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1.
身体测量指标与女性乳腺癌关系的前瞻性队列研究   总被引:1,自引:1,他引:1       下载免费PDF全文
目的研究上海女性身体测量指标与绝经前后乳腺癌之间的关系.方法采用前瞻性队列研究方法.1997-2000年在上海市区建立一个73 461人年龄40~70岁的女性队列.每2年随访一次,至2004年6月共收集乳腺癌新发病例432例.用Cox回归模型估计身体测量指标与女性乳腺癌发生的相对危险度(RR)和95%可信区间(CI).结果调整年龄、文化程度、能量摄入、月经、生育等混杂因素后,基线调查时体重、体重指数(BMI)、腰臀围比例(WHR)和20岁后体重增加与绝经后女性乳腺癌危险性呈正相关,与绝经前女性乳腺癌发生无关.身高与乳腺癌危险的显著正相关关系仅在绝经前女性中发现,20岁时身高在161 cm以上者发生乳腺癌的危险是157.1 cm以下者的1.84倍(95%CI:1.30~2.61).20岁时BMI处于平均水平者绝经前患乳腺癌的危险性显著高于其他两组.BMI和WHR互相调整后,WHR独立于BMI的作用接近显著性水平.调整BMI后,20岁后体重增加会显著增加绝经后乳腺癌危险(RR=1.61,95%CI:1.09~2.37).结论对于绝经后女性,成年后体重增加和中心性肥胖都是预测乳腺癌危险的指标.因此控制成年后体重、减少腹部脂肪堆积是预防绝经后乳腺癌发生的有效措施.身高可能是影响绝经前女性乳腺癌发生的危险因素.  相似文献   

2.
曾艳华 《中国妇幼保健》2012,27(35):5691-5694
目的:探讨金坛市子宫内膜癌发病的危险因素。方法:采用病例对照研究,选择2005年12月~2011年6月在金坛市人民医院妇产科就诊并经过病理诊断为子宫内膜癌的患者165例为病例组,同时选择528例健康体检者为对照组,采用单因素与多因素非条件Logistic回归分析子宫内膜癌发病的危险因素。结果:单因素分析表明,年龄≤50岁、年龄≥61岁、BMI超重、患有高血压、患有糖尿病、月经初潮年龄≤12岁、初次分娩年龄≤20岁、一级亲属中有乳癌、子宫内膜癌、结肠癌、卵巢癌患病史与子宫内膜癌发病有关。通过多因素Logistic逐步回归分析,最终引入回归方程的变量为年龄≤50岁、年龄≥61岁、BMI超重、患有高血压、患有糖尿病、月经初潮年龄≤12岁、一级亲属中有结肠癌及卵巢癌患病史。结论:年龄≥61岁、BMI超重、患有高血压、患有糖尿病、月经初潮年龄≤12岁、一级亲属中有结肠癌及卵巢癌患病史是子宫内膜癌发病的危险因素,年龄≤50岁是子宫内膜癌发病的保护因素。  相似文献   

3.
巨大儿与13~18岁青少年肥胖的关系   总被引:1,自引:0,他引:1  
目的探讨出生体重4000g以上与青少年体质量指数(BMI)及腰围的关系,为探讨出生体重与青少年BMI及腰围的相关性提供参考。方法共抽取出生体重在2500g以上的13~18岁青少年3458人,测量身高、体重、腰围。根据出生体重分为巨大儿组(n=514)和正常出生体重组(n=2944)。结果巨大儿组身高、体重、BMI及腰围均明显高于正常出生体重组(P值均〈0.01)。巨大儿组超重、肥胖检出率分别为15.2%和10.5%,正常出生体重组分别为11.4%和6.5%。校正年龄和性别后,非条件Logistic回归显示,巨大儿组超重和肥胖的危险性分别是正常出生体重组的1.404和1.552倍。以腰围为应变量进行多元线性回归分析显示,性别、年龄、出生体重为腰围的独立危险因素。结论巨大儿组青少年BMI和腰围均存在异常。肥胖的预防应该从胎儿期抓起。  相似文献   

4.
用病例-对照的方法探讨了子宫内膜癌(以下简称内膜癌)发生的有关危险因素。调査内膜癌病例及对照共102对,详细了解了病例和对照的月经史、生育史、疾病史、避孕史等。发现怀孕次数少、生产次数少、月经初潮早、肥胖患内膜癌的相对危险性较大,均显示有剂量效应关系,经趋势性检验均有显著性意义。此外,髙血压、糖尿病、盆腔X线照射、刮宫、精神创伤亦可能与内膜癌发病有关。  相似文献   

5.
肥胖增加发病危险 肥胖,特别是绝经后肥胖,明显增加子宫内膜癌的危险性,体重大于90千克与小于60千克的妇女相比,其发生子宫内膜癌的相对危险度高出17.1倍;体重超过正常的15%者,发生子宫内膜癌的危险性可增加3倍。值得注意的是,晚年肥胖及矮胖型身材更危险。  相似文献   

6.
目的对武汉市女性子宫内膜癌流行病学调查及危险因素进行分析。方法选取2016年5月-2017年5月于该院进行子宫内膜癌症状筛查的1 000例女性为研究对象。使用经阴道彩色多普勒超声对子宫内膜癌症状进行筛查,对所有入选研究对象的个人资料进行统计,使用化学发光分析法检测血清人附睾蛋白4 (HE4)、癌胚抗原(CEA)、糖链抗原125 (CA125)、糖链抗原199 (CA199)及甲胎蛋白(AFP)水平,并对子宫内膜癌发病相关因素与发病情况的相关性进行统计分析。结果 55岁以上的人群、50岁之后绝经的人群、有恶性肿瘤家族病史的人群、12岁之前月经初潮的人群患病率较高,有妊娠史的人群大专及以上人群子宫内膜癌患病率较低(P0. 05);体质指数(BMI)≥25 kg/m~2、有糖尿病病史、高血压病史的人群,子宫内膜癌症状患病率相对较高(P0. 05);长期坚持体育锻炼的人群子宫内膜癌发病率较低(P0. 05); HE4、CEA、CA125、CA199及AFP在子宫内膜癌患者血清中表达水平显著较高(P0. 05);年龄、BMI、恶性肿瘤家族病史以及HE4、CEA、CA125、CA199及AFP高表达等因素均为子宫内膜癌发病的主要危险因素。结论年龄、BMI、恶性肿瘤家族病史以及HE4、CEA、CA125、CA199及AFP高表达等因素均为子宫内膜癌发病的主要危险因素,具有这些因素的女性需进行子宫内膜癌筛查,为子宫内膜癌症状的预防和早发现、早治疗提供一定的帮助。  相似文献   

7.
目的分析儿童青少年各类营养不良与父母体重指数(BMI)、身高的关系。方法从1991—2011年8次"中国营养与健康调查"资料中选择6 950人次6~18岁儿童青少年及其父母作为研究对象,调查地点包括黑龙江、辽宁、山东、江苏、河南、湖南、湖北、广西和贵州9个省(自治区),进行8次追踪调查。调查内容包括社区调查、住户调查、膳食调查、体格测量、医学体检。对儿童青少年的生长迟缓、消瘦、营养不良和肥胖与其父母的BMI、身高的关系进行分析。结果 1991—2011年,儿童青少年生长迟缓率、消瘦率、营养不良率呈下降趋势。儿童青少年肥胖,父母超重、肥胖和身高总体呈上升趋势。广义线性模型显示,儿童青少年生长迟缓与母亲、父亲的身高及母亲的BMI有关,儿童青少年消瘦与父母BMI有关,儿童青少年营养不良与父母身高、BMI有关;儿童青少年肥胖与父亲身高有关,儿童青少年肥胖与父母超重、肥胖有关。时间延迟效应模型显示,相比母亲身高150 cm,母亲身高≥165 cm的儿童青少年生长迟缓(RR=0.2,95%CI:0.0~1.0)和营养不良(RR=0.4,95%CI:0.2~0.8)的发生风险低;相对正常体重者,父亲低体重的儿童青少年消瘦(RR=2.5,95%CI:1.5~4.3)和营养不良发生风险高(RR=2.5,95%CI:1.5~4.3),父亲超重、肥胖的儿童青少年消瘦发生风险低(RR=0.5,95%CI:0.3~0.8;RR=0.1,95%CI:0.0~0.5)、儿童青少年肥胖发生风险高(RR=2.6,95%CI:1.3~5.0;RR=4.3,95%CI:1.8~10.3);相对正常体重者,母亲低体重的儿童青少年消瘦发生风险高(RR=1.9,95%CI:1.1~3.1),母亲超重、肥胖的儿童青少年消瘦发生风险低(RR=0.6,95%CI:0.4~1.0;RR=0.7,95%CI:0.3~1.5)、儿童青少年肥胖的发生风险高(RR=2.0,95%CI:1.0~3.9;RR=6.4,95%CI:2.8~15.0)。结论儿童青少年各种营养不良与父母的身高、BMI存在一定的关系,合理的家庭营养干预有利于改善整个人群的营养状况。  相似文献   

8.
儿童青少年人体质量指数与脂肪肝的相关分析   总被引:1,自引:0,他引:1  
目的了解7~18岁儿童青少年人体质量指数(BMI)与脂肪肝的关系,为中小学生肥胖的早期预防与干预提供科学依据。方法采取分层整群随机抽样法对北京市海淀区22所中小学校7~18岁儿童青少年2286名进行身高、体重测量及肝胆B型超声波等检查,按照中国肥胖问题工作组推荐的中国儿童青少年超重、肥胖分类标准将人群分为正常组,肥胖组及超重组,采用Person相关分析、t检验、Х^2检验等统计学方法对资料进行分析。结果在控制了年龄、性别的影响后,7~18岁儿童青少年的BMI与脂肪肝独立正相关(r=0.318,P〈0.01);脂肪肝组体质量指数(BMI)垃著高于非脂肪肝组.差异有统计学意义(P〈0.01);正常组、超重组和肥胖组的脂肪肝患病率分别为7.2%,15.4%和34.1%,差异有统计学意义(P〈0.01),结论儿童青少年的体质量指数(BMI)与脂肪肝显著正相关;预防儿童青少年超重、肥胖是预防脂肪肝及成年期疾病的重要手段.  相似文献   

9.
目的探讨宫内节育器(IUD)使用与子宫内膜癌的关系。方法采用病例对照研究方法,调查上海市区1997年1月~2000年12月间确诊、年龄在30~69岁之间的子宫内膜癌患者(n=1204)和普通对照人群(n=1212)的一般情况、月经生育史、饮食、个人生活习惯、口服避孕药(OC)及宫内节育器使用情况、疾病及家族史等。采用非条件Logisfic回归模型分析宫内节育器使用与子宫内膜癌的关系。结果上海市区女性所使用的宫内节育器类型主要为金属环和V型塑料环。分别占使用者的68.1%和20.7%。与从未使用过宫内节育器的女性比较,使用者发生子宫内膜癌的危险性显著降低。调整后OR=0.57(95%CI=0.47~0.69),且随使用时间增加而降低。分层分析显示,在从未服用口服避孕药的女性中,曾使用IUD者发生子宫内膜癌的危险降低,OR=0.51(95%CI=0.41~0.64)。结论绝经前后女性使用宫内节育器可能会降低子宫内膜癌的风险。  相似文献   

10.
目的综合评价子宫内膜癌发病的危险因素。方法收集国内有关子宫内膜癌危险因素的病例对照研究文献13篇,采用可信区间方差分析法计算各相关因素的ORc及95%CI。结果使用宫内节育器年数1年、口服避孕药、有生育史、饮酒为子宫内膜癌的保护因素;糖尿病、高血压、肥胖、初潮年龄≤12岁、不孕等为子宫内膜癌的危险因素。结论子宫内膜癌的发病不仅与糖尿病、高血压等慢性病有关,还与月经、生育因素密切相关。应注意控制相关危险因素,加强妇女保健,做好高危人群的定期普查。  相似文献   

11.
Weight history and risk of endometrial cancer among Chinese women   总被引:4,自引:0,他引:4  
BACKGROUND: Adult obesity is a well-established risk factor for endometrial cancer. However, little is known about the association of endometrial cancer risk with body size early in life and weight change during adulthood. We investigated whether women with greater early-age body size or with greater weight change during adulthood have an increased risk of endometrial cancer. METHODS: We analysed data from a population-based case-control study of endometrial cancer conducted between 1997 and 2001 in Shanghai, China. Included in this analysis were 832 endometrial cancer cases aged 30-69 years and 846 population controls. Information on weight and height history from adolescence through adulthood was obtained via structured in-person interviews. A logistic regression model was used to derive odds ratios (ORs) and 95% confidence intervals (CIs) for endometrial cancer in association with adolescent and adult adiposity, as well as adult body weight change. All ORs were adjusted for age, education, menstrual status, duration of menstruation, number of pregnancies, oral contraceptive use, and family history of cancer. RESULTS: Perceived weights and heights during puberty that were greater than average were associated with a modestly increased risk of cancer. The association for perceived weight was substantially weakened after adjustment for current body mass index (BMI). High BMI at all adult ages significantly predicted endometrial cancer risk, with recent BMI being the strongest predictor. Further analyses disclosed that weight gain during adulthood, particularly during the peri-menopausal period (age 40-50 years), was associated with a significantly elevated risk of endometrial cancer, even among currently non-obese women. Gaining >5 kg between age 40 and 50 was related to ORs of 2.3 (95% CI 1.4-3.9) for women with a BMI<25 kg/m2 and 2.0 (95% CI 1.3-3.0) for women with BMI>or=25 kg/m2. CONCLUSIONS: Adult weight gain, particularly during the peri-menopausal period, plays a significant role in the development of endometrial cancer risk.  相似文献   

12.
Increasing prevalence of overweight and obesity motivated this prospective examination of gestational diabetes mellitus in relation to self-reported adult height, weight, and weight fluctuation. Gestational diabetes was assessed by use of medical records in 1,644 women enrolled in Seattle and Tacoma, Washington, between 1996 and 2002. After adjustment, risk was inversely related to height and directly related to pregravid body mass index (p(trend) < 0.001). The relation with body mass index at age 18 years was J shaped, with higher risk among lean women (adjusted relative risk (RR) = 1.79, 95% confidence interval (CI): 1.01, 2.84) and obese women (RR = 4.53, 95% CI: 1.25, 16.43) versus normal-weight women. Weight gain between age 18 years and the study pregnancy was associated with increased risk independently of body mass index at 18 years and other confounders (>/=10-kg gain vs. <2.5-kg change: RR = 3.43, 95% CI: 1.60, 7.37). Weight cycling (loss and regain of >/=6.8 kg) was not associated after adjustment for body mass index at 18 years and adult weight change (>/=3 vs. zero cycles: RR = 1.23, 95% CI: 0.56, 2.73). Cycling was nonsignificantly related among women who gained 10 kg or more during adulthood (>/=3 vs. zero cycles: RR = 2.04, 95% CI: 0.83, 5.02). Efforts to prevent obesity and weight gain among young women may reduce gestational diabetes risk.  相似文献   

13.

Background

Current obesity is an established risk factor for endometrial cancer; however, the roles of weight gain during adulthood and obesity in early adulthood on endometrial cancer have not been elucidated. Here, we conducted a case-control study comprising 222 histologically diagnosed incident endometrial cancer cases and 2162 age- and menstrual-status matched non-cancer controls.

Methods

Information on current body weight, weight and height at age 20 years, and lifestyle/environmental factors was obtained from a self-administered questionnaire. Subjects were classified into 3 groups according to change in body mass index (BMI, kg/m2) from age 20 years to enrollment (≤0 [reference], 0–3, and >3 kg/m2). The effects of adult BMI change and obesity in early adulthood were evaluated using an unconditional logistic regression model adjusted for potential confounders.

Results

A high BMI at age 20 (BMI ≥25, BMI <25 as reference) was significantly positively associated with endometrial cancer risk (P = 0.005), as was a BMI increase during adulthood (0–3 BMI change, multivariate odds ratio [OR] = 1.28, 95% confidence interval [CI] = 0.88–1.87; >3 BMI change, OR = 2.02, 95% CI = 1.38–2.96; P-trend < 0.001). Parity and BMI at age 20 appeared to modify the effect of weight gain on cancer risk, albeit without statistical significance. This positive association of weight gain with risk was observed only for endometrioid adenocarcinoma.

Conclusions

The results show that endometrial cancer is positively associated with obesity at age 20 and weight gain during adulthood among Japanese women.Key words: endometrial cancer, weight gain, case-control study  相似文献   

14.
The authors conducted a population-based case-control study of 832 endometrial cancer cases and 846 frequency-matched controls in Shanghai, China (1997-2001), to examine the association of overall adiposity and body fat distribution with disease risk. Overall adiposity was estimated using weight and body mass index (BMI); upper body fat distribution was evaluated using waist circumference and waist:hip ratio. Overall and upper-body obesity were both associated with an elevated risk of endometrial cancer. Adjusted odds ratios and 95% confidence intervals for highest-versus-lowest quartile comparisons were 2.6 (95% confidence interval (CI): 2.0, 3.5) for weight, 2.9 (95% CI: 2.2, 3.9) for BMI, 4.7 (95% CI: 3.4, 6.4) for waist circumference, and 3.5 (95% CI: 2.6, 4.8) for waist:hip ratio. The positive associations with weight and BMI vanished after results were controlled for waist circumference, while associations with waist circumference and waist:hip ratio persisted after adjustment for BMI. The positive association with upper-body obesity was more pronounced among younger women, women who had never used oral contraceptives, and women with a history of diabetes mellitus (p for multiplicative interaction < 0.05). Upper-body obesity was related to increased risk among women with low BMI. These results suggest that obesity, particularly upper-body fat deposition, is associated with an increased risk of endometrial cancer.  相似文献   

15.
BackgroundThe impact of weight change, physical activity, and sedentary behavior on endometrial cancer risk among the Asian population is uncertain. We investigated the association of those factors with endometrial cancer risk among Japanese women with a low body mass index level.MethodsWe performed a large-scale nationwide cohort study consisting of 33,801 female participants aged 40–79 years. The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident endometrial cancer.ResultsThe mean body mass index of participants was 22.8 kg/m2. During a median follow-up of 14.8 years, 79 participants developed endometrial cancer. After adjustment for potential confounding factors, body mass index over 23.0 kg/m2 was linearly associated with the risk of endometrial cancer. The HR per 5 kg/m2 increase was 1.80 (95% CI, 1.28–2.54). Weight increment ≥+5 kg since age 20 was associated with an increased risk of endometrial cancer compared to a weight change of −5 to <+5 kg (multivariable HR 1.96; 95% CI, 1.12–3.40). Compared with females who were mainly sitting at the worksite, those who were mainly standing and moving were at lower risk; the multivariable HRs were 0.79 (95% CI, 0.39–1.59) and 0.46 (95% CI, 0.22–0.97), respectively (P for trend = 0.042). Hours of physical exercise, daily walking, and TV viewing were not associated with endometrial cancer risk.ConclusionsOverweight and weight gain were positively associated with the risk of endometrial cancer, while worksite physical activity was inversely associated with the risk.Key words: endometrial carcinoma, body mass index, exercise, sedentary behavior, cohort study  相似文献   

16.
Weight change and risk of endometrial cancer   总被引:2,自引:0,他引:2  
BACKGROUND: Obesity is an established risk factor for endometrial cancer. Less well understood is the role of weight gain and weight change in determining risk. METHODS: We analysed data from a population-based case-control study to evaluate the associations of body mass index (BMI), weight gain, and weight cycling with risk of endometrial cancer. Cases (n=740) under age 80 with a new diagnosis of endometrial cancer were identified from Wisconsin's cancer registry. Controls (n=2342) were randomly selected from driver's license lists and Medicare beneficiary files. Body size at three time points and other risk factor information were ascertained by interview in 1992-95. RESULTS: Endometrial cases were more likely than controls to be nulliparous, have early ages at menarche and late ages at menopause, be diabetic, smoke cigarettes, and use post-menopausal hormones. After adjustment for these factors, increasing BMI was associated with increased risk (P-trend<0.001); women in the top quartile of BMI (>29 kg/m2) had a 3-fold greater risk of endometrial cancer [95% confidence interval (95% CI) 2.4-4.2] compared with women in the lowest quartile (<23 kg/-m2). For each 5 kg weight gain, the odds ratio (OR) for endometrial cancer risk equalled 1.2 (95% CI 1.2-1.3). History of weight cycling modestly increased risk after adjustment for BMI and other factors (OR=1.3; 95% CI 1.0-1.6). In addition, women who reported sustained weight loss had a reduced risk of endometrial cancer (OR=0.7; 95% CI 0.6-0.9). CONCLUSIONS: These results suggest that weight gain and lack of weight stability are associated with risk of endometrial cancer.  相似文献   

17.
Obesity before age 30 years and risk of advanced prostate cancer   总被引:3,自引:0,他引:3  
Adult obesity has shown little association with prostate cancer risk, but obesity at younger ages may be associated with reduced risk. In 1997-2000, the relation between obesity before age 30 years and incident advanced prostate cancer was investigated in a population-based case-control study of African-American and White men (568 cases, 544 controls) in California. Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals, adjusted for age, race, family history of prostate cancer, and saturated fat intake. Measures of obesity for age 10 years tended to be inversely associated with prostate cancer (odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.46, 1.38 for selecting the "obese" pictogram and OR = 0.76, 95% CI: 0.52, 1.11 for reporting being heavier than peers). The decreased risk was more pronounced at ages 20-29 years (OR = 0.53, 95% CI: 0.28, 1.00 for the "obese" drawing, OR = 0.59, 95% CI: 0.40, 0.88 for being heavier than peers, and OR = 0.40, 95% CI: 0.20, 0.81 for body mass index > or =30 kg/m(2)). In addition, both "obese" and small waist size at ages 20-29 years showed inverse trends. This research implicating early-life body size in prostate cancer development helps to elucidate causal mechanisms, such as altered sex hormone profiles during critical developmental periods, potentially involved in development of the disease.  相似文献   

18.
PURPOSE: Reported associations between ovarian cancer and body size are inconsistent. We assessed ovarian cancer and anthropometry in the Breast Cancer Detection Demonstration Project Follow-Up Study. METHODS: The 46,026 participants completed a baseline interview and mailed questionnaires between 1979 and 1998. By using multiple sources, we identified 346 incident ovarian cancers during follow-up. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) to estimate relative risks for developing ovarian cancer associated with height and weight (measured 1973 to 1980) and self-reported current and usual adult weight (collected during follow-up). RESULTS: Neither taller height (> or =66 versus <62 inches; RR, 0.90; 95% CI, 0.64-1.26) nor greater weight (> or =161 versus < or =120 lbs; RR, 1.09; 95% CI, 0.77-1.55) was associated with ovarian cancer. Compared with normal weight (body mass index [BMI], 18.5 to 24.9 kg/m(2)), overweight (BMI, 25 to 29.9 kg/m(2); RR, 1.00; 95% CI, 0.78-1.29) and obesity (BMI, 30 to 34.9 kg/m(2); RR, 0.94; 95% CI, 0.59-1.48) were not associated with ovarian cancer. Severe obesity (BMI > or = 35 kg/m(2)) produced a nonsignificantly elevated RR (1.55; 95% CI, 0.84-2.84). Associations with histologic types and statistical interactions with menopausal status and hormone therapy use were null. CONCLUSIONS: Based on height and weight measured before baseline, overweight and obesity were not significantly associated with ovarian cancer in this cohort.  相似文献   

19.
To determine whether risk of endometrial cancer among women with type 2 diabetes differs with respect to other endometrial cancer risk factors, the authors used data from a population-based case-control study (1,303 cases and 1,779 controls) conducted in western Washington State during 1985-1999. History of type 2 diabetes was associated with endometrial cancer (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.2, 2.3), more strongly among women with a recent diabetes diagnosis (<5 years) (OR = 2.6, CI: 1.5, 4.7) than among those with a more distant diagnosis (> or =5 years) (OR = 1.3, CI: 0.8, 1.9). Type 2 diabetes was associated with endometrial cancer among women with a body mass index (BMI) (weight (kg)/height (m)(2)) less than 35 but not among women with a BMI of 35 or more. The observed associations persisted after finer adjustment for BMI to control for residual confounding. History of diabetes was associated with a twofold increased risk of endometrial cancer among hypertensive women, but no association was observed among nonhypertensive women. The risk associated with type 2 diabetes appeared not to vary greatly with respect to other endometrial cancer risk factors. These results support the hypothesis that type 2 diabetes is associated with endometrial cancer irrespective of the presence of other risk factors for this disease, except possibly hypertension and extreme obesity.  相似文献   

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