福建省仙游县胃癌环境危险因素及其交互作用:基于病例对照研究

Environmental risk factors of gastric cancer and their interactions in Xianyou County of Fujian Province: based on case-control study

[目的]通过病例对照研究,探讨仙游县胃癌发病的危险因素及其存在的交互作用。[方法]选取2013年5月—2015年6月期间经病理确诊并在仙游县生活达10年或以上的胃癌病例433例,选取866位健康人作为对照进行1∶2个体匹配,进行面对面问卷调查。构建分类回归树发现存在交互作用的因素并应用条件logistic回归分析各因素可能存在的相乘交互作用。[结果]多因素条件logistic回归分析结果显示:饮食速度快(OR=1.321,95%CI:1.055~1.653)、食物较硬(OR=1.709,95%CI:1.344~2.174)、食用腌菜(OR=1.359,95%CI:1.083~1.704)、吸烟(OR=1.875,95%CI:1.261~2.786)、慢性萎缩性胃炎(OR=2.395,95%CI:1.228~4.672)、肿瘤家族史(OR=1.545,95%CI:1.061~2.250)、接触农药(OR=2.840,95%CI:2.003~4.025)及对家庭现状不满意(OR=2.383,95%CI:1.708~3.326)为仙游县胃癌发病的主要危险因素;而食用新鲜蔬菜(OR=0.653,95%CI:0.485~0.878)、食用菌(OR=0.657,95%CI:0.494~0.872)、海带(OR=0.671,95%CI:0.500~0.901)及洋葱大葱(OR=0.638,95%CI:0.518~0.787)为其保护因素。交互作用结果显示:接触农药和食用腌菜、食物硬,食用腌菜和饮食速度快、吸烟之间存在相乘交互作用。[结论]接触农药、食用腌菜、食物硬、饮食速度快及吸烟在仙游县胃癌发生、发展中存在交互作用。

[Objective] To identify risk factors of gastric cancer and their probable interactions through a case-control study in Xianyou County of Fujian Province. [Methods] Using a case-control study design, 433 patients living in Xianyou County for more than 10 years and pathologically diagnosed as gastric cancer were selected from May 2013 to June 2015. At the same time, 866 healthy controls were matched（1∶2） to the cases. A face-to-face questionnaire survey was carried out. A classification and regression tree was built to find the factors with interactions and a conditional logistic regression model was used to analyze probable multiplicative interactions. [Results] According to conditional logistic regression analysis, eating fast（OR=1.321, 95%CI： 1.055-1.653）, eating hard food（OR=1.709, 95%CI： 1.344-2.174）, eating pickles（OR=1.359, 95%CI： 1.083-1.704）, smoking（OR=1.875, 95%CI： 1.261-2.786）, chronic atrophic gastritis history（OR=2.395, 95%CI： 1.228-4.672）, family history of cancer（OR=1.545, 95%CI： 1.061-2.250）, pesticides exposure（OR=2.840, 95%CI： 2.003-4.025）, and being unsatisfied with family status（OR=2.383, 95%CI： 1.708-3.326）were the risk factors for gastric cancer in Xianyou County; whereas eating fresh vegetables（OR=0.653, 95%CI： 0.485-0.878）, edible fungus（OR=0.657, 95%CI： 0.494-0.872）, kelp/seaweed（OR=0.671, 95%CI： 0.500-0.901）, and onion/shallot（OR=0.638, 95%CI： 0.518-0.787） were the protective factors. There were multiplicative interactions between pesticides exposure and eating pickles, pesticides exposure and eating hard food, eating pickles and eating fast, as well as eating pickles and smoking.[Conclusion] Pesticides exposure, eating pickles, eating hard food, eating fast, and smoking may have interactions in the occurrence and development of gastric cancer in Xianyou County.