上海市区慢性肺部疾病史与男性肺癌关系的前瞻性队列研究

The history of chronic pulmonray diseases and male lung cancer risk:a prospective cohort study in urban Shanghai

目的:研究肺气肿、肺结核、慢性支气管炎和哮喘等慢性肺部疾病史与男性肺癌之间的关系。方法:建立2002—2006年上海市区61500例男性队列调查资料,应用COX回归模型分析肺气肿、肺结核、慢性支气管炎和哮喘等慢性肺部疾病史与男性肺癌发生的风险比(hazard ratio,HR)及其95%可信区间(confidence interval,CI)。结果:截至2008年12月31日,队列中共发生323例肺癌病例。调整了年龄、教育程度、家庭收入、吸烟状态和吸烟包-年等混杂因素后发现,慢性支气管炎可增加男性肺癌的危险性,其HR值为1.87(95%CI:1.35～2.57);进一步调整了体质指数(body mass index,BMI)、能量摄入和体力活动等因素后发现,慢性支气管炎仍可增加男性肺癌发生的危险性,与未患慢性支气管炎者相比差异有统计学意义(P<0.01)。在排除了基线调查前3年内诊断为慢性肺部疾病的对象后发现,慢性支气管炎与肺癌危险性的关联强度没有明显变化。按吸烟史和BMI分层分析发现,在有吸烟史者中,慢性支气管炎增加了肺癌的危险性,其HR为1.58(95%CI:1.14～2.19);在从未吸烟者中,则未发现2者有关联。在非肥胖者(BMI<25)和肥胖者(BMI≥25)中,慢性支气管炎均可使肺癌的发病风险增加。同时各种分析均提示,肺气肿、肺结核和哮喘与肺癌的关联均无统计学意义。结论:慢性支气管炎可能增加了男性肺癌的发病风险。

Objective：To investigate the association between history of chronic pulmonary diseases （e.g. pulmonary emphysema, pulmonary tuberculosis, chronic bronchitis, and asthma） and risk of lung cancer for male patients in urban Shanghai.Methods：A total of 61 500 male residents aged 40 to 74 years in urban Shanghai were recruited in the prospective cohort study named as Shanghai Men’s Health Study from 2002 to 2006. COX regression model was used to estimate hazard ratio （HR） and 95% confidence interval （CI）.Results：Lung cancer was identified in 323 men in the cohort until December 31,2008. After adjustment for the confounding factors such as age, education degree, family income, smoking status, pack-year of smoking, we found that chronic bronchitis increased the risk of developing lung cancer （HR：1.87, 95%CI： 1.35-2.57）. After further adjustment for body mass index （BMI）, energy intake, and physical activity, the difference between the patients with or without chronic bronchitis was still statistically significant （P〈0.01）. Because early symptoms of lung cancer were likely to be incorrectly diagnosed as prior lung diseases, after excluding the subjects who were diagnosed with prior lung diseases within three years before baseline survey, the correlation intensity of chronic bronchitis with lung cancer had no significant change. Stratification analysis by smoking history showed that smokers with chronic bronchitis had increased risk of lung cancer （HR：1.58, 95%CI： 1.14-2.19）, but no correlation was found in non smokers. Stratified by BMI, chronic bronchitis increased the risk of developing lung cancer in both non obese （BMI25） and obese （BMI≥25） subjects. Pulmonary emphysema, pulmonary tuberculosis and asthma were not correlated with lung cancer in the study population. Conclusion：Chronic bronchitis increased the risk of lung cancer for men.