445对肺癌病例对照的危险因素分析

目的 探讨人群中肺癌的危险因素。方法 应用病例对照的方法．收集广州市l998—2001年部分新诊断的原发性肺癌病例445例。按性别、年龄1：1配对选取正常对照，用由245个项目组成的问卷调查病例和对照有关危险因素的暴露史，通过单因素分析和多因素条件Logistic回归分析筛选肺癌的主要危险因素。结果 经单因素分析发现35个暴露因素与肺癌发生有关。多因素分析发现肺癌有9个主要危险因素和1个保护因素。它们是：吸烟,OR及95％可信区间为3．19(2.18,4.67)；被动吸烟来源于父亲，OR为2.88(1．64，5．04)；被动吸烟来源于配偶，OR为2．73(1．32,5.66)；肺结核病史，OR为2.36(1．13，4.94)；家庭用煤为燃料。OR为3．44(1.38，8．57)；常食用腌、酸菜．OR为3.83(2．34,6．27)；常食用咸鱼，OR为4.49(2.86，7．06)；经常下厨用猛火炒菜，OR为4.45(3.03，6．56)；职业接触金属类毒物。OR为8．76(2．28，33．64)。经常体育锻炼OR为0．59(0．33，1．06)。可能是一个候选的保护因素，P＝0.075。按细胞类型分层．发现肺鳞癌的危险因素与肺腺癌的危险因素有较大差别。结论 肺癌的发生与多种环境危险因素的暴露有关，不同细胞类型肺癌的危险因素也有所差异。从肺癌的病因学来看，它是可以预防与控制的。

The Risk Factors of Human Lung Cancer with 445 Paired Cases and Controls

Objective To investigate the risk factors of human lung cancer. Methods 445 newly diagnosed primary lung cancer cases and equal number of control, matched for age and sex, were enrolled and interviewed in Guangzhou between 1998 to 2001. The questionnaire consists of 245 items about lung cancer aetiological factors was applied. Statistical analysis of single-factor and multivariate conditional Logistic regression were performed to screen the risk factors of lung cancer. Result During the single-factor analysis, 35 exposure factors were identified as aetiological factors for lung cancer. 9 main risk factors and 1 protective factor were showed by multivariate conditional Logistic regression, there were: smoking with odds ratio (OR) 3.19 (95% C.I., 2.18-4.67), exposure to environmental tobacco smoke (ETS) from father with OR 2.88 (95% C.I., 1.64-5.04), exposure to ETS from spouse with OR 2.73 (95% C.I., 1.32-5.66), history of lung tuberculosis with OR 2.36 (95% C.I., 1.13-4.94), coal fuel usage with OR 3.44 (95% C.I., 1.38-8.57), eating pickled vegetable with OR 3.83 (95% C.I., 2.34-6.27), eating pickled and salted fish with OR 4.49 (95% C.I., 2.86-7.06), cooking practice by strong fire with OR 4.45 (95% C.I., 3.03-6.56), occupational exposure to metal poisons with OR 8.76 (95% C.I., 2.28-33.64), and physical exercises might be a protective factor with OR 0.59 (95% C.I., 0.33-1.06), P=0.075. By performing lung cancer cell type stratified analysis, it showed that the risk factors among lung squamous cell carcinomas and adenocaicinomas varied greatly. Conclusion Human lung cancer may be connected with many environmental exposures, different cell types lung cancers with different risk factors, on the view of risk factors, it can be concluded that lung cancer is a preventable disease.