甲状腺良、恶性结节发病的影响因素及其Ordinal回归分析

目的 了解不同人群中甲状腺良、恶性结节的发病情况及其影响因素.方法 采取分阶段整群随机抽样方法,选取在某医院进行体检的人群进行一般情况及甲状腺疾病发生影响因素的问卷调查,数据资料采用Wilcoxon秩和检验和Kruskal-Wallis H检验,并进行Ordinal回归分析.结果 共调查8 090名体检者,有效问卷8 039份,有效率99.37%.甲状腺正常者2 912名,占36.2%,结节性甲状腺肿、其他甲状腺良性疾病和甲状腺癌分别为2 470,1 539和1 118例,各占30.7%、19.1%和13.9%.单因素分析显示,工作单位、生存环境、从事职业、饮食习惯、电磁辐射、尾气尘埃等对体检人群发生甲状腺良、恶性结节的影响差异有统计学意义(P<0.05).Ordinal回归分析显示,从事电化企业、银行工作、厨卫保洁的人群甲状腺疾病发生的概率分别是医药卫生系统的8.53倍(OR=8.53,95%CI:7.02~9.89)、1.69倍(OR=1.69,95%CI:1.26~1.94)和7.29倍(OR=7.29,95%CI:5.81~9.03).与普通街区比较,生活或工作在干道工地旁、电器高压线旁和新近装修、尾气油烟尘埃之中为发生甲状腺疾病的危险因素.接触手机、电脑等电磁辐射越多,以及碘、钙、氟的过度摄入,甲状腺疾病发生的概率越高.结论 甲状腺良、恶性结节发病的风险因素有手机、电脑、微波、电器等电磁辐射,建筑尘埃、雾霾、装修以及油烟尾气等;保护性因素则是花园式绿色环境.

Impact Factors of Benign and Malignant Thyroid Nodules based on Ordinal Regression Analysis

Objectives To investigate the prevalence and impact factors of thyroid nodules among health examination people.Methods Multistage stratified cluster random sampling technique was used to choose health examination people to carry out the survey of impact factors of thyroid diseases.The data were analyzed with Wilcoxon rank sum test and Kruskal-Wallis H test and Ordinal regression using SPSS version 20.0 for windows.Results 8 090 persons were interviewed,and 8 039(99.37%)effective questionnaires were retrieved.The numbers of people with normal thyroid,nodular goiter,toxic goiter or Hashimoto's thyroiditis and papillary thyroid carcinoma were 2 912(36.2%),2 470(30.7%),1 539(19.1%)and 1 118(13.9%),respectively.Univariate analysis showed that work units or life environment,occupation,dietary habits,electromagnetic radiation,exhaust and dust,excessive intake of fluorine and calcium,inspiring dust and waste air were risk factors of thyroid nodules.Ordinary regression analysis revealed people working in electron or chemistry factories(OR=8.53,95% CI:7.02-9.89),bank employee(OR=1.69,95% CI:1.26-1.94),cook and janitor(OR=7.29,95% CI:5.81-9.03)were more likely to develop thyroid disease than people working in health system.Persons living and working in the environment near express road or building or constructing,electric high-voltage,new decoration buildings and atmospheres of dust,fog and haze had an increased risk of thyroid nodules after exposure.Furthermore,excessive intake of iodine salt,fluorine and calcium were also the risk factors.Conclusions The study found that the risk factors of thyroid nodules were electromagnetic radiation of computers or cell phones or microwave besides ionization radiation,construction dust and haze,renovation and exhaust fumes,while the protective factor was garden-like green environment.