中国农村恶性肿瘤早期筛查及干预模式探讨

目的寻求恶性肿瘤早期筛查方法,探讨农村干预模式,以控制恶性肿瘤的高发态势。方法采用病例对照研究方法,选定慈溪市境内现患肺癌、肝癌、胃癌、乳腺癌、直肠癌病人861人及相对应的健康者861人做对照。确定研究对象的生活习惯、居住环境、职业爱好、饮食卫生、遗传因素、家族史等200个项目,进村入户,面对面实施问卷调查。结果用SPSS13.0系统软件包统计,分析OR值。遴选出高度危险因素(OR>2以上),拟定慈溪市境内恶性肿瘤测评表,进行自测打分。大于60分者列入干预对象,实施GI4P方案,即指导整合(Guide In-tegerter)、预测性(Predictive)、预防性(Preventive)、个体性(Persondlized)、参与性(Participatorg),具体采取健康教育促进、心理疏导、早期TAP筛查。对TAP阳性的早期实施免疫调节剂和中药扶正治疗、观察。结果恶性肿瘤高度危险因素有情绪自我调节能力差、A型性格、慢性炎症、溃疡、慢性肝炎、爱吃肥肉、喜动物内脏、咸鱼、咸菜、咸虾皮、吸烟、酗酒、父母有恶性肿瘤史、长期服避孕药,用TAP进行筛查(26/460)阳性率5.65%。实施健康教育干预、休息、复检;以中药和免疫调节剂,5周内全部转阴。结论农村恶性肿瘤早期筛查及干预模式是目前我国全新的干预方法,其采用现场流行病学和实验流行病学相结合方法和理念,遴选危险因素,结合早期的恶性肿瘤异常蛋白(TAP)检测手段,GI4P方案是科学、简捷、正确、可行的,为我国农村恶性肿瘤的预防干预创出了一条新的路子。

Discussion of model of early screening and intervention for cancer in China＇s rural areas

Objective To explore the methods for early screening of cancer and approach the intervention model in rural areas,as to control the high incidence of cancer.Methods 861 cancer patients and 861 health people had been collected to research by case-control study.Design questionnaires to survey the living habit,inhabited environment,occupation preference,dietary hygiene,genetic factor,family history and other 200 projects of the above people.The results were analyzed by SPSS 13.0.Selected high risk factors（OR2）,designed cancer evaluation tables to score by self test.The people whose scores were more than 60 were included in the intervention.The objectives were interfered by GI4P programs（guide integrate,predictive,preventive personalized and participative）.These programs included health education promotion,psychological counseling and early TAP-screening.TAP-positive people were treated by immune modulators and traditional Chinese drugs therapy.Results High risks of cancer included poor emotional self-regulation.A-type personality,chronic inflammation,ulcers,chronic hepatitis,high fat,animals internal organs,salted fish,pickled vegetables,salted shrimp diets,smoking,alcohol abuse,parental history of malignancy,long-term oral contraceptives.The positive rate of TAP-screening was 5.65%（26/460）.TAP-positive people were treated by health education intervention,re-examination,immune modulators and traditional Chinese drugs therapy.All the results were into negative in 5 weeks.Conclusion Early screening and interfering model for cancer was the new intervention methods in rural areas.It utilized experimental epidemiology and field epidemiology methods to select risk factors,combined with early TAP-Screening,interfered by GI4P schemas.The program was scientific,simple,accurate and feasible.It created a new path for cancer prevention and intervention in rural areas.