林州市人民医院9a间食管、贲门癌3933例分析

为进一步了解林州市人群贲门癌和食管癌的发病构成状况及其特征，分析１９８７～１９９５年９ａ间林州市（原林县）人民医院食管和贲门癌收治记录。结果显示：９ａ间，该市医院每年平均行食管和贲门癌手术４３７例，其中，来自林县当地居民１９８例，占４５％。食管癌１１８例，占６０％；贲门癌８０例，占４０％。提示：这一地区贲门癌占有较高的比例。     

Time Trends of Esophageal Cancer Mortality in Linzhou City During the Period 1988-2010 and a Bayesian Approach Projection for 2020

In recent decades, decreasing trends in esophageal cancer mortality have been observed across China.We here describe esophageal cancer mortality trends in Linzhou city, a high-incidence region of esophagealcancer in China, during 1988–2010 and make a esophageal cancer mortality projection in the period 2011–2020using a Bayesian approach. Age standardized mortality rates were estimated by direct standardization to theWorld population structure in 1985. A Bayesian age–period–cohort (BAPC) analysis was carried out in orderto investigate the effect of the age, period and birth cohort on esophageal cancer mortality in Linzhou during1988–2010 and to estimate future trends for the period 2011–2020. Age-adjusted rates for men and womendecreased from 1988 to 2005 and changed little thereafter. Risk increased from 30 years of age until the veryelderly. Period effects showed little variation in risk throughout 1988-2010. In contrast, a cohort effect showedrisk decreased greatly in later cohorts. Forecasting, based on BAPC modeling, resulted in a increasing burden ofmortality and a decreasing age standardized mortality rate of esophageal cancer in Linzhou city. The decreaseof esophageal cancer mortality risk since the 1930 cohort could be attributable to the improvements of socialeconomicenvironment and lifestyle. The standardized mortality rates of esophageal cancer should decreasecontinually. The effect of aging on the population could explain the increase in esophageal mortality projectedfor 2020.     

林州市饮用不同地下水居民食管癌发病现状调查

目的　探讨林州市饮用不同地下水居民食管癌发病现状。方法　通过三级预防保健网 ,对该市饮水类型、水井深度、改水时间、饮水人口、各村食管癌发病数和死亡数进行了调查。结果　饮用山泉水居民食管癌发病率为 141.98/10万 ,饮用浅层地下水居民食管癌发病率为 97.6 7/ 10万 ,饮用深层地下水居民食管癌发病率为 86 .0 6 / 10万。饮用井深 <5 0 m和 >2 5 0 m井水的居民食管癌发病率高于饮用井深 5 0～ 2 5 0 m井水的居民 (P<0 .0 5 )。食管癌发病率山区 >丘陵 >平原。 80年代后由泉水、浅井水改为机井水 ,10～ 15年后食管癌发病率显著下降 (P<0 .0 1)。结论　该地区食管癌高发与饮用地下水类型和深度有关。山泉水、浅层地下水、 >2 5 0 m深层地下水中可能含有致癌促癌物质或缺乏某些物质 ,致使该地区居民食管癌高发     

Risk Factors for Oesophageal Cancer in Linzhou,China: a Case-Control Study

Linzhou City has one of the highest incidences of oesophageal cancer in China, and in the world. A case-control ‍study was here conducted to investigate potential risk factors in this area. Linzhou Cancer Registry was used to ‍identify cases of oesophageal cancer, aged between 30 and 75, diagnosed between January 1998 and April 1999. ‍Three neighbourhood controls were selected for each case, matched according to age, sex and village of residence. A ‍total of 211 cases and 633 controls were interviewed. A strong association was found between socio-economic status ‍and the risk of oesophageal cancer. Increased income, residential space and education were all significantly associated ‍with a decreased risk (OR 0.54, 0.36 and 0.30 respectively). Using a drinking water source other than tap water was ‍significantly associated with an increased risk (OR 5.49). The consumption of beans, vegetables and vinegar all ‍showed a protective effect with odds ratios of 0.37, 0.44 and 0.37 respectively. Preferences for a low salt diet or a high ‍salt diet were both associated with an increased risk. It can be concluded that in Linzhou, oesophageal cancer is a ‍disease related to poverty. Having a drinking water source other than tap water increases the risk of oesophageal ‍cancer. As in other populations, a high consumption of vegetables and beans are associated with a decreased risk and ‍a preference for a high salt diet is associated with an increased risk. ‍     

林州市肿瘤登记的机构设置及质量控制

林州市于1959年起建立了食管癌登记报告制度,于1988年建立了全肿瘤登记报告制度。登记机构由各级诊疗医院和村卫生室、乡（镇）卫生院和市食管癌防治研究所三级卫生机构组成肿瘤防治网络。     

A Population-based Case-control Study on Risk Factors for Gastric Cardia Cancer in Rural Areas of Linzhou

Gastric cancer is the second most common cause of cancer-related deaths in the world. Although certaindietary factors and lifestyles have been suggested to be associated with gastric carcinogenesis, there have beenfew investigations focusing on rural areas. A case-control study was therefore carried out to investigate the riskfactors of gastric cardia cancer (GCC) in rural areas of Linzhou. A total of 470 newly diagnosed cases of GCCand 470 healthy controls were included. Face-to-face interviews were conducted, using a uniform questionnairecontaining questions on demographics, per capita income, living habits, dietary habits and family history oftumors. The relationship between putative risk factors and GCC was assessed by odds ratios (OR) and their 95%confidence intervals (95%CI) derived from conditional logistic regression model by the COXREG commandusing SPSS 12.00. Multivariate logistic regression analysis was used to evaluate simultaneously the effects ofmultiple factors and other potential confounding factors. Multivariate logistic analysis showed that smoking(OR=1.939, 95%CI:1.097-3.426), alcohol drinking (OR=2.360, 95%CI: 1.292-4.311), hot food consumption(OR=2.034, 95%CI: 1.507-2.745), fast eating (OR=1.616, 95%CI: 1.171-2.230), mouldy food (OR=4.564, 95%CI:2.682-7.767), leftover food (OR=1.881. 95%CI: 1.324-2.671), and family history of tumor (OR=2.831, 95%CI:1.588-5.050) were risk factors for GCC. High per capita income (OR=0.709, 95%CI: 0.533-0.942), high educationlevel (OR=0.354, 95%CI: 0.163-0.765), consumption of fresh fruits (OR=0.186, 95%CI: 0.111-0.311) and vegetables(OR=0.243, 95%CI: 0.142-0.415), and high BMI (OR=0.367, 95%CI: 0.242-0.557) were protective factors forGCC. Our data indicate that unhealthy lifestyle and dietary habits might be important contributors to GCC inthis population.     

林州市县-乡-村三级医疗机构接诊疾病类型分析

目的对比分析林州市县-乡-村三级医疗机构接诊的疾病类型,评估该地区三级医疗网络是否有效地解决了常见病和多发病就诊问题。方法收集林州市县-乡-村三级医疗网络中11所医疗机构2013年10月-2015年7月所接诊的疾病信息,进行回顾性对比统计分析。结果县级医疗机构住院患者疾病分类中循环系统疾病的构成比（22.66%）最高,其次是呼吸系统疾病（14.16%）、妊娠分娩和产褥期疾病（14.16%）、肿瘤（10.98%）和消化系统疾病（7.22%）。各乡级医疗机构的接诊能力及接诊病种差异明显,其中姚村卫生院因独有的早期食管癌诊疗特色使肿瘤高居其疾病分类首位,其他乡镇卫生院则以循环系统疾病为主要病种。各村级医疗机构整体以呼吸系统疾病、消化系统疾病为主要疾病。结论林州县-乡-村三级医疗机构间的主要接诊病种既有层次差异又有相互重叠之处;同级医疗机构接收疾病类型存在一定差距,但能满足林州市居民的基本就诊需求。     

河南林州食管癌高发区食管癌和癌前病变患者血清蛋白质质谱

背景与目的:食管癌和癌前病变组织中部分分子改变可在血液中反映出来,但这些指标的灵敏度和特异性较低,临床应用受到限制。血清蛋白质质谱分析技术有助于筛选癌变密切相关蛋白。本研究通过探讨食管癌高发区人群食管正常粘膜(normal,NOR)、食管上皮基底细胞过度增生(basalcellhyperplasia,BCH)、不典型增生(dysplasia,DYS)和食管癌(esophagealcarcinomc,EC)患者的血清蛋白质质谱的变化特征,为筛选和建立早期诊断和高危人群检测的血清学指标提供理论依据。方法:采用弱阳离子结合芯片(WCX2)及表面增强激光解吸电离飞行时间质谱仪(SELDI-TOF-MS)检测EC高发区无症状普查人群130人(NOR63人、BCH40人、DYS27人)和高发区EC30人的血清蛋白质质谱进行分析。应用BiomarkerPattern软件建立决策树分类模型,经10倍交叉验证得到该分类模型进行验证,测试组病变人群的诊断率和特异性(排除率)。结果:BCH组质荷比(M/Z)为M9306.61u的一种、DYS组M/Z为M13765.90u的一种及EC组M/Z为M2942.15u和M15953.40u的两种蛋白质分别建立决策树分类模型,训练组BCH、DYS和EC的敏感性(检出率)分别为57.5%(23/40)、88.8%(24/27)和96.6%(29/30),特异性分别为96.8%(61/63)、63.4%(40/63)和92.0%(58/63);测试组BCH、DYS和EC敏感性分别为57.5%(23/40)、66.6%(18/27)和60.0%(18/30),特异性为95.2%(60/63)、71.4%(45/63)和84.1%(53/63)。结论:M/Z为M9233.09u、M13657.15u、M2918.91u和M15827.37u的4种蛋白质可能包含有可用于食管癌高发区人群筛查的血清标记物,血清蛋白质质谱检测为食管癌和癌前病变的诊断和筛查提供了新的手段。     

山西长治地区健康林州移民及食管鳞癌患者血浆核黄素水平的比较及其意义

目的 探讨核黄素缺乏与食管鳞癌发生的关系.方法 采用ELISA法检测山西长治地区食管鳞癌患者(445例)、长治当地健康人群(689例)及健康林州移民(347例)3组人群的血浆中核黄素水平并比较其差异.结果 长治地区食管鳞癌患者[ (731.69 ±330.67) μg/L]血浆中核黄素水平显著低于长治当地健康人群[(1090.43±445.08) μg/L]和健康林州移民[(897.58±177.78)μg/L],P值均＜0.05;而长治当地健康人群血浆中核黄素水平高于健康林州移民,P＜0.05.结论 在食管鳞癌患者中存在核黄素缺乏现象,长治本地健康人群血浆中核黄素水平高于健康林州移民,具体机制有待于进一步研究.     

河南省林州地区儿童肠道寄生虫感染情况调查

目的为了解林州地区儿童肠道寄生虫的感染情况,尤其是机会性致病原虫和人兽共患寄生虫的流行情况。方法2007年10月至2008年5月,对林州地区8个乡镇进行了调查。采用卢戈氏碘液染色法、饱和蔗糖溶液漂浮法、改良抗酸染色法和分子生物学方法对林州地区23个调查点的1949名15岁以下儿童进行了检测。结果寄生虫总感染率为1.33%（26/1949）,共查出6种肠道寄生虫,其中原虫和蠕虫均为3种,感染率分别为0.72%和0.62%。男女寄生虫感染率分别为1.27%（14/1103）和1.42%（12/846）,差异无统计学意义（P〉0.05）。姚村镇、城郊乡、茶店乡、临淇镇、五龙镇、东姚镇、横水镇和采桑镇儿童感染率分别为1.76%、1.42%、0.83%、2.71%、0.00%、0.74%、1.45%、0.75%和1.33%,各个乡镇之间感染率差异无统计学意义（P〉0.05）。首次摸清了林州地区儿童隐孢子虫感染的流行状况,感染率为0.15%。对分离到的1例等孢球虫进行了分子鉴定,序列分析结果显示与雀类的一种球虫Atoxoplasma sp.（AY331571）最为接近,同源性达99.4%,表明可能为鸟类粪便污染所致。结论 林州地区儿童肠道寄生虫感染率较低,但仍应进一步开展健康教育,普及卫生知识,提高自我保健意识和自我保健能力。预防寄生虫病的发生和流行。