青少年直肠癌发病危险因素分析与防治

目的：探讨青少年直肠癌发病危险因素及防治策略。方法：选择随访至今发生的直肠癌青少年存活病例45例,及45名与病例匹配的同年龄、同性别、同居住地的非直肠癌健康者,采用1∶1配对的病例对照研究方法,以条件Logistic回归法分析各因素与直肠癌的关系。结果：食用红色肉及肥肉（OR=3.634）、食用腌制品（OR=5.865）、情绪自我调节能力差（OR=2.057）、粘液血便史（OR=7.588）、肠息肉史（OR=7.857）、家族结直肠癌史（OR=10.936）与结直肠癌发病呈正相关,P〈0.01;而食用蔬菜水果（OR=0.597）与结直肠癌发病呈负相关,P〈0.01。结论：食用红色肉及肥肉、食用腌制食品、情绪自我调节能力差、粘液血便史、肠息肉史、家族结直肠癌史是直肠癌发病危险因素,而食用蔬菜水果是直肠癌发病的保护因素。因此,防治青少年直肠癌,除需特别重视个人病史及家族史外,可以从改变饮食习惯和加强精神心理辅导等方面着手。     

肠息肉与结直肠癌发病关系队列研究

目的研究肠息肉与结直肠癌发病之间的关系.方法以1989年5月～1990年4月,参加浙江省嘉善县大肠癌筛查的10个乡镇30岁及以上人口为研究队列,按是否具有肠息肉分为暴露组和非暴露组,从1990年5月～2000年1月进行随访,应用回顾性队列研究的方法,对结直肠癌发病率进行分析,并作相对危险度(RR)估计.结果暴露组和非暴露组的结直肠癌发病率具有显著性差异(P＜0.05),Logistic回归分析表明,控制年龄因素后,肠息肉史仅在男性结肠癌表现出有统计学意义,有肠息肉史者结肠癌的发病风险较无肠息肉史者高10余倍,RR为10.79,95%可信限为3.802～30.605.结论肠息肉史与结肠癌的发病有关,肠息肉史是结肠癌的重要危险因子.     

贲门癌危险因素病例对照研究

目的：探讨贲门癌发生的危险因素，为深入进行病因学研究提供线索。方法：对福州市6所医院2000年和2001年4月至7月的住院病人603例进行多组病例对照研究。贲门癌组为病理、手术和胃镜确诊的贲门癌191例，非贲门部胃癌190例，健康对照组为与肿瘤病例同期住院的骨科、泌尿外科的非肿瘤病人222例。采用统一调查表进行床边询问，对资料进行单因素及多因素Logistic分析。结果：贲门癌的主要危险因素有一一级亲属患肿瘤（OR＝4．286 95％CI：2．431－7．554）、进食速度快（OR＝2．028 95％ CI：1．142－2．912）、三餐不按时吃（OR＝1．909 95％ CI：1．396－2．610）、饮用井水（OR＝1．741 95％CI：1．042－2．910）每日吸烟量多（OR＝1．347 95％CI：0．989－1．835）。主要保护 因素有：常吃新鲜水果（OR＝0．645 95％CI：0．439－0．945）、使用冰箱年数长（OR＝0．731 95％CI：0．536－0．997）、化程度高（OR＝0．468 95％CI：0．276－0．74）。结论： 贲门癌与非贲门部胃癌可能有不同的危险因素，值得进一步研究。     

男性不育症危险因素的病例对照研究

目的：探讨男性不育症的危险因素，方法：对94对病例和对照1：1配比进行病例对照研究。结果：长期大量吸烟（OR＝3．45，95％ CI：1．95－6．10）、婚外性生活史（OR＝7．29，95％CI：2．54－20．89）、高温大棚蔬菜种植（OR＝6．73，95％CI：1．91－23．69）、苯类化学品接触（OR＝20．53，95％CI：4．67－90．25），解脲支原体感染（OR＝5．55，95％CI：2．8－13．533）与男性不育症有关联，为其危险因素，结论：男性不育症是由多种因素长期反复作用的结果，其预防应从整治环境污染，加强职业防护，提高自我防护能力，改变不良工作生活习惯等方面做起。     

胃癌发病危险因素的病例对照研究

目的 探讨胃癌发病的危险因素。方法 以本院确诊的70例胃癌病例作为病例组，按性别、年龄、民族、居住地作为配比条件选取70名健康人群进行1：1配对的病例配对研究。并将研究因素进行条件的Logistic回归分析。结果 多因素条件Logistic回归分析显示胃癌发病与保护因素新鲜蔬菜水果(OR=0．232，95％CI=0．067—0．797)、危险因素盐腌食物(OR=7．215，95％CI=1．149—45．307)、慢性胃病史(OR=3．015，95％CI=1．021-8．904)和家族肿瘤史(OR=5．354，95％CI=1．506-19．036)关系密切。结论 多吃新鲜蔬菜水果，少吃盐腌食物，积极治疗慢性胃病可减少胃癌的发病。     

慢性阻塞性肺疾病危险因素病例对照研究

目的探讨慢性阻塞性肺疾病（COPD）发病的相关危险因素，为开展COPD的一级预防提供依据。方法采用按年龄±3岁进行1：1配比的病例一对照研究方法，对435例来源于2003年1月-2006年4月某市级医院的COPD患者及其对照者应用条件Logistic回归进行危险因素分析。结果单因素分析结果显示，性别（OR=1．802，95％CI：1．385--2．346）、药物过敏史（OR=4．346，95％CI：2．838～6．657）、吸烟（OR=2．857，95％CI：2．145～3．807）、吸烟年限〉10a（OR=2．719。95％CI：2．041～3．621）、日吸烟量〉10支（OR=2．250，95％CI：1．601～3．161）、开始吸烟年龄≤20岁（0R=1．909，95％CI：1．140。3．198）、吸烟指数大于300年支（OR=2．241，95％CI：1．645-3．054）和高血糖（OR=2．469，95％CI：1．772～3．441）为COPD的危险因素。多因素分析结果显示，性别（OR=1．595，95％CI：1．124～2．264）、药物过敏史（OR=4．029，95％（CI：2．411～6．735）、吸烟（OR：2．635，95％CI：1．844～3．764）和高血糖（OR=2．390，95％CI：1．632-3．502）为COPD的危险因素。结论男性、药物过敏史、吸烟和高血糖为COPD的主要危险因素。     

尿石症危险因素人群病例对照研究

目的 探索尿石症发病的危险因素，为人群预防提供依据。方法 选取深圳市尿石症现况调查发现的334例患者为病例组，721名健康者为对照组，进行尿石症危险因素人群病例对照研究；采用非条件logistic回归对34个变量进行分析，采用Falconer回归法估算遗传变。结果 尿石症病例组和对照组配比条件均衡可比，单因素logistic回归分析共有17个变量有统计学意义，但最终进入模型的因素有10个，其中4个变量为尿石症发病危险因素，OR值大小依次为既往泌尿系慢性炎症史（OR＝4.09,95%CI:1.38-12.14)，一级亲属尿石症史（OR＝2.61,95%CI:1.70-4.01)和多食动物蛋白质（OR＝2．14，95％CI：1．71－2．69），暴露日照时间长（OR＝1．39，95％CI：1．16－1．66）；而较高文化程度（OR＝0．46，95％CI：0．29－0．73），日引水量多（OR＝0．59，95％CI：0．48－0．72），饮果汁（OR＝0．41，95％CI：0．18－0．94），多食奶及奶制品（OR＝0．82，95％CI：0．68－0．99），多食蔬菜（OR＝0．70，95％CI：0．55－0．91）和多食水果（OR＝0．78，95％CI：0．64－0．94）6个变量为尿石症发病的保护因素。一级亲属尿石症患病率病例组高于对照组，尿石症分离比为0．0109，95％CI：0．0050－0．0168，一级亲属尿石症的遗传度为28．48％，男，女分别为32．06％和24．60％。结论 尿石症主要受饮食习惯影响，尿石症家族史和社会经济状况也与发病有关。     

隐睾发生的危险因素研究

目的：研究隐睾发生的危险因素。方法：采用以医院为基础的1：2配比的病例对照研究方法，按统一的调查方法对99例隐睾及198例对照组面对面问卷调查。应用SAS6。12软件对所调查因素进行单因素及多因素logistic回归分析，结果：胎儿隐睾与母亲孕早期感冒伴发热（OR＝9．37，95％CI：2．25－39．09），孕期发生先兆流产（OR＝4．66，95％CI，2．02＝10．74），孕期发生先兆子痫（OR＝16．33，95％CI：1．40－191．20），父亲职业性接触农药（OR＝12．79％CI；2．90－56．43），低出生体重（OR＝5．77，95％CI：1．39－23．98），母亲怀孕年龄＜24（OR＝2．89，95％CI：1．29－4．06）呈正相关。结论：母亲孕早期感冒伴发热，孕期发生先兆流产及先兆子痫，父亲职业性接触农药，低出体重，母亲怀孕年龄＜24岁是隐睾发病的主要危险因素。     

胃腺癌危险因素的病例对照研究

目的 探讨与胃癌有关的危险因素。方法 对天津市区1998－1999年的189例新发胃癌病人进行1：1配对病例对照研究,采用条件Logistic回归分析。结果 烟熏食品OR＝2．34,OR95％CI＝1．60－4．98;吸烟量OR＝6．07,OR95％CI＝1．26－7．16;喜食重盐饮食OR＝1．95,OR95％CI＝1．27－3．23;过量摄入动物肉类OR＝1．46,OR95％CI＝1．05－2．02。结论 经常食用烟熏食品、吸烟量大、重盐饮食、过量摄入动物肉类等可能是胃癌的危险因素。     

福建省贲门癌病例对照研究

目的：探讨贲门癌发生的危险因素,为病因学研究提供线索。方法：对福州市6所大医院2000年4－7月的住院病人进行多组病例对照研究,其中男性287例（82．5％）,女性61例（17．5％）,病例组为经病理,手术或胃镜确诊的贲门癌病例93例,非贲门部胃癌病例85例及非消化道肿瘤病例73例,对照组为与肿瘤病例同期住院的骨,泌尿外科的非肿瘤病例97例,采用统一调查表进行床边询问,内容包括一般人口学特征,身高,体重体,吸烟,饮酒,饮食状况,既往疾病史,家族肿瘤史等,对资料进行单因素及多因素Logistic分析。结果：贲门癌的危险因素有每日吸烟量（OR＝1．76,95％CI：1．19－2．58）,10年前食用猪油（OR＝4．24,95％CI：2．01－8．92）,父母患胃癌（OR＝3．78,95％）,CI：1．06－13.41）,胃部疾病史（OR＝3。19,95％CI：1．46－6．96）,常吃新鲜蔬菜（OR＝0．21,95％CI：0．07－0．62）,豆及豆制品（OR＝0．29,95％CI：0．09－0．92）为保护因素。结论：贲门癌与非贲门部胃癌可能有不同的危险因素,值得进一步研究。     

非甾体类抗炎药对肠息肉及结、直肠癌保护作用的病例对照研究

目的　研究非甾体类抗炎药 (NSAIDs)对肠息肉、结肠癌及直肠癌的保护作用。方法　将 2 0 0 0年 5月至 2 0 0 1年 7月来医院进行结肠镜检查的病人中诊断为结肠癌 (10 5例 )、直肠癌 (14 2例 )及结直肠息肉 (37例 )的患者设为病例组 ,肠炎及未见异常者为对照组 (6 6例 )。对病例组和对照组采用会晤调查的方法回顾过去服用NSAIDs史 ,同时调查其家族史、生活行为及日常饮食情况。采用Egert软件进行logistic回归分析。结果　单因素分析结果表明 ,NSAIDs对肠息肉、结肠癌及直肠癌有明显的保护作用 ,经多变量logistic回归分析其保护作用增强 ,OR值分别 0 2 1(95 %CI为 0 0 7～ 0 6 5 ,P =0 0 0 7)、0 13(95 %CI为 0 0 5～ 0 35 ,P <0 0 0 1)及 0 15 (95 %CI为 0 11～ 0 5 8,P <0 0 0 1)。阿司匹林单因素分析结果表明 ,阿司匹林对肠息肉也有明显的保护作用。logistic回归分析结果显示 ,在控制其他因素的条件下 ,阿司匹林的保护作用加强 ,OR值分别为 0 2 7(95 %CI为 0 0 7～ 0 96 ,P =0 0 4 4 )、0 10 (95 %CI为 0 0 3～ 0 35 ,P <0 0 0 1)、0 ,15 (95 %CI为 0 0 4～ 0 4 9,P =0 0 0 2 )。对布洛芬单独分析结果表明 ,布洛芬对结肠癌和直肠癌均有明显的保护作用 ,但logistic回归分析结果显     

嘉善县286例大肠癌病例－对照研究

为探讨大肠癌发病的高危因子，对大肠癌高发区嘉善县进行了大肠癌病例－对照研究。经条件Ｌｏ－ｇｉｓｔｉｃ回归单因素分析结果发现计会环境因素中的高危因子有：精神刺激史、文盲以及吃红烧鱼者等，与大肠癌相关的症侯有：慢性腹泻、便秘、粘液血便、服导泻药史等；其中发现保护因素有：哮喘史及饮酒。以上各因素经条件Ｌｏｇｉｓｔｉｃ回归模型多因素分析调整后进入模型的有：粘液血便（ＯＲ＝３７．０２，９５％ＣＬ１３．１４～１０４．３）、慢性腹泻（ＯＲ＝５．１８６，９５％ＣＬ２．１０１～１２．８０）、饮酒（ＯＲ＝０．３５５，９５％ＣＬ０．１５９～０．７９５）。此外还发现有家族大肠癌史者大肠癌发病年龄提前，有家族肿瘤史的女性直肠癌相对危险增高，遗传因素在大肠癌发病过程中起一定的作用。     

病例对照研究分析膳食与炎症危险因素与结直肠癌的关系

目的：膳食与炎症被认为是结肠癌重要危险因素。本次研究中通过病例对照研究分析膳食炎症指数与结直肠癌发生风险。方法研究包括1225例结肠癌患者,728例直肠癌患者以及医院住院的非肿瘤患者4154例作为对照。膳食炎症指数计算依据一份包括78个项目食物频率问卷表。 Logistic回归分析模型用于鉴定校正后的年龄、性别、教育背景、BM I指数、饮酒、体育活动和结直肠癌家族史的 OR值。结果膳食炎症指数较高的参数为结直肠癌患病高风险因素,膳食炎症指数为连续性变量的 OR值1．13,95％ C I：1．09～1．18;膳食炎症指数为分类变量的 OR值1.55,95％ C I：1.29～1．85。结论根据本次研究结果发现促炎饮食可增加结直肠癌的发病风险。     

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.     

Oral contraceptive use does not protect against large bowel cancer

The association between oral contraceptive (OC) use and colorectal cancer was examined in 190 female colorectal cancer cases and 200 age-matched female controls in data derived from a population-based study of large bowel cancer, "The Melbourne Colorectal Cancer Study" conducted in Melbourne, Australia. There were 47 cases (24 colon cancer, 23 rectal cancer cases) and 39 controls, who were past OC users. After adjustment was made for the confounding factors of age, number of children and age at birth of first child, a statistically significant risk was found among rectal cancer OC users, but not among colon cancer OC users (RR rectal cancer = 2.04, 95% CI = 1.00-4.14, p = 0.04; RR colon cancer = 1.17, 95% CI = 0.59-2.29, p = 0.60). These risks were not affected by adjustment for socioeconomic level, country of birth, religion, previous diet and family history of colorectal cancer. Rectal cancer risk was higher among those OC users who were also beer drinkers (RR = 6.96, 95% CI 2.09-23.1, p = 0.001).     

Moderate beer consumption and the risk of colorectal cancer

The relationship between beer consumption and the risk of colon and rectal cancer was considered in a case‐control study conducted in northern Italy. The study was based on 828 histologically confirmed incident cases of colon cancer, 498 of rectal cancer, and 2,024 controls in hospital for a wide spectrum of acute, nonneoplastic, nonalcohol‐related diseases. Beer drinking was reported by 6% of colon cancer cases, 7% of rectal cancer cases, and 10% of controls; regular beer drinkers (≥1 drinks/day) made up 2.6% of colon cancer cases, 3.2% of rectal cancer cases, and 4.1% of controls. Thus the multivariate relative risks (RR) for irregular drinkers were 0.6 [95% confidence interval (CI) 0.4–1.0] for colon and 0.7 (95% CI 0.4–1.2) for rectum. Corresponding values for regular drinkers were 0.7 (95% CI 0.4–1.2) for colon and 0.9 (95% CI 0.5–1.5) for rectal cancer. Despite the low frequency of beer drinking in this study, and hence its limited statistical power, the originality of the population in terms of colorectal cancer incidence, patterns of risk factor exposure, and the large dataset provide interesting and useful confirmation that moderate beer drinking is not associated with elevated colon or rectal cancer risk.     

Childhood body mass index and height in relation to site-specific risks of colorectal cancers in adult life

As colorectal cancers have a long latency period, their origins may lie early in life. Therefore childhood body mass index (BMI; kg/m²) and height may be associated with adult colorectal cancer. Using a cohort design, 257,623 children from The Copenhagen School Health Records Register born from 1930 to 1972 with measured heights and weights at ages 7 to 13 years were followed for adult colon and rectal adenocarcinomas by linkage to the Danish Cancer Registry. Hazard ratios (HRs) with 95% confidence intervals (CI) were estimated by Cox proportional hazard regressions. During follow-up, 2676 colon and 1681 rectal adenocarcinomas were diagnosed. No sex differences were observed in the associations between child BMI or height and adult colon or rectal cancers. Childhood BMI and height were positively associated with colon cancer; at age 13 years the HRs were 1.09 (95% CI 1.04–1.14) and 1.14 (95% CI 1.09–1.19) per z-score, respectively. Children who were persistently taller or heavier than average, had increased risk of colon cancer. Similarly, growing taller or gaining more weight than average was positively associated with colon cancer. No associations were observed between BMI or height and rectal cancer. Childhood BMI and height, along with above average change during childhood are significantly and positively associated with adult colon cancers, but not with rectal cancer, suggesting different etiologies.     

Bowel movement, state of stool, and subsequent risk for colorectal cancer: the Japan public health center-based prospective study

PURPOSE: Evidence about whether irregular bowel movements or unusual stool conditions are associated with colorectal cancer is still inconsistent. METHODS: We identified 479 newly diagnosed cases of colorectal cancer (303 men and 176 women) during a 7.9-year follow-up of a cohort consisting of 57,940 subjects (27,529 men and 30,411 women) aged 40 to 69 years at baseline. Bowel movements and stool conditions were asked through a self-administered questionnaire. RESULTS: Neither high nor low frequency of bowel movements was associated with colorectal cancer incidence compared with one bowel movement per day. Multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for two bowel movements or more per day were 1.03 (95% CI, 0.76-1.41) in men and 1.16 (95% CI, 0.68-2.00) in women. HRs for two to three bowel movements per week were 0.97 (95% CI, 0.61-1.55) in men and 0.75 (95% CI, 0.49-1.13) in women. There was no clear association between an unusual stool state, such as diarrhea or hard stools, and colorectal cancer. CONCLUSION: Our results suggest that neither bowel movement frequency nor any specific state of stool causes colorectal cancer.     

Diabetes Mellitus and Site-specific Colorectal Cancer Risk in Korea: A Case-control Study

Objectives:

Previous large-scale cohort studies conducted in Korea have found a positive association between diabetes mellitus (DM) and colorectal cancer (CRC) in men only, in contrast to studies of other populations that have found significant associations in both men and women.

Methods:

A total of 1070 CRC cases and 2775 controls were recruited from the National Cancer Center, Korea between August 2010 and June 2013. Self-reported DM history and the duration of DM were compared between cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by binary and polytomous logistic regression models.

Results:

DM was associated with an elevated risk of CRC in both men (OR, 1.47; 95% CI, 1.13 to 1.90) and women (OR, 1.92; 95% CI, 1.24 to 2.98). This association remained when we controlled for age, body mass index, alcohol consumption, and physical activity level. In sub-site analyses, DM was associated with distal colon cancer risk in both men (multivariate OR, 2.04; 95% CI, 1.39 to 3.00) and women (multivariate ORs, 1.99; 95% CI, 1.05 to 3.79), while DM was only associated with rectal cancer risk in women (multivariate OR, 2.05; 95% CI, 1.10 to 3.82). No significant association was found between DM and proximal colon cancer risk in either men (multivariate OR, 1.45; 95% CI, 0.88 to 2.41) or women (multivariate OR, 1.79; 95% CI, 0.78 to 4.08).

Conclusions:

Overall, DM was associated with an increased risk of CRC in Koreans. However, potential over-estimation of the ORs should be considered due to potential biases from the case-control design.     

Prospective study on milk products, calcium and cancers of the colon and rectum

OBJECTIVE: To study the relationship between consumption of milk and milk products, calcium, lactose and vitamin D and occurrence of colorectal cancers. DESIGN: Prospective cohort study. SUBJECTS: A total of 9959 men and women aged 15 y or older without history of cancer at baseline. During a 24 y follow-up, 72 new cancers of the large bowel (38 in the colon and 34 in the rectum) were detected. RESULTS: Consumption of milk and total milk products was suggested to be inversely related to colon cancer incidence, whereas no similar association was seen for rectal cancer. The relative risk between the highest and lowest quartiles of intake adjusted for potential confounding factors was 0.46 (95% confidence interval 0.14-1.46, P for trend 0.09) for milk and 0.37 (95% CI=0.12-1.39, P for trend 0.06) for total milk products. Lactose intake showed a similar inverse relationship with colon cancer: the relative risk was 0.31 (95% CI=0.08-1.15, P for trend 0.03). Intake of vitamin D or total dietary calcium was not significantly related to colorectal cancer risk, whereas calcium provided by fermented milk products was associated with increased colorectal cancer incidence; in the highest quartile the multivariate adjusted relative risk for colorectal cancer was 2.07 (95% CI=1.00-4.28). CONCLUSIONS: Our results indicate that individuals showing high consumption of milk have a potentially reduced risk of colon cancer; however, the association does not appear to be due to intake of calcium, vitamin D, or to specific effects of fermented milk. SPONSORSHIP: This study was supported by a grant from the Swedish Cancer Foundation.