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.     

女性肺癌高发原因多

正肺癌是目前我国发病率最高的癌症,吸烟是肺癌最重要的诱发与危险因素。虽然大多数女性都不吸烟,但肿瘤流行病学资料显示,女性肺癌的发病率也很高,且有逐年上升的趋势。研究与调查表明,之所以出现这种情况,主要与以下七大因素有关。被动吸烟大多数女性虽然自己不吸烟,但被动吸烟的现象十分严重。许多家庭中的父亲、丈夫与兄弟都有吸烟的不良习惯,加之很多公共场所对不准吸烟的规定执行不坚决,因此导致了许多女性遭受被动吸烟     

“熏”出来的肺癌

“二手烟”让女性被动受害 有资料显示,如今在肺癌患者中,不吸烟的女性患者人数逐渐增多.这是怎么回事?调查表明,这些女性患者疾病诱因来自于被动吸烟,也就是“二手烟”.被动吸烟所受危害甚至比吸烟还高,一些与吸烟者共同生活的女性,患肺癌的几率能比正常人多出6倍.因此女性预防肺癌,除了自身不抽烟,还应远离被动吸烟的毒害.     

妇女被动吸烟的健康影响

目的探讨被动吸烟对妇女的健康影响.方法于2002-2004年采用病例-对照的研究方法,对妇女被动吸烟与肺癌的关系、孕妇被动吸烟与足月出生小于胎龄儿的关系进行研究.妇女被动吸烟与肺癌的病例-对照研究收集北京、上海和成都指定医院经病理诊断确诊的肺癌新发住院病例157例,以1(肺癌病例):2(医院对照 人群对照)配对;孕妇被动吸烟与足月出生小于胎龄儿的病例-对照研究收集北京市足月分娩小于胎龄儿产妇155例,以1:1配对.结果妇女被动吸烟显著增加发生肺癌的相对危险性(OR=2.95),在24岁以前开始被动吸烟者发生肺癌的相对危险性显著增加(OR=4.12),经常吃动物内脏(OR=1.91)、职业接触有害物(OR=3.16)、职业接触粉尘(OR=3.41)、工作场所通风不良(OR=4.02)为非吸烟女性发生肺癌的危险因素.常吃蔬菜(OR=0.24)、常喝牛奶(OR=0.53)、经常服用维生素(OR=0.53)为非吸烟女性发生肺癌的保护因素.趋势性χ2检验显示,随着被动吸烟指数和被动吸烟年限的增加,肺癌的发生显著增加(P＜0.001).多因素条件Logistic逐步回归分析显示,被动吸烟指数≥50人·年、经常吃动物内脏、职业接触粉尘、工作场所通风不良是非吸烟女性发生肺癌的主要危险因素;常吃蔬菜、经常服用维生素是非吸烟女性发生肺癌的保护性因素.病例组与对照组在孕期体重增加少、孕期被动吸烟、工作场所通风不良、配偶身高较低和孕期进行胎教等方面的差异均有统计学意义(P＜0.01),产妇和配偶文化程度高、产妇孕前体重指数高、家庭总月收入高和孕期进行胎教等可能是足月出生小于胎龄儿的保护因素.多因素条件Logistic回归分析显示,产妇孕前体重低(OR=2.08)、孕期体重增加少(OR=2.83)、被动吸烟(OR=3.42)及孕期饮茶(OR=2.72)、孕期及怀孕之前3个月内进行染发、烫发或焗油(OR=5.67)、配偶身高较低(OR=2.92)等因素均使足月出生小于胎龄儿的相对危险性显著增加,是足月出生小于胎龄儿的主要危险因素;产妇孕前体重指数高使足月出生小于胎龄儿的相对危险性显著降低(OR=0.41),是足月出生小于胎龄儿的保护因素.结论被动吸烟是非吸烟女性发生肺癌的主要危险因素.孕期被动吸烟是足月出生小于胎龄儿的主要危险因素.     

非吸烟女性被动吸烟与肺癌发生的Meta分析研究

目的　探讨非吸烟女性中 ,被动吸烟与肺癌的关系。方法　通过计算机检索CBM、Medline、中国期刊网、英国国家医学图书馆等 ,并结合文献追溯的方法 ,收集国内外于 1990～ 2 0 0 2年间公开发表的关于非吸烟女性被动吸烟与肺癌的研究文献 ,采用随机效应模型 ,对各研究结果进行Meta分析 ,计算其合并比值比。结果　纳入合并分析的文章共有 14篇 ,合并结果表明 :被动吸烟年限与肺癌的关系无显著意义 ;不同年龄段的被动吸烟与肺癌发病的关系均不显著 (P >0 .0 5 ) ,未成年期和成年期 (婚后 )被动吸烟与肺癌合并OR值分别为 0 .814 1(95 %CI :0 .60 68～ 1.0 92 2 )和 0 .9988(95 %CI :0 .82 0 1～ 1.2 164 ) ;而成年期暴露于丈夫 (配偶 )的合并OR 1.2 784(95 %CI 1.0 3 2 0～ 1.5 83 8) ,关联具有显著意义 ,成年期暴露于工作场所的环境烟草烟雾与肺癌发生的 OR 为 1.0 2 44 (95 % CI:0 .83 2 5～ 1.2 60 6) ,但关联无显著意义。结论　在非吸烟女性中 ,被动吸烟与肺癌的关系仍不明确 ,需要进一步研究和探讨。     

宣威肺癌危险因素的病例对照研究

云南省宣威县是我国农村肺癌髙发地区。前一阶段研究结论认为:室内煤烟污染是其髙发的主要原因。本研究试图在平衡煤烟因素以后,研究其他因素(如吸烟等)与宣威肺癌发生的关系,进一步探索宣威肺癌髙发的原因。本研究采取个体匹配的方法,收集了110例新发的原发性肺癌病例和426个对照。经条件Logistic回归分析结果发现:除煤烟污染因素外,宣威男性肺癌与吸烟也有一定的关系。而女性肺癌与吸烟和被动吸烟无明显关系,另外也发现宣威肺癌可能有家族聚集性现象。     

非吸烟女性肺癌发病危险因素的Meta分析

目的：综合评价我国非吸烟女性肺癌发病的危险因素。方法：应用Meta分析方法对国内6个有关非吸烟女性肺癌危险因素的病例对照研究进行定量综合分析,共累积病例915例,对照1321例。统计处理采用Meta分析的随机效应模型。结果：肺部疾病史、家族肺癌史、油烟污染、煤烟污染、被动吸烟等5个研究 因素的合并OR值分别是2．87、2．79、2．51、1．42和1．29,进一步分层研究显示随着油烟污染程度的加重,其OR值也有明显的上升。结论：家族肺癌史、肺部疾病史、油烟污染、煤煨污染等因素可能与非吸烟女性肺癌的发生有关,被动吸烟的作用尚不能肯定。     

非吸烟女性肺癌发病危险因素的Meta分析

目的：综合评价我国非吸烟女性肺癌发病的危险因素。方法：应用Meta分析方法对国内7篇有关非吸烟女性肺癌危险因素的病例对照研究进行定量综合分析,共累积病例1115例,对照1520例。统计处理采用Meta分析的随机效应模型。结果：肺部疾病史、家庭肺癌史、油烟污染、煤烟污染、被动吸烟等5个研究因素的合并比值比（OR值）分别是2.87、2.79、2.52、1.42和1.64进一步分层研究提示随着油烟污染程度的加重,其OR值也有明显的上升。结论：家庭肺癌史、肺部疾病史、油烟污染、煤烟污染等因素可能与非吸烟女性肺癌的发生有关,被动吸烟的作用尚不能肯定。     

被动吸烟与非吸烟妇女的肺癌

目前,对非吸烟妇女肺癌的患病原因尚未完全明确。为评价被动吸烟与非吸烟妇女肺癌的联系,作者进行了此项研究。研究对象为美国密苏里州白人妇女,病例组为618例1988年1月～1991年6月确诊的原发性肺癌病人,平均年龄为71.5岁,其中包括终生非吸烟者432例(70%和戒烟者(停止吸烟15年以上或每年吸烟不超过1包)186例(30%)。另选1402例平均年龄为69.9岁的非肺癌病人作对照。调查时由受试者或其家属填写包括年龄、种族、吸烟状况、居住史、被动吸烟状况、自身及家族健康史、职业及饮食习惯等内容的调查表,然后由调查人员逐项核对。同时对468例(76%)病人作组织学检查。最后根据调查结果用多元logistic回归模型计算比数比(OR)及95%可信区间(CI),确定被动吸1烟与肺癌的关系。结果发现,儿童时期被动吸烟妇女中,患肺癌的危险无明显增加,而终生非吸烟妇女中     

体质指数与非吸烟女性肺癌关系的病例对照研究

研究分析体质指数与非吸烟女性肺癌的关系。方法１９９２年２月至１９９３年１２月,上海地区开展的一项大规模女性肺癌人群基础上的病例对照研究,共调查了非吸烟女性肺癌病例５０４例及人群对照６０１例。     

Smoky indoor cooking fires are associated with elevated hemoglobin concentration in iron-deficient women.

OBJECTIVE: Indoor air pollution from the burning of such biomass fuels as wood and agricultural waste is associated with a higher risk of a number of respiratory problems. The effect on other health outcomes, such as fetal growth, has not yet been adequately documented. The objective of this study was to determine whether, among women who burn biomass fuels for cooking indoors, the use of "smoky" fires is associated with elevated hemoglobin concentration in comparison to women using "smokeless" stoves, that is, stoves that are designed to reduce indoor air pollution. This research was conducted as part of a series of preliminary studies to determine the feasibility and potential health benefits of a randomized stove intervention to reduce indoor air pollution from the burning of biomass fuels for cooking. METHODS: A cross-sectional observational study was conducted in rural highland communities of Guatemala from March to August 1994. Venous blood samples were collected and analyzed for hemoglobin and ferritin. All the women studied burned biomass fuels and cooked indoors, and none of the women was pregnant. Eighty-nine indigenous women using smokeless stoves (designated as the not-exposed group) and 185 indigenous women from the same communities using smoky fires (the exposed group) were studied. Multiple linear regression analyses were used to investigate the relationship between exposure (smokeless stove or smoky fire) and hemoglobin concentration, with adjusting for potential confounding factors. RESULTS: No effect of exposure (smokeless stove or smoky fire) on hemoglobin concentration was found in univariate or multivariate analyses. In routine post hoc analysis to determine whether hemoglobin elevation is observed in some particular subgroup, we found that the use of a smoky fire was associated with a 5.2 g/L elevation in hemoglobin concentration among women with low ferritin stores (P < 0.10). CONCLUSIONS: The elevation of hemoglobin concentration through exposure to indoor air pollution resulting from the burning of biomass fuels in smoky fires for cooking could have important implications for the diagnosis of anemia. However, considering the observational nature of this study, further research using more rigorous measures of exposure to carbon monoxide as well as additional measures of iron status are needed to confirm the relationships among iron status, exposure to smoke from the burning of biomass fuels indoors, and hemoglobin concentration of women living at moderately high altitude. Further study of this matter could help to assure that appropriate adjustments to anemia cutoffs are made, if warranted, and could assist in clarifying potentially negative outcomes of exposure to smoke from biomass fuels burned indoors.     

Lung cancer and indoor air pollution arising from Chinese-style cooking among nonsmoking women living in Shanghai, China.

Associations between indoor air pollution from Chinese-style cooking and lung cancer have been found in several investigations. To provide more detailed estimates of the associations while accounting for key confounding factors, we conducted a population-based, case-control study of lung cancer among nonsmoking women living in Shanghai, the People's Republic of China. Five hundred four incident, primary lung cancer cases diagnosed from February 1992 through January 1994 were identified through the population-based Shanghai Cancer Registry. A control group of 601 nonsmoking women was selected randomly from the Shanghai-Residential Registry, and they were frequency-matched to the expected age distribution of the cases. Exposure to indoor air pollutants from Chinese-style cooking was ascertained through in-person interviews. We estimated adjusted odds ratios (OR) and 95% confidence intervals (CI) by unconditional logistic regression. There were similar patterns of excess risk for exposure to indoor air pollutants from Chinese-style cooking across different histological types of lung cancer. Women who did not have a separate kitchen experienced a 28% increased risk of lung cancer (OR = 1.28; 95% CI = 0.98-1.68). We found little association with area of the windows of the apartment where subjects had lived for the longest period of time. Heating cooking oils to high temperatures was associated with a 1.64-fold increased risk of lung cancer (95% CI = 1.24-2.17). An 84% excess risk was found among women who most often cooked with rapeseed oil (OR = 1.84; 95% CI = 1.12-3.02). Lung cancer risks were also related to "considerable" smokiness of the kitchen during cooking (OR = 2.38; 95% CI = 1.58-3.57), frequent eye irritation during cooking (OR = 1.68; 95% CI = 1.02-2.78), to a more than weekly use of frying (OR = 2.09; 95% CI = 1.14-3.84) and deep-frying (OR = 1.88; 95% CI = 1.06-3.32). This population-based case-control study confirmed that exposure to indoor air pollution from Chinese-style cooking, especially cooking unrefined rapeseed oil at high temperatures in woks, may increase the risk of lung cancer.     

哈尔滨市女性肺癌危险因素分析—室内空气污染

An investigation including a matched case-control study and measurement of indoor air pollution, of risk factors for female lung adenocarcinoma in Haerbin showed that high coal consumption index (HCCI OR = 10.59), indoor smog pollution in winter (OR = 15.19) and low ceiling height of the living room (OR = 12.49) were main risk factors for the cancer. It was further confirmed by the measurement that the mean daily measured concentrations of TSP and Bap in inhabitants' bedroom in winter were 4.4 and 26.7 times respectively as high as those of outdoor air concentrations. No significant association with cigarette smoking and indoor passive smoking was found.     

The epidemiology of lung cancer in Xuan Wei, China: current progress, issues, and research strategies

In Xuan Wei, a rural Chinese county of about one million people, females' annual lung cancer mortality is China's highest, and males' is among China's highest. Xuan Wei's very high indoor air pollution levels (sometimes exceeding 20 mg/m3), residentially stable population, relatively uncomplicated lifestyle, and wide geographic variation in lung cancer mortality render it highly amenable to quantitative, interdisciplinary investigation of chemical carcinogens due to indoor air pollution. To date, epidemiologic findings reveal a closer association of lung cancer with the indoor burning of "smoky" coal (as opposed to "smokeless" coal or wood) than with tobacco use or occupation. Current aerometric, chemical, and toxicologic findings tend to confirm this association, though the specific carcinogenic constituents of Xuan Wei indoor air pollution have not yet been determined. Chinese and American investigators are conducting interdisciplinary field and laboratory investigations to quantify the lung cancer risk attendant on indoor air pollution relative to other factors, to measure and compare the characteristics of pollution from different Xuan Wei fuels, to determine the relative etiologic importance of pollution composition and concentration, and to develop quantitative relationships between air pollution dose and lung cancer risk.     

Relative Hepatotoxicity

In Xuan Wei, a rural Chinese county of about one million people, females' annual lung cancer mortality is China's highest, and males' is among China's highest. Xuan Wei's very high indoor air pollution levels (sometimes exceeding 20 mg/m³), residentially stable population, relatively uncomplicated lifestyle, and wide geographic variation in lung cancer mortality render it highly amenable to quantitative, interdisciplinary investigation of chemical carcinogens due to indoor air pollution. To date, epidemiologic findings reveal a closer association of lung cancer with the indoor burning of “smoky” coal (as opposed to “smokeless” coal or wood) than with tobacco use or occupation. Current aerometric, chemical, and toxicologic findings tend to confirm this association, though the specific carcinogenic constituents of Xuan Wei indoor air pollution have not yet been determined. Chinese and American investigators are conducting interdisciplinary field and laboratory investigations to quantify the lung cancer risk attendant on indoor air pollution relative to other factors, to measure and compare the characteristics of pollution from different Xuan Wei fuels, to determine the relative etiologic importance of pollution composition and concentration, and to develop quantitative relationships between air pollution dose and lung cancer risk.     

宣威男性肺癌危险状态分析研究

本文对１９７６～１９９６年宣威肺癌病因学干预试验研究数据库中男性人群的原始记录进行了分析。运用状态风险分析理论，选择生活燃料（包括改炉改灶）、吸烟和慢性支气管炎病史为伴随变量，建立了宣威男性肺癌的危险状态分类模型。该模型可对人群及个体患肺癌危险度进行评价，有助于确定肺癌高危人群和高危个体，为指导当地肺癌的预防提供科学依据。     

Risk of developing lung cancer in relation to exposure to fumes from Chinese-style cooking.

In an evaluation of the association between exposure to indoor air pollution from Chinese-style cooking and the risk of lung cancer, epidemiologic and experimental studies were reviewed. The 9 case-referent studies that were identified showed consistent positive associations between the risk of lung cancer and a variety of indices of exposure to indoor air pollution arising from Chinese-style cooking. Three experimental studies showed that volatile emissions from oils heated in woks are mutagenic in several in vitro short-term test systems. Several toxic agents, including some accepted or suspected carcinogens, have been detected in the emissions of the heated cooking oils. While experimental data support the epidemiologic data, it may be premature to conclude that the association is causal. However, simple precautions can be taken to reduce the risk in the event that exposure to indoor air pollution arising from Chinese-style cooking is indeed a cause of lung cancer.     

Respiratory symptoms and lung function effects of domestic exposure to tobacco smoke and cooking by gas in non-smoking women in Singapore.

STUDY OBJECTIVES--To investigate the effects of passive exposure to tobacco smoke and gas cooking at home on respiratory symptoms and lung function of non-smoking women. SETTING--Evidence on the effects of passive smoking and exposure to nitrogen dioxide from gas cooking on the respiratory health of adults is limited and variable. Over 97% of women in Singapore do not smoke, and a principal source of indoor air pollution for housewives is passive smoking and gas cooking. DESIGN--This was a cross sectional (prevalence) study of a population based sample of 2868 adults aged 20 to 74 years in Singapore. A structured questionnaire administered by trained interviewers was used to collect data on passive smoking, gas cooking, respiratory symptoms, and other relevant variables. Passive smoking was defined as exposure to cigarette smoke from one or more members of the household who had ever smoked. Gas cooking was defined in terms of the weekly frequency of gas cooking, as well as the frequency with which the respondent's kitchen was filled with heavy cooking fumes (rarely, occasionally, often). Forced expiratory volume in one second (FEV1) was measured by using a portable Micro-spirometer. Multivariate analyses were used to estimate relative odds of association for respiratory symptoms and FEV1 effect, with adjustment for potential confounding variables. PARTICIPANTS--Of a total of 1438 women in the sample, 1282 women who had never smoked provided questionnaire data and 1008 women provided acceptable readings of FEV1 for analysis. MAIN RESULTS--Passive smoking was significantly associated with greater relative odds of usual or chronic cough and phlegm, wheezing, and breathlessness on exertion, as well as lower FEV1. Greater relative odds of respiratory symptoms were also associated with the weekly frequency of gas cooking, although these results were statistically insignificant. Chronic cough and phlegm and breathlessness on exertion, however, were significantly associated with the frequency with which the kitchen was filled with heavy cooking fumes. A lower FEV1 was found in women who cooked frequently (more than thrice a week). CONCLUSION--Domestic exposure to cigarette smoke and gas cooking is associated with increased risks of respiratory symptoms and impairment of lung function in non-smoking women in Singapore.