饮水与上消化道癌症的关系

Exploration on the relationship between drinking-water types and the risks for three kinds of Upper-GI cancers in South China

目的探讨不同饮水类型与上消化道癌症(肝癌、胃癌、食管癌)发病危险度的关系。方法在江苏省泰兴市进行以人群为基础的病例-对照研究,包括肝癌、胃癌、食管癌病例各204、206、218例,对照415例。Logistic回归计算OR值及95%可信区间。结果所有饮水类型中,浅井水和河水所占比例最高,平均饮用年限最长。饮河水史与胃癌、食管癌上升的危险度有关,而饮浅井水显示与胃癌下降的危险度有关,均呈明显剂量-效应关系;将只有自来水饮用史而无河水饮用史的人群作为参照组进行比较,河水饮用在3种癌症中呈现不同程度的剂量效应关系;当饮用年限大于37年时,肝癌、胃癌、食管癌调整的危险度分别上升到3.37(95%可信区间1.36～8.39),5.41(95%可信区间2.24～13.11),5.93(95%可信区间2.35～14.93)。此外,肝癌危险度随个体饮生水频率的增高而上升,剂量-效应关系显著,经常饮用肝癌危险度上升到3.4。结论河水暴露可能与当地胃癌、食管癌的高发有关,饮生水可能增高个体患肝癌的危险度,自来水则对3种癌症均有一定程度的保护作用。

Objective To explore the possible relationship between water drinking history and the risks for three kinds of Upper-GI cancers. Methods A population based case-control study was conducted in Taixing city, Jiangsu province. 204 cases with liver cancer, 206 stomach cancer, and 218 esophageal cancer and 415 randomly selected controls were collected. Logistic regression model was used to estimate the adjusted OR and 95%CI. Results Among all eight drinking-water types, drinking of shallow well water and river water were shown with higher exposure proportion and longer exposure period. River water drinking was observed being related to the increased risk for stomach cancer and esophageal cancer, while shallow well water was found some protective effect on stomach cancer, and dose-response relationships were found in them. Using the subjects with tape water drinking history and without river water drinking history as control, all three kinds of cancer risks were elevated with the longer exposure to river water drinking. For subjects with more than 37 years river water drinking history, adjusted ORs for three cancer were increased to 3.37 (95%CI: 1.36～8.39),5.41(2.24～13.11),5.93(2.35～14.93) respectively. In addition, raw water drinking history was found strongly associated with the risk for liver cancer. Conclusions River water drinking might be related to the elevated risk for all three kinds of cancers, raw water drinking might increase the risk for liver cancer, while tap water drinking history was observed some protective effect on all three cancers.