广东省肺癌危险因素病例对照研究

A case-control Study on the Risk Factors of Lung Caucer in Guangdong

对广东省３９０例肺癌作１：１病例对照研究，比较不同性别、不同病理类型肺癌的危险因素。女性肺癌的流行特征、病理类型、危险因素与男性肺癌不尽相同。２９１例男性肺癌以肺鳞癌多见（鳞癌：腺癌＝１：０．５），９９例女性肺癌以肺腺癌为主（鳞癌：腺癌＝１：２．７）；女性肺癌诊断时年龄明显比男性小（Ｐ＜０．０００１）。单因素Ｌａｇｉｓｔｉｃ回归分析发现，家族肿瘤史、家族肺癌史、慢支／肺气肿病史、肺结核史、其他肺疾患病史、吸烟、家庭被动吸烟、工作环境被动吸烟、职业司机、口服避孕药和吃酸咸菜等因素与肺癌有关（Ｐ＜０．０５）；多因素Ｌｏｇｉｓｔｉｃ回归分析的结果显示肺结核史、慢支／肺气肿病史、家族肿瘤史、吸烟、家庭被动吸烟、工作场所被动吸烟和吃酸咸菜是肺癌独立的危险因素；对数线性模型分析证实，肺癌与慢支／肺气肿病史、被动吸烟、肺结核史、吸烟有显著的交互作用。只有１／５的女性肺癌患者有吸烟史，但９３％的女性肺癌有被动吸烟史，被动吸烟是女性肺癌的重要危险因素之一。家族肺癌史和口服避孕药与女性肺癌存在着一定程度的关联。肺腺癌除了与慢支／肺气肿病史有微弱联系外，与其他危险因素的关系尚未被证实。

case-control study on interaction among the risk factors of primary lung cancer with 390 matched pairs was carried out in Guangdong from 1990 to 1993.The subjects of study were the in-patients with primary lung cancer(age 32-78),which consisted of 171 cases of primary lung squa-mous cell cancer(L,S),138 cases of primary lung adenocarcinoma (L. A),and 81 casps of otherpathological type(L.S:L. A=1:0.8).Primary lung squamous cell cancer accounted for the majori-ty(51.55%)of 291 male cases (L.S:L. A=1:0.5).Primary lung adenocacinoma made up themajority (57.57%)of 99 female cases(L. s:L. A=1:2.7). Single factor conditional logistic regression analysis showed that the occurrence of lung cancerwas closely associated with history of chronic bronchitis, emphyserma,pulmonary tuberculosis andother pulmoriary diseases(OR=2.9-3.6,X￣2=13. 52-37.55,P<0.01)other risk factors were smo-king,passive smoking from spouse or in the working place and family history of tumour (OR=2.7-3.6,X￣2=8.53-33.15, P<0.01). Driver, taking oral contraceptivek,liking pickles or saltedfish and bad ventilation in kitchen could be the risk factors of lung cancer(OR=1.3-3.0,X￣ 2=4.78-5.0,P<0.05).Further mutiple conditional logistic regression analysis turned out that history ofchronic bronchitis,emphysema,pulmonary tuberculosis, smoking,family history of tumour,passivesmoking from spouse or in the working place,liking pickles were the independent risk factors oflung cancer (OR=1.7-3.5). In search of the interaction between lung cancer and the risk factors which included history ofchronic bronchitis, emphysema,pulmonary tuberculosis, smoking and passive smoking, a loglinearmodel analysis was performed.The result revealed that there was significant interaction betweentwo factors in one-stage analysis.Although the interaction existed between chronic bronchitis andtuberculosis,chronic bronchitis and smoking or passive smoking,tuberculosis and passive smokingin the meantime,it had not attained the level of significance among three or more factors(includingthe principal effect of lung cancer)in two-stage analysis (X￣2=1.31-2.27,P>0.13),and thereforethe interaction of the former was not affected by the effect:of the latter as yet.