嚼槟榔与口腔癌关系的病例对照研究

Relationship between chewing betel nut and oral cavity cancer,a case-control study

目的分析口腔癌发病的危险因素，并进一步探讨嚼槟榔与口腔癌的关系。方法采用以医院为基础的1：1病例对照研究方法，对2014年在湘潭市某综合医院确诊的口腔癌病例及同期该院其他科室就诊的非口腔疾病、非肿瘤病人共100对进行问卷调查。采用条件logistic回归对资料进行分析，计算OR值及95％CI，并分析嚼槟榔与吸烟、饮酒的交互作用。结果单因素条件logistic回归分析结果：吸烟（OR=3．441，95％CI：1．671-7．001，P=0．001）、饮酒（OR=3．010，95％CI：1．497-6．063，P=0．002）、嚼槟榔（OR=3．340，95％CI：1．423-7．844，P=0．006）是口腔癌的危险因素；而多因素条件logistic回归分析结果：吸烟（OR=2．700，95％CI：1．289-5．656，P=0．008）、饮酒（OR=2．257，95％CI：1．071-4．756，P=0．032）是口腔癌的危险因素，但未发现嚼槟榔（OR=2．070，95％CI：0．790-4．758，P=0．139）能独立升高口腔癌的发病风险。交互作用分析结果：嚼槟榔与吸烟（OR相乘交互=0．696，95％CI：0．140-1．465，P=0．658）、饮酒（OR相乘交互=1．416，95％CI：0．318-6．300，P=0．648）间不存在相乘交互作用。相加交互作用：嚼槟榔与吸烟之间不存在相加交互作用，相对超危险度比（RERI）的95％CI（-1．573-2．225），归因比（AP）的95％CI（-0．364-0．514）包括0，且交互作用指数（S）的95％CI（0．589-2．087）包括1。但嚼槟榔与饮酒之间存在相加交互作用，嚼槟榔且饮酒患口腔癌的危险性是不嚼槟榔不饮酒的5．034倍，RERI为2．263、AP为0．449、S为2．275。结论嚼槟榔、吸烟、饮酒都是口腔癌的主要危险因素。嚼槟榔与饮酒存在相加交互作用，可增加饮酒患口腔癌的发病风险。

Objective To analyze the risk factors for oral cancer, and to further explore the relationship between chewing betel nut and oral cavity cancer. Methods A hospital-based 1 ： 1 matched case-control study was can＇ied out in a comprehensive hospital in Xiangtan City in 2014. 100 patients with confirmed diagnosis of oral cavity cancer and 100 patients without oral diseases and cancers from the other departments of the same hospital were recruited as the research subjects to finish the questionnaire. The data were analyzed with the conditional logistic regression. The OR value and its 95%CI were calculated, and the interactions between chewing betel nut and smoking, drinking alcohol were analyzed. Results The univariate conditional logistic regression analysis showed that smoking （ OR= 3.441, 95%C1：1.671-7.001, P= 0.001 ）, drinking alcohol （ OR = 3.010, 95%CI： 1.497- 6. 063, P= 0.002） and chewing betel nut （OR = 3.340, 95% CI： 1. 423-7. 844, P = 0.006） were the risk factors for oral cavity cancer. The multivariate logistic regression analysis showed that smoking （ OR = 2.700, 95% CI ： 1. 289- 5. 656, P = 0.008） and drinking alcohol （OR= 2.257, 95%CI： 1.071-4.756, P= 0.032） were risk factors, but betel nut chewing （OR=2.070, 95%CI： 0.790-4.758, P= 0.139） was not found to be an independent risk factor for increased risk of oral cancer. Interaction analysis did not find muhiplicative interactions between chewing betel nut and smoking （ OR= 0.696, 95%C1： O. 140-1.465, P= 0.658） and drinking alcohol （OR= 1.416, 95%CI： 0.318-6.300, P= 0.648）. No additive interaction was found between chewing betel nut and smoking. The 95%Cis of relative excess risk due to interaction （RERI, -1.573-2.225） and attributable proportion of interac- tion （ AP, -0.364-0.514） both included 0, and the 95%CI of syuergy index （ S, 0.589-2.087） included 1. However, there exis- ted an additive interaction between chewing betel nut and drinking alcohol. People who had behavior of chewing betel nut and drinking alcohol were 5.034 times more risky for developing oral cavity cancer than those who did not, and the RERI, AP and S were 2.263, 0.449 and 2.275 respectively. Conclusions Chewing betel nut, smoking and drinking alcohol are the main risk factors for oral cavity cancer. Chewing betel nut has an additive interaction with drinking alcohol, which can increase the risk of developing oral cavity cancer in people with drinking.