我国两地区上消化道癌症的危险、保护因素和分子流行病学研究

目的为进一步搞清胃、肝和食管癌的危险和保护因素,并以分子流行病学的方法研究其发病的规律。方法选择福建长乐和江苏泰兴癌症高发区,用流行病学病例对照研究的方法,对三种癌症的危险和保护因素以及分子流行病学进行调查。结果福建调查表明：摄食鱼露可能是福建胃癌高发的因素之一。胃癌病例对照研究调查表明：鱼露的摄入和CYP4502E1C2基因与胃癌的高发有关。泰兴调查表明：乙型和丙型肝炎病毒感染、霉变食品摄入、饮用生水等是肝癌的主要危险因素,同时有三项危险因素比无此三项因素发生肝癌的危险度高约22倍（OR=21.96,95%CI6.22-77.50）,如果再加上基因MTHFR677（AnyT）时,肝癌的危险度高约72倍（OR=71.69,95%CI12.84-400.19）。肝癌病例对照研究中还证明冰箱使用、多吃蔬菜和水果、乙肝疫苗接种、饮绿茶是肝癌的保护因素。胃部疾病、幽门螺杆菌感染、吃霉变食品、嗜辣食和饮河水是胃癌的危险因素;饮自来水、吃大蒜和饮绿茶是其保护因素。吸烟、进食快、嗜辣食是食管癌的危险因素,摄食霉变食品和胡椒粉可能也是食管癌的危险因素;饮自来水是其保护因素。单独的GSTM1、GSTT1、GSTP1基因多态性可能与肝癌、胃癌、食管癌的危险无显著直接关系。但当上述基因与肝癌、胃癌、食管癌的主要危险因素发生交互协同作用时提高了患癌的危险度,而GSTT1、GSTP1还可与某些特异危险因素发生拮抗交互作用。结论应针对胃、肝和食管癌主要危险因素采取预防措施：如预防乙型、丙型肝炎病毒和幽门螺杆菌感染,不吸烟,不吃霉变和一些调味品（鱼露、胡椒粉）不要饮用生水和河水,要大力提倡饮自来水和饮绿茶,多使用冰箱,多吃蔬菜和水果,广泛接种乙肝疫苗。

Using case-control study and molecular epidemiological methods to detect risk and protective factors on upper GI cancers in two districts,Southern China

Objective To study the risk and protective factors and using molecular epidemiologic methods to research the etiological rule of gastric and liver cancers.Methods The case-control method was used to detect risk and protective factors for three cancers in Chang-le,Fujian and Taixing,Jiangsu.Results In Chang-le,Fujian,fish sauce intake and gene CYP450 2E1 C2 related with high risk of gastric cancer.The odds ratio of HBV and HCV infection,moldy food intake and drinking rude water was 22 among people (OR=21.96,95%CI6.22~77.50),if they also carried with the gene of MTHFR677(Any T),the OR increased to 72 times (OR=71.69,95% CI 12.84~400.19).Moreover,using refrigerator,intake of fruit and vegetable,inoculation of HBV vaccine,and drinking green tea were protective factors of liver cancer,however,stomach diseases,HP infection,moldy food,bareley porridge and pepper intake were indicated as specific risk factors for gastric and esophageal cancer in Tai-xing.The interaction between GSTT1,GSTT1,GSTP1 and p53 codon 72 any Pro with upper GI cancers was concerned.Conclusions The prevention has been put on the high risk factors such as HBV,HCV infection,non smoking,non intake moldy food and less flavouring (fish sauce,pepper).We have to ask people inoculation of HBV vaccine,drinking disinfection tap water,more using refrigerator,intake more fruit and vegetable.