甘肃省武威市肝癌危险因素流行病学研究

Investigation of risk factors in the liver cancer of Wuwei city

目的探讨肝癌危险因素在我国西北部肝癌低发区甘肃省武威市的普遍性，给肝癌一级预防提供病因线索。方法用病例．对照研究方法对武威市居民的肝癌危险因素及家族史进行调查。用简单分离分析方法及Penmse法估计遗传模式，按Falconer回归法计算肝癌遗传度。用培养鉴定及实验检测等手段检测居民膳食中的致（促）癌真菌、挥发性N-亚硝基化合物、饮用水中的硝酸盐、亚硝酸盐、健康成年人血清总维生素C含量。结果乙肝病史、亲属肿瘤史、食用盐腌食品史、肝硬化病史、饮用地表水与浅井水、饮酒、食用霉变食物等因素是武威市肝癌的危险因素，经分离分析及遗传模式估计，武威市肝癌发病不符合单基因遗传模式，可能为多基因遗传模式。先证者一级亲属的遗传度h2为58．74％。居民膳食中检出8种亚硝胺，14种致（促）癌真菌。饮用的地表水中硝酸盐氮和亚硝酸盐氮含量分别为（38．97±3．14）mg／L和（0．086±0．043）mg／L；浅井水中硝酸盐氮和亚硝酸盐氮含量分别为（25．88±1．76）mg／L和（0．063±0．032）mg／L。健康成年人夏季血清总维生素C含量为（5．74±2．79）mg／L。结论乙肝病史、家族肿瘤史、食用盐腌食品史、肝硬化、饮用地表水与浅井水、饮酒、食用霉变食物、饮用水中硝酸盐氮和亚硝酸盐氮含量高、膳食中存在挥发性N-亚硝基化合物等多种强致癌物质、缺乏维生素C等防护因素等是武威市居民肝癌发病的危险因素；遗传易感性为导致癌变的内环境。

Objective To investigate the widespread of the liver cancer risk factors in Wuwei city, where low-incidence for liver cancer and offer the cause clue to first-level prevention. Methods Investigate the risk factor and family history of the Wuwei city resident who with liver cancer by using case-control study. Estimate the liver cancer heredity mode with the method of Penrose and simple segregation analysis, calculate the degree of heritability with the method of Falconer,s regression. Detect the content of the resulting and promoting cancer fungi, volatility N-second nitroso compound in the meal, nitrate and nitrite in the drinking water and the vitamin C in the health adults＇ serum by means of culturing appraisement, experiment examination etc. Results The risk factors of liver cancer in the Wuwei city were history of viral hepatitis type B, kinsfolk tumor, the eating salting or mildewed foods, cirrhosis, drinking surface water, well water, or wine. By using segregation analysis and estimation of heredity mode show that the morbidity of liver cancer discrepancy to the monogenic inheritance mode, maybe the polygenic inheritance mode in Wuwei city. The b2 of index case first degree relative was 58.74 %. Picking out 8 kinds of nitrosamine, 14 kinds of resulting and promoting cancer fungi from resident meal. The content of nitrate and nitrite was （38.97±3.14） mg/L, （0.086±0.043） mg/L respectively in shallow well water, the vitamin C in the health adults＂ serum in summer was （5.74±2.79） mg/L. Conclusion It can be seen that the history of viral hepatitis type B, kinsfolk tumor, eating salting or mildewed foods, cirrhosis, addicted to drink; higher content of nitrate and nitrite in the drinking water and strong carcinogens such as volatility N-nitroso compound in the meal, and also lacking protection factors such as vitamin C are the risk factors of the Wuwei city resident who with liver cancer. The inherit susceptivity is the internal environment of resulting cancer change.