吸烟、被动吸烟与肺癌发病风险的病例对照研究

目的 探讨吸烟、被动吸烟与肺癌的关联.方法 采用病例对照研究设计,面访肺癌新发病例1 303例和按性别、年龄(±2岁)频数匹配的健康对照1 303例.结果 吸烟是男性肺癌的重要危险因素(调整OR=4.974,95％ CI:3.933 ～6.291),随着开始吸烟年龄提前、吸烟年限延长、日吸烟量、吸烟包年以及吸烟深度的增加,患肺癌危险性增高,呈剂量反应关系(Ptrend＜0.001),戒烟≥10年患肺癌的危险性降低45.4％.男性吸烟患肺鳞癌的危险性比患肺腺癌大.被动吸烟是非吸烟者肺癌的危险因素(调整OR=1.912,95％CI:1.486～2.460),工作环境被动吸烟的男性非吸烟者患肺癌的调整OR为2.221(95％CI:1.361 ～3.625),家庭环境被动吸烟的女性非吸烟者患肺癌的调整OR为1.804(95％ CI:1.270～2.562).68.04％男性肺癌的发生可归因于吸烟,26.51％非吸烟者肺癌的发生可归因于被动吸烟.结论 吸烟是肺癌的重要危险因素,工作环境被动吸烟是男性非吸烟者肺癌的主要危险因素,家庭环境被动吸烟是女性肺癌的主要危险因素.戒烟具有重大的公共卫生学意义.     

非小细胞肺癌患者发病危险因素的logistic回归分析

目的通过对本院非小细胞肺癌患者的发病危险因素进行分析,以期为非小细胞肺癌的预防和治疗提供依据。方法选取本院2015年1月至2017年1月收治的268例非小细胞肺癌患者作为观察组,选取同期收治的良性肺部疾病患者268例作为对照组,收集两组患者的年龄、性别、民族、吸烟、被动吸烟、家族恶性肿瘤史、呼吸系统疾病史、精神创伤史、职业暴露史、BMI等一般临床资料和相关资料,采用病例对照研究、单因素分析、多因素logistic分析等方法对其进行统计分析,探讨影响非小细胞肺癌患者发病的危险因素。结果单因素分析结果显示,非小细胞肺癌发病的危险因素有年龄、BMI、吸烟、被动吸烟、家族恶性肿瘤史、呼吸系统疾病史、职业暴露史等;多因素分析结果显示,非小细胞肺癌发病的主要危险因素为吸烟(OR=4.361,P=0.005)、被动吸烟(OR=2.229,P=0.009)、家族恶性肿瘤史(OR=1.413,P=0.01)和职业暴露史(OR=2.883,P=0.009)。结论针对非小细胞肺癌的发病危险因素,采取相应的改善措施,预防非小细胞肺癌的发生。     

良性前列腺增生与吸烟、体质指数关系

目的应用病例对照研究方法,对临床前列腺增生（BPH）手术病例进行调查,以研究吸烟、体质指数与良性前列腺增生危险性之间的关系。方法病例组为2004～2006年施行良性前列腺增生手术,年龄在50～82岁的343名男性;对照组为与病例年龄相同的361名患其他疾病的男性。采用自行设计的调查表对住院期间研究对象进行调查,内容包括人口学特征、身体测量、生活方式（吸烟、膳食情况）、个体疾病既往史以及家族一级亲属前列腺疾病史等。采用多元回归模型测量各因素与BPH关系的比值比（OR）及其相应的95%CI。结果控制了年龄和体质指数后,每天吸烟1～29支与发生BPH的危险性无关,OR=0.97,95%CI=0.68～1.46,P〉0.05。但每天吸烟≥30支与不吸烟者比较,发生BPH的危险性增加,OR=1.32,95%CI=0.92～2.58,P〈0.01。超重者（BMI24.0～27.9）或肥胖者（BMI≥28）吸烟与发生BPH的危险性显著地增高,与不吸烟者比较分别为：OR=1.68,95%CI=1.32～3.67和OR=2.35,95%CI=1.83～4.16。结论只有现行吸烟≥30支/d的男性才与BPH呈正相关,超重和肥胖的男性吸烟发生临床BPH的危险性显著地升高。     

青岛地区儿童哮喘影响因素病例对照研究

目的探讨儿童哮喘的影响因素。方法应用1：1配对的病例一对照研究方法，采用问卷调查方式，调查300对病例和对照儿童，并分析有关的暴露因素。结果单因素Logistic回归分析结果显示，有17个因素与儿童哮喘有关联，包括父亲呼吸系统疾病史、母亲呼吸系统疾病史、家庭收入情况、特应性体质、急性呼吸道感染史、食肉习惯、海产品摄入量、是否有泡沫制品、是否装修过、厨房排烟方式、排烟效果、是否饲养宠物、家族哮喘病史、家族过敏性鼻炎史、父母食物过敏史、父母粉尘过敏史、首次发病后是否经过系统治疗。多因素Logistic回归分析显示，7个因素进入主效应模型，其中父亲有呼吸系统疾病史（OR=3．771，95％CI：1．533～9．278）、家庭低收入（OR=I．503，95％CI：1．258～1．795）、特应性体质（OR=3．788，95％CI：2．368～6．058）、喜食肥肉（OR=2．042，95％CI：1．481～2．815）、家族哮喘病史（OR=I．710，95％CI：0．988～2．958）、家族过敏性鼻炎史（OR=I．991，95％CI：1．234～3.211）是儿童哮喘的危险因素，饲养宠物（OR=0．443，95％CI：0．265～0．739）是保护因素；回归系数分别为1．327，0．407，1．332，0．714，0．536，0．689，-0．814。结论儿童哮喘是遗传和环境双重因素共同作用导致的一种复杂疾病。     

高血压、体质指数与良性前列腺增生关系

目的 探讨高血压、体质指数(BMI)与临床术后良性前列腺增生(BPH)的关系.方法 采用病例对照研究方法,病例为55～90岁临床诊断为BPH、施行手术治疗、术后病理证实为BPH的患者;对照为同期住院的非前列腺增生患者,年龄与病例相同;病例与对照各380例,以1:1匹配;采用自行设计的调查表对研究对象进行调查,内容包括一般情况、身体测量、生活方式、既往史以及BPH家族史等,采用Logistic回归模型计算OR值及其相应的95%C1.结果 调整年龄因素后,与收缩压正常者(＜140 mmHg),(1 mmHg=O.133 3 kPa)相比较,收缩压160-179mmHg者和收缩压≥180 mmHg者发生BPH的危险性明显增加(分别为OR=2.135,95%CI=1.139～4.001和OR=2.704,95%CI=1.475-4.958);高血压病程与BPH呈正相关(x2=8.876,P=0.031),病程≥20年组发生BPH的危险性明显增加(OR=4.984,95%a=2.006-12.203,P=0.001).与非高血压者比较,超重或肥胖者罹患高血压发生BPH的危险性明显地增高(OR=2.548,95%CI=1.397-4.648和OR=2.667,95%CI=1.038-13.212).结论 高血压是BPH发病的危险因素;长期罹患高血压、尤其是高收缩压状态能够促进BPH的发生和发展;超重和肥胖的男性高血压BPH的危险性明显增加.     

父母癌症史、吸烟与癌症死亡率

本文对364,592个男性和553,681个女性从1960年到1966年进行了前赡性队列研究,观察父母亲癌症史、个人吸烟史和癌症死亡率的关系。结果表明,父母亲有癌症史者较父母亲无癌症史者,全癌年龄调整死亡率增高13～16％(P<0.001)。父母亲癌症史对男女性结肠癌(SMR男性1.48,女性1.24)和女性乳腺癌及卵巢癌(SMR均为1.26)是重要的危险因素。在男性吸烟者中,父母亲癌症史是胃癌的一个危险因素,但在男性不吸烟者及女性中则无相关。父母亲皆有癌症史一般来说比父母一方有癌症史的危险性较大。本文所见对家族癌症链的观点是有力地支持,但不能区分这种联系是共同环境因素的作用或是遗传因素的作用。     

河北省体检人群肺癌和肺结节阳性低剂量螺旋CT筛查

目的了解河北省体检人群肺癌和肺结节阳性低剂量螺旋CT(LDCT)筛查情况,为肺癌的早期干预提供参考依据。方法整群抽取2015年1月—2018年12月在河北医科大学第四医院进行肺癌筛查的8 898名体检人群进行问卷调查、体格检查和LDCT检查,并对肺结节阳性者和可疑肺癌患者进行后期随访。结果河北省8 898名体检人群中,检出肺癌患者66例,肺癌检出率为0.74%;检出肺结节阳性者1 038例,肺结节阳性检出率为11.67%。多因素非条件logistic回归分析结果显示,年龄≥60岁体检人群发生肺癌的风险为50岁体检人群的4.008倍(OR=4.008,95%CI=1.976～8.129),有肺部疾病史体检人群发生肺癌的风险为无肺部疾病史体检人群的2.298倍(OR=2.298,95%CI=1.200～4.402);年龄50～59岁和≥60岁体检人群发生肺结节阳性的风险分别为50岁体检人群的1.362倍(OR=1.362,95%CI=1.156～1.605)和2.204倍(OR=2.204,95%CI=1.880～2.585),吸烟和戒烟体检人群发生肺结节阳性风险分别为不吸烟体检人群的1.198倍(OR=1.198,95%CI=1.028～1.396)和1.962倍(OR=1.962,95%CI=1.352～2.846),有肺部疾病史体检人群发生肺结节阳性风险为无肺部疾病史体检人群的1.644倍(OR=1.644,95%CI=1.356～1.994)。结论 LDCT检查可有效筛查出肺癌和肺结节阳性患者,年龄≥60岁和有肺部疾病史的人群是肺癌和肺结节阳性的高危人群。     

抚顺市职业暴露与肺癌关系的病例对照研究

本文着重评价职业暴露与肺癌的关系。研究结果表明,病例组与对照组的职业暴露史有显著差异,有职业暴露史者患肺癌的相对危险性为 OR_(MH)=3.84,95％CI 为1.58～9.30(调整吸烟后的 OR值)。且随职业暴露年限的延长患肺癌的危险性增大,存在剂量反应关系。据人群回归危险度估计,抚顺市大约有16.47％的肺癌是由职业暴露所致。吸烟与职业暴露存在正交互作用,符合相加模型     

南京市人群DNA修复基因XRCC1多态性与肺癌易感性的关系

[目的]研究碱基切除修复基因XRCC1多态性与南京市人群肺癌易感性的关系。[方法]采用配对病例．对照研究，收集南京籍原发性肺癌患者104例为病例组，同时按1：1配对选择非肿瘤、非呼吸道疾病患者104例为对照组，并进行流行病学调查。应用PCR-RFLP方法分析了病例组和对照组的XRCC1基因Arg194Trp和Arg399Gln两个位点的多态性，比较不同基因型与肺癌易感性的关系，以及基因多态性与吸烟之间对肺癌易感性的交互作用。[结果]携带399Gln等位基因的个体其肺癌危险性增高(OR=1．790，95％CI=1．033～3．103，P=0．038)，且主要增加患鳞癌的危险(OR=2．426，95％CI=1．123～5．237，P=0．023)；并与吸烟指数≥20的有一定的协同作用(OR=2．536，95％CI=1．043～6．165)。Arg194Trp与肺癌危险性之间未见显著性相关(0R=1．040，95％CI=0．600～1．805)。[结论]碱基切除修复基因XRCC1的多态性可能会对肺癌易感性产生影响，并可能与吸烟量之间存在一定的协同作用。     

中国人群肺癌发病危险因素的Meta分析

[目的]探讨中国人群肺癌发生的主要危险因素,为预防决策提供依据。[方法]利用Meta分析方法对我国1995～2007年间公开发表的有关肺癌危险因素病例对照研究的12篇文献资料进行定量综合分析。[结果]各因素合并OR值及95%CI分别为:吸烟OR=2.7820(2.3428～3.3035);油烟OR=2.6257(1.7312～3.9879);家族肿瘤史OR=1.8075(1.4745～2.2157);肺结核OR=2.6018(1.8946～3.5731);慢性支气管炎OR=2.3052(1.8013～2.9500);精神因素OR=2.2648(1.8364～2.7932);饮酒OR=1.4942(1.2491～1.7873);被动吸烟OR=1.7064(0.9109～3.1965);新鲜蔬菜OR=0.5376(0.4445～0.6503)。[结论]吸烟、饮酒、油烟、家族肿瘤史、肺结核、慢性支气管炎、精神因素是目前中国人群肺癌发病的危险因素;而多吃新鲜蔬菜是肺癌发生的保护性因素。     

胃癌患者复发恐惧及其与抑郁的相关性研究

目的 探讨胃癌患者癌症复发恐惧及其与抑郁之间的关系,为进一步干预提供依据。方法 采用一般资料问卷、癌症患者恐惧疾病进展简化量表（FoP - Q - SF）、抑郁自评量表(SDS)对212例胃癌患者进行调查分析。结果 胃癌患者癌症复发恐惧总得分(35.43±10.44)分,抑郁程度得分为（57.05±9.52）分。FoP - Q - SF各维度与SDS各维度均呈正相关;多重线性回归分析显示患者年龄、病程、家庭人均收入、FoP - Q - SF是抑郁的影响因素,可解释总体变异度的58.5%,其中FoP - Q - SF独立影响抑郁水平总体变异的36.7%。结论 本研究中胃癌患者癌症复发恐惧处于中等水平,推测可通过降低复发恐惧水平来降低抑郁的发生。     

Breast and cervical cancer screening: exploring perceptions and barriers with Hmong women and men in Oregon

Background. Hmong women are reported to have very low rates of breast and cervical cancer screening compared to other Asian and White women in the USA. Reasons for low cancer screening rates among this population are not well understood.

Methods. This qualitative study (n=83) explored Hmong women and men's perceptions of breast and cervical cancer and cancer screening, women's experiences with breast and cervical cancer screening, and health care system barriers to screening.

Results. Hmong women and men perceived breast cancer to be more severe than other types of cancers. Participants believed that breast cancer is curable if detected early. Cervical cancer was not well understood and was of greater concern than breast cancer because of its location within the body and its consequences for reproduction. In general, few participants had personal experiences with breast and/or cervical cancer. Overall, women and men had positive things to say about screenings for breast and cervical cancer, expressing that screenings offered a ‘proof of illness.’ The majority of women did not report any concerns with the exams themselves, although some discussed embarrassment, pain, and discomfort. Barriers to screening included lack of health insurance, making co-payments, language, and issues related to scheduling appointments. Barriers differed for younger and older women.

Conclusion. Results of this study provide new insight into perceptions, experiences, and barriers to breast and cervical cancer screening among Hmong women and men. These findings have implications for developing culturally appropriate interventions to increase breast and cervical cancer screening in this population.     

宁化县1973—1987年常见肿瘤流行时间变化趋势及癌谱分析

本文根据宁化县近15年的肿瘤资料分析了常见肿瘤的流行时间变化趋势。结果表明,历年肿瘤死亡率呈波浪式上升,死因位次提前三位。近期与前期死亡率比较,男性增加19.68%,女性减少20.93％,出现死亡年龄前移与后移两型肿瘤.但各个时期内癌谱相对稳定。     

Symptom prevalence,characteristics and distress in a cancer population

Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and out-patients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 avaluable patients was 55.5 years (range 23–86 years); over 60% were women and almost two-thirds had metastatic disease. The Karnofsky Performance Status (KPS) score was80 in 49.8% and 123 were inpatients at the time of assessment. Across tumour types, 40–80% experienced lack of energy, pain, feeling drowsy, dry mouth, insomnia, or symptoms indicative of psychological distress. Although symptom characteristics were variable, the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing. The mean (±SD, range) number of symptoms per patient was 11.5±6.0 (0–25); inpatients had more symptoms than outpatients (13.5±5.4 vs. 9.7±6.0, p<0.002) and those with KPS80 had more symptoms than those with KPS>80 (14.8±5.5 vs. 9.2±4.9, p<0.0001). The number of symptoms was highly associated with heightened psychological distress and poorer quality of life (for example, r=0.67 for the relationship with the Functional Living Index-Cancer, a QOL measure). These data clarify the prevalence and characteristics of cancer-related symptoms and suggest that the number of symptoms per patient may be a useful quality of life indicator.Supported by American Cancer Society Grant PRB-78 and by NIH-CA52477.     

Geographical pattern of malignant neoplasm by cluster analysis using standardized mortality ratios (SMRs) in Ibaraki Prefecture,Japan

We investigated the geographical patterns of mortality from eight (males)/ten (females) sites of malignant neoplasm, using cluster analysis with Standardized Mortality Ratios (SMRs), and examined the relationship between the mortality structure and urbanization. To explore the geographical tendencies is important for the prevention of cancers; such as noticing risk factors associated with regional variance. The death rates, by site, gender and age from 1990 to 1994 in Japan, were obtained from Vital Statistics. The deaths and population in municipalities were obtained from "Population of Ibaraki Prefecture". These were represented as averaged values in five-year periods. As an indicator of urbanization and mortality structure, the population density of municipalities and the overall rank scores of SMRs were used, respectively. Cluster analysis formed some distinctive structures. For males, Cluster 1 included four municipalities and three of these were located in the mountainous area in northwest Ibaraki, characterized by high SMRs from bone marrow. Cluster 5 consisted of the mid-south areas, characterized by high SMRs from stomach cancer. For females, the clusters seemed to be characterized by SMRs from esophagus cancer. An association between mortality structure and urbanization was found for females, 0.364 (p<0.01), but not for males, 0.162 (p=0.14).     

Mortality trends from oral cancer in Andalusia, Spain, 1975-1998

Morbidity and mortality rates from oral cancer appear to be on the rise among developed countries throughout the world during the last decades. The object of the present study was to investigate the recent changes in the mortality from oral cancer in the more than seven million inhabitants of Andalusia, Spain.Data on the number of deaths by oral cancer from 1975 to 1998 were obtained from annual publications by the Statistics Institute. Crude, age-standardized, truncated, cumulative and age-specific rates of mortality were calculated by gender as well as potential years of life lost rates. Poisson regression models were fitted in order to quantify the influence of age and year of death on the mortality rates by gender.Age-adjusted mortality rates increased from 2.79 in 1975-79 to 3.41 in 1995-98 in males and from 0.39 to 0.45 in females during the same period. Increases were more marked when comparing the truncated age-adjusted rates. Relative risks increased with age from 2.35 to 23.12 in 55 to 64-y-old and 85-y-old males respectively, and from 2.91 to 21.50 in 55 to 64-y-old and 85-y-old females respectively, when comparing with the 35-54-y-old age group. There was an interaction between age at death and year of death in males but not in females.Mortality from oral cancer increased in males in Andalusia over the study period, simultaneous to an important change in the pattern of occurrence by age. There was a cohort effect in males and females across the studied time interval.     

上海市嘉定区居民肿瘤早发现知识和行为监测分析

目的 了解嘉定区居民肿瘤早发现知识及行为情况,以利针对性地开展健康教育工作。方法 采用随机整群抽样的方法从全区抽取15岁以上的居民,采用\     

Cost of breast cancer in Sweden in 2002

Breast cancer is the most common cancer among Swedish women and an important cause of illness and death. The aim of this study was to estimate the total cost of breast cancer in Sweden in 2002, using a top-down prevalence-based cost-of-illness approach. The total cost of breast cancer in Sweden in 2002 was estimated at 3.0 billion SEK (1 € = 9.4 SEK). The direct costs were estimated at 895 million SEK and constituted 30% of the total cost. Indirect costs were estimated at 2.1 billion SEK and constituted 70% of the total cost. The main cost driver was production losses caused by premature mortality, amounting to 52% of the indirect costs. The reason that indirect costs were the dominant cost is because most newly detected breast cancers occur in patients aged below 65, thus causing significant production losses due to sick leave, early retirement, and premature mortality.

胃癌及癌前状态MG7表达的动态观察及分析

目的：探讨在胃癌发生发展过程中MG7抗原表达的动态变化及意义。方法：采用免疫组化技术及组化技术检测406例胃黏膜MG7抗原的表达情况及肠上皮化生类型。结果：从组织学角度观察，正常胃黏膜→肠上皮化生及异型增生→胃癌；Ⅰ、Ⅱ型肠上皮化生→Ⅲ型肠上皮化生，MG7抗原阳性表达率依次上升(P＜0．01)。从临床疾病角度观察，浅表性胃炎→萎缩性胃炎→胃癌，MG7抗原阳性表达率依次上升(P＜0．01)。结论：MG7抗原与胃癌发生发展有良好的相关性，对胃癌具有较高的特异性；对萎缩性胃炎，Ⅲ型肠上皮化生与异型增生进行严密监测有可能提高早期胃癌的检出率，MG7在胃癌前疾病动态随访中具有重要应用价值。     

调强适形放射治疗技术应用研究现状

恶性肿瘤是威胁人类健康的主要疾病之一。为了更好地提高肿瘤治愈率,必须迅速发展肿瘤精确治疗。肿瘤精确治疗最有效的方法是采用调强放射治疗（Intensity Modulated Radiation Therapy,IMRT）,它能最大限度地提高肿瘤的局部控制率,减少正常组织的并发症。IMRT被认为是肿瘤治疗技术的重大突破,它产生的剂量优于三维适形放射治疗（3D-CRT）,能得到更好的治疗效果,这在头颈部肿瘤、前列腺癌、乳腺癌、宫颈癌、胰腺癌等的临床治疗中已得到证实。所以,着重介绍了IMRT的发展过程、调强方式、调强治疗的实施过程及治疗计划的可行性验证。