鲁北地区子宫内膜癌发病因素病例对照研究

Case-control study on risk factors of endometrial cancer in northern Shandong area

目的：了解子宫内膜癌发病情况及相关因素,为临床进行预防及治疗提供依据。方法：采用病例-对照流行病学分析方法,对鲁北地区6所三级医院2006-05-01-2011-10-01病理确诊的289例子宫内膜癌患者及174例对照进行统一问卷调查;采用单因素和多因素的Logistic回归分析,以OR和95%可信区间为评价指标,分析与子宫内膜癌有关联的危险性因素。结果：鲁北地区子宫内膜癌患者289例,其中子宫内膜样腺癌259例（90%）;非子宫内膜样腺癌（浆液性腺癌,透明细胞癌等）30例（10%）。Ⅰ期患者219例（76%）,Ⅱ期患者29例（10%）,Ⅲ~Ⅳ期患者共41例（14%）。子宫内膜癌的发病年龄为25~78岁,平均发病年龄为55.41岁,58~61岁为发病高峰。已绝经妇女占62%。单因素分析结果表明,高血压（OR=3.67,χ2=33.70,P=0.00）、糖尿病（OR=1.92,χ2=4.13,P=0.04）、肥胖（OR=4.63,χ2=50.62,P=0.00）、饮用茉莉花茶史（OR=2.63,χ2=19.84,P=0.00）、重体力劳动（OR=1.82,χ2=9.28,P=0.00）、月经不规律（OR=12.68,χ2=107.20,P=0.00）、口服中草药调经（OR=15.21,χ2=68.82,P=0.00）、绝经年龄（OR=1.10,χ2=11.56,P=0.00）、未产（OR=19.07,χ2=15.84,P=0.00）和一级亲属恶性肿瘤家族史（OR=2.91,χ2=12.22,P=0.00）等可增加子宫内膜癌发病风险;使用宫内节育器（intrauterine device,IUD）可降低子宫内膜癌发病风险,OR=0.29,χ2=37.21,P=0.00。多因素Logistic回归分析结果表明,高血压（OR=3.69,95%CI：1.89~7.22）、肥胖（OR=3.06,95%CI：1.62~5.75）、月经不规律（OR=4.53,95%CI：2.13~9.60）、口服中草药调经（OR=9.31,95%CI：2.91~29.76）、绝经年龄晚（OR=1.13,95%CI：1.06~1.20）和一级亲属恶性肿瘤家族史（OR=5.20,95%CI：2.13~12.73）是内膜癌发病的危险因素;使用IUD是内膜癌的保护性因素,OR=0.84,95%CI：0.79~0.88。结论：高血压、肥胖和绝经年龄等因素可影响子宫内膜癌的发生,应针对相关危险因素采取相应的预防措施。

OBJECTIVE：To explore the morbidity and relevant factors of endometrial cancer,and to provide evidence for clinic prevention and treatment.METHODS：The data of 289endometrial carcinomas pathologically diagnosed in six hospitals in northern Shandong area between 05-01-2006and 10-01-2011and a control group of 174healthy people were analyzed uniformly with a case control-study based on a epidemiological survey.We analyzed the data using single factor analysis and multivariate regression analysis with OR and 95%confidence interval as evaluation index to learn the risk factors associated with endometrial cancer.RESULTS：The number of endometrial cancer in northern Shandong area was 289.The number of endometrioid cancer was 259（90%）,and the number of non-endometrioid cancer was 30（10%）.The number of patients with stageⅠ was 219（76%）,the number of patients with stageⅡ was 29（10%）,the number of patients with stageⅢandⅣ was 41（14%）.The age of the patients ranged from 25to 78with the mean of 55.41,and the peak onset age was 58to 61.The number of postmenopausal women accounted for 62%.The single factor analysis showed that hypertension（OR =3.67,χ2=33.70,P=0.00）,diabetes mellitus（OR=1.92,χ2=4.13,P=0.04）,obesity（OR=4.63,χ2=50.62,P=0.00）,taking jasmine tea（OR=2.63,2=19.84,P=0.00）,heavy physical labour（OR=1.82,χ2=9.28,P=0.00）,irregular menstruation（OR=12.68,χ2=107.20,P=0.00）,taking Chinese herbal medicine（OR=15.21,χ2=68.82,P=0.00）,age of menopause（OR=1.10,χ2=11.56,P=0.00）,nullipara（OR=19.07,χ2=15.84,P=0.00）,family history of cancer（OR=2.91,χ2=12.22,P=0.00）could increase the risk of endometrial cancer;and the using of intra-uterine device could reduce the risk of endometrial cancer（OR=0.29,χ2=37.21,P=0.00）.Multiple factors regression analysis showed that the OR（95%CI）of hypertension,obesity,irregular menstruation,taking Chinese herbal medicine for irregular menstruation,age of menopause,family history of cancer were 3.69（1.89-7.22）,3.06（1.62-5.75）,4.53（2.13-9.60）,9.31（2.91-29.76）,1.13（1.06-1.20）,5.20（2.13-12.73）respectively.The OR（95%CI）of intra-uterine device was 0.84（0.79-0.88）and intra-uterine device was the protective factor of endometrial cancer.CONCLUSION：Factors such as hypertension,obesity,age of menopause may be the influence factors on endomtial cancer and early preventive procedures should be taken.