环境低浓度石棉暴露与肺癌危险性的巢式病例对照研究

The association between the risk of lung cancer and environmental low-concertration exposure to asbestos: a nested case-control study

目的 探讨云南省大姚县环境低浓度青石棉暴露与肺癌之间的关联以及肺癌高发的主要危险因素,为当地的肺癌防制提供依据。方法 采用巢式病例对照研究方法,从队列中获得5 3例肺癌病例,按1∶3的比例分别匹配以性别相同、年龄相当的对照。结果 单因素条件logistic回归分析发现石棉环境污染、吸烟、饮酒、喝茶与肺癌有统计学关联,石棉环境污染的各种形式中,只有使用石棉炉对肺癌发生有显著性意义。用多因素条件logistic回归进一步分析,使用石棉炉和吸烟与肺癌有统计学关联,OR值分别是3.38(95 % CI1.4 3～7.95 )和2 .6 2 (95 % CI1.0 8～6 .5 6 ) ,其他各因素对肺癌的影响未发现有显著性意义。对吸烟与使用石棉炉的交互作用进行相乘模型的拟合,未发现两因素存在相乘模型的交互作用(P =0 .310 )。相加模型交互作用分析结果显示,吸烟和使用石棉炉对肺癌发病的影响可能存在着相加模型的交互作用。结论 吸烟和使用石棉炉是当地肺癌高发的主要危险因素。

Objective To explore the major risk factors for lung cancer and the relationship between environmental low concentration exposure to crocidolite and lung cancer in Dayao county, Yunnan province so as to provide epidemiological evidences for prevention of this disease in this area. Methods A 1∶3 nested case-control study was carried out, 53 cases was obstained from cohort study,and every case was matched with three controls with same age and gender. Results From the analysis of univariate conditional logistic regression model, several factors were found to have statistically significant association with the risk of lung cancer, including environmental exposure to asbestos, smoking, drinking and drink tea. Upon further analysis of multivariate conditional logistic regression model showed that using asbestos stove and smoking have statistical associations with the risk of lung cancer,and odds ratios were 3.38 (95%CI 1.43～7.95) and 2.62 (95%CI 1.08～6.56) respectively. Others were not found to have significant association with the risk of lung cancer. No multiplicative interaction between using asbestos stove and smoking was found (P=0.310). And the analysis of additive interaction model indicated that the interaction between using asbestos stove and smoking might be additive. Conclusions Smoking and using asbestos stove were the major risk factors of lung cancer in Dayao county, Yunnan province, and migh have additive interaction.