N-亚硝胺与消化道恶性肿瘤发生风险的关系:基于队列研究的Meta分析

目的 分析N-亚硝胺与消化道恶性肿瘤发生/死亡风险的关系。方法 通过系统检索中国生物医学文献数据库、中文期刊全文数据库、万方电子期刊、PubMed、EBSCO等文献数据库,纳入N-亚硝胺与消化道恶性肿瘤发生/死亡风险队列研究文献,采用RevMan 5.1软件进行Meta分析。结果 共检索到相关文献13篇,纳入其中7篇含有消化道恶性肿瘤的文献进行Meta分析;N-亚硝胺显著增加消化道癌症的发生风险(RR=1.12,95%CI:1.03~1.21);与食管癌发生风险无显著性关联(RR=1.18,95%CI:0.98~1.41),但显著增加食管鳞状细胞癌发生风险(RR=1.72,95%CI:1.01~2.96),而与食管腺癌无显著性相关(RR=0.88,95%CI:0.57~1.37);N-亚硝胺能显著提高胃癌的发生风险(RR=1.08,95%CI:1.00~1.18),但对贲门癌与胃腺癌发生风险的影响无显著性。结论 现有人群队列研究证据显示,N-亚硝胺会显著增加消化道恶性肿瘤的发生风险,但是对不同亚型食管癌和胃癌的影响不同,由于队列研究数量较少且在研究设计、人群选择、暴露测量等方面存在差异,仍需进一步积累相关研究证据。

Relationship between N-nitrosodimethylamine and risk of digestive tract cancers:a Meta analysis based on cohort studies

Objective To analyze the relationship between N-nitrosodimethylamine (NDMA) and the risk of digestive tract cancers. Methods The papers about the relationship between NDMA and the risk of digestive tract cancers published from 1980 to 2012 were retrieved following databases:Chinese BioMedical Literature Database (CBM), the Chinese Journal Full-text Database (CNKI), Wanfang Database, PubMed and EBSCO. The fix and random effect model was used and statistical analyses were conducted by using RevMan 5.1 software. Results Thirteen papers were found, in which 7 about digestive tract cancers were used in this Meta analysis. The NDMA had significant positive effect on the incidence of digestive tract cancers (RR=1.12, 95%CI:1.03-1.21). The relationship between NDMA and esophageal cancer was not significant (RR=1.18, 95%CI:0.98-1.41) but NDMA could increase the risk of gastric cancer (RR=1.08, 95%CI:1.00-1.18). For the subtypes of esophageal and gastric cancer, NDMA had positive relationship with esophageal squamous cell carcinoma (RR=1.72, 95%CI:1.01-2.96), but had no significant relationship with esophageal adenocarcinoma, cardiac carcinoma and gastric adenocarcinoma. Conclusion The population-based cohort studies have showed that the NDMA could significantly increase the risk of digestive tract cancers, but the effects differed with subtypes of esophageal and gastric cancer. However, it is necessary to collect more evidence due to the limited studies and obvious differences in the study design, sampling and exposure measurement of these cohort studies.