橡胶职业暴露与肺癌关系的前瞻性研究 Ⅱ 巢式病例对照和病例队列设计

A Prospective Study on the Relationship between Rubber Occupational Exposure and Lung Cancer Ⅱ Nested Casecontrol and CaseCohort Studies

目的研究橡胶职业暴露、生活方式习惯、家庭环境和经济状况与肺癌之间以及因素相互之间的关系，并对本文应用的两种分析方法进行比较和评价。方法对队列在随访期间死亡的５１例病例及其对照用巢式病例－对照和病例－队列两种方法进行多因素分析。结果在控制非职业性危险因素条件下，亚硝胺暴露的危险度有显著增高（ＲＲ＝２．７１，９５％ＣＩ：１．３２～５．５７），并发现亚硝胺暴露与肺癌间有明确的剂量－反应关系存在。结论（１）本文数据提示病例－队列分析因标准误较小、抽样更简便而优于巢式病例－对照研究方法；（２）亚硝胺暴露与肺癌之间有较确定的关系，但受到吸烟和经济状况等因素作用的修饰。

Objective Relationship between occupational exposure in rubber industry,lifestyle and habits,family environment,economic status and lung cancer,and interaction between those factors were studied.And,two analytic methods used in the study were compared and evaluated. Methods Fiftyone patients died during the period of followup and their controls were studied with nested casecontrol and casecohort methods by multivariate analysis. Results Risk for lung cancer caused by exposure to nitrosoamine increased significantly after adjustment of nonoccupational risk factors (RR=271,with 95% CI of 132 to 557),with a significant doseresponse relationship between exposure to nitrosoamine and lung cancer. Conclusion(1)Results suggest that casecohort study is better than nested casecontrol study,due to its smaller standard error and simpler sampling.(2)There is a definite relationship between exposure to nitrosoamine and lung cancer,but due to the modification of smoking and economic status,further studies are needed.