肝内胆管细胞癌的危险因素分析

目的探讨肝内胆管细胞癌(intrahepatic cholangio carcinoma,ICC)的危险因素。方法将北京大学深圳医院2012年9月~2014年9月收治的ICC患者79例作为研究的试验组,并选择同期158例健康体检者作为对照组。计数资料采用χ2检验,计量资料采用t检验,对相关危险因素先用单因素Logistic回归分析,并对可疑危险因素采用多因素Logistic回归法进行分析。结果经单因素分析,ICC可能的危险因素有肝内胆管结石、酒精性肝硬化、乙型肝炎相关性肝硬化、其他原因肝硬化、胆总管结石,血清HBsAg阳性以及肝血吸虫病(P0.05)。多因素分析,ICC相关的危险因素是肝内胆管结石、酒精性肝硬化、乙型肝炎相关性肝硬化、其他原因肝硬化、肝血吸虫病、血清HBsAg阳性(P0.05)。结论 ICC的危险因素有多种,肝内胆管结石是其中的一个危险因素。     

肝内胆管细胞癌微血管浸润的危险因素分析及预测模型建立

目的 探讨肝内胆管细胞癌（ICC）发生微血管浸润（MVI）的危险因素,并建立预测模型。方法 选择100例ICC患者,其中MVI组24例、非MVI组76例。收集两组基线资料,采用多因素Logistic回归模型分析ICC患者发生MVI的危险因素。并建立临床预测模型,绘制该模型的受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评价该模型对MVI的诊断价值。通过rms程序包构建列线图预测模型,并进行内部验证。结果 两组总胆红素（TBIL）、异常凝血酶原-Ⅱ（PIVKA-Ⅱ）、肿瘤数量、肿瘤直径比较,差异有统计学意义（P均<0.05）,其他临床指标比较,差异无统计学意义（P均>0.05）。多因素Logistic回归分析筛选出PIVKA-Ⅱ高水平、肿瘤多发和肿瘤直径较大是ICC患者发生MVI的独立危险因素,并利用其建立预测模型,P=（-5.381）+1.521×（PIVKA-Ⅱ）+1.289×（肿瘤数量）+0.271×（肿瘤大小）,该模型的AUC为0.74(95%CI:0.65～0.84)。结合以上危险因素构建列线图,校准曲线显示该模型能准确预测ICC患者发生MVI的风险。结论...     

大肠癌危险因素分析

目的研究广东省惠州市大肠癌的患病相关危险因素，为制订本地区大肠癌的监测与筛查方案提供科学依据。方法采用基于结肠镜检查的病例对照研究，应用Logistic回归对大肠癌相关变量进行单因素和多因素分析。把可能的危险因素先行单因素分析，发现某些有意义的因素后，纳入Logistic回归模型进行多因素分析。结果有统计学意义的危险因素有年龄≥45岁、排血便或黏液血便、排便次数增多（≥2～3次，天），摄食水果少。结论惠州地区大肠癌的发病与年龄、进食水果、排便性状及次数有关。     

北京市肺癌发病危险因素的初步探索

我们于１９９０年１月１日￣６月３０日对北京市城近郊区市级以上医院诊断的２２０例新发并存活的原发性肺癌病人，按１：１配对方法进行了病例对照研究。采用配对资料单因素及多元条件ｌｏｇｉｓｔｉｃ回归分析法。初步结果显示：煤炉取暖、吸烟、肺结核病史、饮食中Ｖｉｔｃ和β－胡萝卜素摄入量不足似与北京市肺癌发病有关，并再次证实患者随每日吸烟量的增加和开始吸烟年龄的减小，肺癌危险性呈明显增加趋势。     

肝内胆管癌的危险因素与发病机制

肝内胆管癌(ICC)病因复杂,高度侵袭、预后不良,是仅次于肝细胞癌的第二大肝胆恶性肿瘤。早期手术切除仍是ICC的最佳治疗方案,但因其起病隐匿,恶性程度高,多数患者就诊时已处于中晚期,失去了最佳的手术时机。因此,临床上能够对ICC进行早期及时的识别和干预十分重要。目前已经有研究证实了原发性硬化性胆管炎、病毒性肝炎、肝内胆管结石等危险因素与ICC的密切关系,分子生物学和遗传学技术的迅速发展也为ICC发病机制的深入研究提供了更好的方法。现将近年来ICC的危险因素及发病机制相关研究作一综述,以期为其临床早期诊治提供更多有价值的信息。     

初发急性心肌梗死发病危险因素分析

目的 探讨2004-2005年北京及沈阳城市居民急性心肌梗死发生的主要危险因素,并初步估计和分析各危险因素的归因危险度百分比(ARP)和人群归因危险度百分比(PARP).方法 采用1:1配比病例对照研究方法,连续纳入初发急性ST段抬高心肌梗死患者共426例,以性别和年龄为匹配因素,为每位患者匹配健康对照1例.结果 经多因素条件logistic回归分析,最终纳入了8个主要危险因素,依次为大量吸烟、糖尿病史、早发冠心病家族史、豆类摄人较少、心理压力较大、海鱼摄入较少、文化程度较低及6个月内曾经历过负性生活事件.其OR值依次为3.170、2.835、2.243、2.243、2.138、1.740、1.572和1.515;ARP值依次为71.53%、58.33%、54.05%、40.81%、56.85%、41.53%、48.62%和54.00%;PARP值依次为38.79%、10.40%、4.69%、33.72%、36.03%、24.96%、29.56%,14.83%.结论 2004-2005年,对我国北京和沈阳城市居民人群发生急性心肌梗死危害最大的危险因素依次为大量吸烟、心理压力较大、豆类摄入较少、文化程度较低、海鱼摄入较少、6个月内曾经历过负性生活事件、糖尿病和早发冠心病家族史.     

肝内胆管细胞癌的临床病理学观察

常见肝内胆管恶性肿瘤有肝内胆管癌（ICC）、细胆管细胞癌（CLC）及混合细胞型肝癌（CHC）中的胆管癌成分。ICC是肝脏第二常见恶性肿瘤,根据我院手术切除的3．3万余例肝脏恶性肿瘤的病理资料统计,肝细胞癌（HCC）和ICC分别占85．6％和7．7％,ICC的发病呈逐年上升趋势,具有易转移复发的生物学特性;CLC少见,因起源于肝脏双向分化的前体细胞而具有侵袭性强的特点;CHC的病理检出率有增多趋势,预后较HCC和ICC更差。准确的病理分型对于临床诊治和预后评估具有实际意义。     

济南军区肺结核危险因素的病例对照研究

目的：了解影响部队肺结核发病的危险因素,有针对性地采取预防措施,方法：按1：1配比对20个单位中新发肺结核病人进行病例对照调查,计算各因素的比值比（OR）和95％可信区间（CI）,并用条件logistic回归模型进行多因素逐步回归分析。结果：单因素分析中,劳动强度、体质指数、卡痕、住房类别、结核病接触史、入伍地、性能等因素的OR值分别为5．12、0．37、0．42、0．51、1．82、0．57和1．63（P＜0．05）。上述因素中除性格外均进入回归模型,结论：完善卡介苗的接种,加强对肺结核传染源的发现、治疗、管理工作,以及针对其他发病危险因素采取相应的防治措施对于结核病疫情的控制具有重要意义。     

大肠癌危险因素的病例对照研究

目的 研究广东省惠州市大肠癌的相关危险因素,为制订本地区大肠癌的监测与筛查措施提供科学依据.方法 采用基于结肠镜检查的病例-对照研究,应用Logistic回归对大肠癌相关变量进行单因素和多因素分析.将可能的危险因素先行单因素分析,发现某些有意义的因素后,纳入Logistic回归模型进行多因素分析.结果 有统计学意义的危险因素有年龄、排血便或黏液血便、排便次数增多(≥2～3次/d)、常吃肥肉及有饮酒史.结论 惠州地区大肠癌的发病与年龄、常吃肥肉及有饮酒史、排便性状及次数有关.     

江苏省太仓市胆囊结石危险因素病例对照研究

胆石症是江苏省太仓市的常见病,１９９７年江苏省太仓市人民医院外科手术病例的１／４是胆石症。本文概括胆囊结石的主要危险因素,为当地胆石症的预防和干预提供科学依据。材料与方法本研究采用了基本人群的成组病例对照研究设计。在太仓市选取５个自然村,作为研究现场。病例通过Ｂ超检查获取,共检查３５～７９岁居民２４５８例,以受检人群中胆囊结石病人为研究对象。对照为随机人群,共６１１例。直接面访被调查者,对研究对象实施同一问卷的询问调查。调查内容包括一般情况、饮食、行为、胆石症家族史、既往史、女性生理与生育因素等…     

Risk factors for intrahepatic cholangiocarcinoma： A casecontrol study in China

AIM： To carry out a hospital-based case-control study to investigate risk factors for intrahepatic cholangiocarcinoma （ICC） in China. METHODS： A total of 312 ICC cases and 438 matched controls were included in the study. The presence of diabetes mellitus, hypertention, hepatolithiasis, primary sclerosing cholangitis, liver fluke infection （Clonorchis sinensis）, was investigated through clinical records. Blood from all participants was tested for hepatitis B surface antigen （HBsAg） and anti-HCV antibodies. Odds ratios （OR） and 95% confidence intervals （95% CI） were estimated using conditional logistic regression. RESULTS： Compared with controls, ICC patients had a higher prevalence of HBsAg seropositivity （48.4% vs 9.6%, P 〈 0.000）, and hepatolithiasis （5.4% vs 1.1%, P = 0.001）. By multivariate analysis, the significant risk factors for development of ICC were HBsAg seropositivity （adjusted OR, 8.876, 95% CI, 5.973-13.192）, and hepatolithiasis （adjusted OR, 5.765, 95% CI, 1.972-16.851）. The prevalence of anti-HCV seropositivity, diabetes mellitus, hypertention, cigarette smoking, and alcohol consumption were not significantly different between cases and controls. CONCLUSION： These findings suggest that HBV infection and hepatolithiasis are strong risk factors for development of ICC in China.     

儿科住院病人医院感染危险因素的病例对照调查

目的探讨儿科病房医院感染发生率及其危险因素。方法选择某医院2003～2005年1352例患儿为研究对象,以其中医院感染者为病例组,非医院感染者为对照组进行病例对照研究。病例组和对照组按1︰1配比设立对照,以条件logistic法筛选出儿科病房医院感染的危险因素。结果儿科病房医院感染率为7.7%。单因素和多因素分析发现,住院时间、不合理使用抗生素、侵袭性操作、重症监护等是医院感染的危险因素。结论合理使用抗生素、缩短住院时间、减少侵袭性操作将有利于预防和控制儿科医院感染。     

Risk factors of intrahepatic cholangiocarcinoma in patients with hepatolithiasis:a case-control study

BACKGROUND:Why 3.3% to 10% of all patients with hepatolithiasis develop intrahepatic cholangiocarcinoma (ICC) remains unknown.We carried out a hospital-based case-control study to identify risk factors for the development of ICC in patients with hepatolithiasis in China.METHODS:Eighty-seven patients with pathologically diagnosed hepatolithiasis associated with ICC and 228 with hepatolithiasis alone matched by sex,age (±2 years),hospital admittance and place of residence were interviewed during the period of...     

广州市肺结核发病危险因素的调查研究

目的 探讨影响广州市居民肺结核发病的危险因素,为肺结核的防治提供科学依据。 方法 采用1：1配比病例对照研究,对广州市250例涂阳肺结核患者及相同数量的对照(从涂阳肺结核患者的家庭密切接触者人群中选取),使用自行设计的调查表进行调查,调查变量共25个指标,包括受教育程度、职业、个人月收入、承担家庭经济责任、家庭经济状况、吸烟、过量饮酒、运动、婚姻、吸毒、糖尿病史、住房面积、居室的通风、阴暗、潮湿和周围环境质量16个指标和心理应激状况9个指标;心理应激状况选用杨德森生活事件量表(LES)、姜乾金特质应对方式问卷（TCSQ）、肖水源社会支持评定量表 （SSRS）。调查表经预调查测其Cronbach’s系数为0.83。调查肺结核患者268例,发出问卷268份,回收有效回卷250份,有效率93.3%,将有效回答的250例患者全部纳入结核病组。调查涂阳家庭密切接触者1206例,发出问卷1206份,回收有效问卷1143份,有效率94.8%;从1143例家庭密切接触者中按照与结核病组患者同性别、年龄相近（≤3岁）原则进行1：1配对,选取250例纳入非结核病组。对所获资料根据资料的类型采用单因素条件logistic回归分析进行单因素分析,初步筛选出的可能影响肺结核发病的危险因素,再纳入多因素条件logistic回归模型进行多因素分析。计算各变量的Wald χ²值、P值、OR值及其95% CI值。取P值≤0.10有统计学意义。 结果 单因素分析有统计学意义的变量共15个,多因素分析进入模型的变量有9个,个人月收入（分3个水平,＜1000元/月,1000～元/月,≥3000元/月,Wald χ²值分别是13.492、1.379,P=0.000、0.240）,承担家庭经济主要责任（Wald χ²=17.820,P=0.000）,吸烟（Wald χ²=9.489,P=0.002）,过量饮酒（Wald χ²=4.141,P=0.042）;生活事件总刺激量（Wald χ²=6.995,P=0.008）,消极应对（Wald χ²=14.806,P=0.000）6个因素是结核发病的危险因素,其OR值（95% CI值）分别为［4.178（1.948～8.961）、1.475（0.771～2.821）］、6.457（2.716～15.352）、2.960（1.484～5.905）、5.048（1.062～24.004）、1.030（1.008～1.052）、1.131（1.062～1.204）。 结论 个人低收入、承担家庭经济主要责任、吸烟、过量饮酒、生活事件总刺激量、消极应对是广州市居民肺结核发病的危险因素。     

Multicenter case-control study of the risk factors for ulcerative colitis in China

AIM:To evaluate potential risk factors in the development of ulcerative colitis(UC) in China.METHODS:A total of 1308 patients with UC and 1308 age-matched and sex-matched controls were prospectively studied in China.The UC cases were collected from 17 hospitals in China from April 2007 to April 2010.Uniform questionnaires were designed to investigate risk factors including smoking,appendectomy,stress,socio-economic conditions,nonsteroidal antiinflammatory drugs(NSAIDs),oral contraceptives,diet,breastfeeding,infections and family sanitary conditions.Group comparisons by each factor were done using simple logistic regression analysis.Conditional logistic regression was used for multivariate analysis.RESULTS:By univariate analysis,the variables predictive of UC included feeling stress,light and heavy alcoholic drinking,spicy food,sugar consumption and infectious diarrhea,while heavy tea intake and tap water consumption were protective against UC.On multivariate analysis,the protective factor for UC was tap water consumption [odds ratios(OR) = 0.424,95%CI:0.302-0.594,P < 0.001];while the potential risk factors for UC were heavy sugar consumption(OR = 1.632,95%CI:1.156-2.305,P < 0.001),spicy food(light intake:OR = 3.329,95%CI:2.282-4.857,P < 0.001;heavy intake:OR = 3.979,95%CI:2.700-5.863,P < 0.001),and often feeling stress(OR = 1.981,95%CI:1.447-2.711,P < 0.001).Other factors,such as smoking habit,appendectomy,breastfeeding,a history of measles,rural or urban residence,education,oral contraceptives,and NSAID use have not been found to have a significant association with the development of UC in the present study.CONCLUSION:Our study showed tap water consumption was a protective factor for UC,while spicy food,heavy sugar consumption and often feeling stress were risk factors for UC in this Chinese population.     

Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a hospital-based case-control study

BACKGROUND: The risk factors for cholangiocarcinoma are poorly defined in the United States. We evaluated hepatitis C virus (HCV), hepatitis B virus (HBV), and liver cirrhosis as risk factors for intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC). METHODS: A case-control study in which cases were cholangiocarcinoma patients referred to the M.D. Anderson Cancer Center between 1992 and 2002 and controls were healthy individuals. Information about liver diseases, family history, diabetes, smoking, and alcohol consumption were collected on both groups. Blood from all participants was tested for HBV and HCV markers. RESULTS: We identified 246 cases (83 ICC and 163 ECC) and matched them to 236 controls. Compared with controls, ICC patients had a higher prevalence of anti-HCV antibodies (6.0%vs 0.8%, P=0.01), anti-HBc (9.6%vs 0%, P<0.0001), and heavy alcohol consumption (21.7%vs 3.8%, P<0.0001). The adjusted odds ratio and 95% confidence interval (CI) were 7.9 (95% CI 1.3-84.5), 28.6 (95% CI 3.9-1,268.1), and 5.9 (95% CI 2.1-17.4), respectively. Only heavy alcohol consumption was higher in patients with ECC than in controls (17.8%vs 3.8%, P=0.003). The prevalence of diabetes and smoking were not significantly different between cases (ICC or ECC) and controls. The prevalence of cirrhosis was higher in patients with ICC than those with ECC (24.1%vs 4.9%, P<0.0001). CONCLUSIONS: Liver cirrhosis and chronic HCV infection are possible risk factors for ICC but not ECC. Heavy alcohol consumption is a risk factor for both ICC and ECC.     

Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study

BACKGROUND & AIMS: The incidence of intrahepatic cholangiocarcinoma has been recently increasing in the United States. In this case-control study, we used the Surveillance, Epidemiology, and End Results-Medicare database to evaluate the prevalence of known risk factors for intrahepatic cholangiocarcinoma and explore other potential risk factors. METHODS: We identified all patients with intrahepatic cholangiocarcinoma aged 65 years and older diagnosed between 1993 and 1999 in the population-based Surveillance, Epidemiology, and End Results registries (14% of the US population). Controls were randomly chosen from individuals without any cancer diagnosis in the underlying population of the Surveillance, Epidemiology, and End Results regions. We obtained information on risk factors from Medicare claims (parts A and B) for all cases and controls with at least 2 years of continuous Medicare enrollment. Unadjusted and adjusted odds ratios were calculated in logistic regression analysis. RESULTS: A total of 625 cases and 90,834 controls satisfied the inclusion and exclusion criteria. Cases were older than controls (78.7 vs. 76.5 years; P=.02) and were more likely to be male (48.3% vs. 36.8%; P <.0001). The racial composition was similar between cases and controls. Several risk factors were significantly more prevalent among cases. These included nonspecific cirrhosis (adjusted odds ratio, 27.2; P <.0001), alcoholic liver disease (adjusted odds ratio, 7.4; P <.0001), hepatitis C virus infection (adjusted odds ratio, 6.1; P <.0001), human immunodeficiency virus infection (adjusted odds ratio, 5.9; P=.003), diabetes (adjusted odds ratio, 2.0; P <.0001), and inflammatory bowel diseases (adjusted odds ratio, 2.3; P=.002). CONCLUSIONS: This population-based study shows that in addition to previously well described risk factors, several others could be associated with intrahepatic cholangiocarcinoma. These include hepatitis C virus, human immunodeficiency virus, liver cirrhosis, and diabetes.     

Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: A systematic review and meta-analysis

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克山病发病危险因素的病例对照研究

目的探讨克山病发病的危险因素，为制定克山病防治措施提供依据。方法在黑龙江省克山病病区选取41例克山病患者作为病例组．另选134例健康人作为对照组，采用氢化物发生原子荧光光度法检测病例组和对照组全血含硒量．采用5，5’-二硫双-2-硝基苯甲酸（DTNB）分光光度法检测全血谷胱苷肽过氧化物酶（GSH—Px）活力：同时对病例组和对照组进行克山病危险因素的问卷调查，先用单因素卡方检验筛选有意义变量，再引入多因素Logistic回归模型进行综合分析。结果全血含硒量病例组[（34．86±13.14）μg／L]明显低于时照组[（40．97±13．62）μg／L]，两组比较差异有统计学意义（t=2．254，P〈0．05）；GSH—Px活力病例组[（104．10±34．19）U／L]明显低于对照组[（118．57±25．49）U／L]．两组比较差异有统计学意义（t=2．312，P〈0.05）。在问卷调查中，经卡方检验和多因素Logistic回归分析，发现年人均收入水平[比值比（OR）=2.570]、肉类（OR=0．284）和蛋类（OR=0．347）的摄入次数与克山病发生有统计学联系，结论在克山病病区人群中，机体内全血含硒量和GSH—Px活力的下降、年人均收入水平低很可能是克山病发病的危险因素，动物性蛋白摄入的增加可能对克山病的发病起到保护作用：