two of three vaccine strains and circulating influenza strains, overall VE in the study population during January 21-February 8, 2008, was 44%. These findings demonstrate that, in any season, assessment of the clinical effectiveness of influenza vaccines cannot be determined solely by laboratory evaluation of the degree of antigenic match between vaccine and circulation strains.     

大肠癌患者心理社会应激状况及应对方式分析

目的探讨社会心理应激因素对大肠癌患者心理健康状况的影响。方法按照1∶1配对设计,对167对研究对象采用团体心理社会应激量表进行测评。结果病例组与对照组的生活事件L值、积极情绪体验PE值、积极应对PC值分数差异有统计学意义（P〈0.05）;多因素条件Logistic回归显示病例组与对照组在生活事件、情绪体验、应对方式等方面都存在差异。结论负性生活事件和消极的应对方式是大肠癌的危险因素,而积极的情绪体验和积极的应对方式是其保护因素。     

煤矿工人胃癌发病危险因素的流行病学研究

[目的]研究煤矿工人胃癌发病的危险因素。[方法]采用1︰2配对病例对照研究方法,以问卷调查的形式对煤矿工人胃癌发病危险因素进行研究,通过条件Logistic回归单因素和多因素分析筛选主要危险因素。[结果]单因素分析显示15个因素与煤矿工人胃癌可能相关,多因素分析显示慢性胃病史、井下工作年限、粉尘暴露强度、高盐饮食、进食速度快、精神压力大、喜食新鲜蔬菜水果及生蒜与煤矿工人胃癌相关,其中喜食新鲜蔬菜水果及生蒜为保护性因素。[结论]煤矿工人胃癌的发生是多因素共同作用的结果,其中慢性胃病史、井下工作年限、粉尘暴露强度是煤工胃癌发病的主要危险因素。     

Folate, vitamin B6, vitamin B12, and vitamin B2 intake, genetic polymorphisms of related enzymes, and risk of colorectal cancer in a hospital-based case-control study in Japan

We conducted a case-control study to investigate the association of nutrient intake involved in the one-carbon pathway of folate for DNA methylation and DNA synthesis and the related enzyme genetic polymorphisms with colorectal cancer. Cases were 107 patients newly diagnosed with colorectal cancer. Controls were 224 subjects matched with cases by sex, age, and residential area. Nutrient intake was assessed by a self-administered, semiquantitative food-frequency questionnaire. Four genetic polymorphisms-MTHFR C677T and A1298C, MTRR A66G, and ALDH2 Glu487Lys-were determined using blood samples. Odds ratios were calculated using conditional logistic regression analysis adjusted for smoking, alcohol consumption, body mass index, and dietary fiber intake. Although folate intake was inversely associated with colorectal cancer, this association was attenuated after further controlling for dietary fiber intake. Neither vitamin B6, vitamin B12, nor vitamin B2, nor any genetic polymorphism was significantly associated with colorectal cancer. MTRR polymorphism interacted with the association of folate (P for interaction = 0.04) or vitamin (P for interaction = 0.02) with colorectal cancer, although the other polymorphisms did not interact with any nutrient intake. In conclusion, the study did not support the existing hypothesis of gene-nutrient interaction in colorectal carcinogenesis.     

The consumption of well-done red meat and the risk of colorectal cancer.

Heterocyclic aromatic amines and polycyclic aromatic hydrocarbons are mutagens that are produced in highly cooked meats. A case-control study of 511 patients with colorectal cancer and 500 matched control subjects examined whether consumption of well-done cooked beef is related to the risk of developing large bowel cancer. Approximately 16% of men and women consumed well-done beef, and 50% ate medium-cooked beef. For both sexes, there was no association between consumption of well-done or medium-cooked beef and colorectal cancer. This paper discusses whether questionnaire data accurately reflect dietary intake of heterocyclic aromatic amines and polycyclic aromatic hydrocarbons.     

代谢酶基因多态性与结直肠癌的易感性

目的研究代谢酶细胞色素P450（cytochrome P450s,CYP）1A1、谷胱甘肽转移酶（glutathione—S-transferase,GST）M1和T1、尿苷二磷酸葡萄糖醛酸转移酶（UDPglucumnosyltransferase,UGT）1A7基因多态性与结直肠癌的易感性及其交互作用。方法2002年5月在浙江省嘉善县开展的现场病例对照研究及单纯病例研究,获得140例结直肠癌患者和343名健康对照,用PCR-限制性片段长度多态性等方法检测CYP1A1、GSTM1、GSTT1和UGT1A7的基因多态,并应用非条件logistic回归方法进行数据分析。结果CYPIA1 MspI多态（非编码区T6235C）C／C基因型、T／C和C／C基因型者相对于T／T基因型者的OR值分别为0．493（95％CI：0．254—0．956）和0．638（95％CI：0．427—0．952）,具有统计学意义;GSTM1、GSTT1非缺陷型与缺陷型的分布频率对照组和病例组比较差异无统计学意义;对照组和病例组UGT1A7变异／变异型基因与野生纯合型基因比较差异有统计学意义（OR=2．501,95％CI：1．456—4．296）。单纯病例研究分析,CYP1A1与GSTT1、GSTM1与GSTT1对结直肠癌的发生存在交互作用,COR值分别为2．617（95％CI：1．015—6．752）和3．935（95％CI：1．323—11．706）;而CYPlAl与GSTM1、CYP1A1与UGT1A7之间无交互作用。结论CYP1A1 MspI变异型可降低机体对结直肠癌的易感性,而UGT1A7的变异／变异基因型可增加结直肠癌的罹患风险,CYP1A1与GSTT1、GSTM1与GSTT1对结直肠癌的发生存在交互作用。     

A general practice-based recruitment strategy for colorectal cancer screening

OBJECTIVE: To determine whether a screening recruitment strategy for first degree relatives of people with colorectal cancer is effective in enabling eligible relatives to request screening from their general practitioner (GP) and to assess acceptability to GPs and patients. METHODS: Thirty GPs, from 26 practices, and 303 of their patients aged over 50 who were first degree relatives of a person with colorectal cancer, participated in a randomised controlled trial of a GP-based recruitment strategy, in the Newcastle Area of New South Wales, Australia. RESULTS: The proportion of relatives requesting screening was statistically significantly higher in the intervention group than in the control group (18% compared to 4%, respectively; p = 0.01). CONCLUSIONS: Interest in the study by GPs was low, however for GPs who were involved, the recruitment strategy did prompt first degree relatives to discuss screening. The strategy may be even more effective when combined with other interventions such as a media campaign. The results may be generalizable to feasibility studies of general population screening for colorectal cancer in Australia. IMPLICATIONS: The results of this work are potentially informative to public health practice in Australia given the ensuing pilot programs of colorectal cancer screening.