上海市松江区结直肠癌发病危险因素研究

Risk Factors of Colorectal Cancer in Songjiang District,Shanghai

背景上海市结直肠癌发病率和在恶性肿瘤中的死亡顺位从20世纪70年代起逐步上升,严重危害了上海市居民的身体健康,成为重大的公共卫生问题。目的探究上海市松江区结直肠癌的发病危险因素,为开展针对性的干预措施提供科学依据。方法选取2015年上海市松江区50～74岁的常住人口。病例组为社区结直肠癌筛查发现的结直肠癌及癌前患者330例,对照组为参加结直肠癌筛查且初筛阴性的社区居民1 016例。根据上海市大肠癌筛查项目工作规范,经社区居民知情同意采取问卷调查结合胶体金免疫便隐血试验的方案进行初筛。问卷调查部分采用上海市统一的《上海市社区居民结直肠癌筛查危险度评估问卷》,由松江区疾病预防控制人员和中山社区医务人员对调查对象进行面对面问卷调查,内容包括个人基本信息(年龄、婚姻、文化程度)、BMI(BMI<18.5 kg/m2为低体质量,18.5～23.9 kg/m2为正常体质量,24.0～27.9 kg/m2为超重,≥28.0 kg/m2为肥胖)、既往疾病史、生活习惯(吸烟、生活/工作中二手烟、饮酒情况)、工作情况。探讨上海市松江区结直肠癌发病的危险因素。结果单因素分析显示,肥胖、慢性腹泻、黏液/血便、慢性阑尾炎/切除、结核病史、高血压、肠息肉史、生活/工作中二手烟为结直肠癌的影响因素(P<0.05);多因素Logistic回归分析结果显示,对于全人群而言,年龄、慢性腹泻、结核病史、肠息肉史、吸烟为结直肠癌的危险因素(P<0.05);对于不吸烟的人群而言,年龄、慢性腹泻、肠息肉史和生活/工作中二手烟为结直肠癌的危险因素(P<0.05)。结论年龄、慢性腹泻、结核病史、肠息肉史和吸烟为上海市松江区居民结直肠癌发病的危险因素,应加强对上述相关人群的早期干预。

Background The morbidity and mortality of colorectal cancer in Shanghai have risen gradually since the 1970s,which seriously harm the health of the residents in Shanghai and become a serious public health problem.Objective To explore the risk factors of colorectal cancer in Songjiang District of Shanghai,providing scientific evidence for the delivery of targeted preventive interventions.Methods We conducted this study among the permanent residents aged 50-74 from Shanghai's Songjiang District after obtaining their informed consent in accordance with the regulations for implementing a colorectal cancer screening in Shanghai 2015.All of them underwent fecal occult blood test by colloidal gold agglutination.From them,we enrolled 330 cases who were found with colorectal cancer or precancerous colorectal lesions(case group),and compared them with randomly selected sex-matched 1 016 controls with normal test results(control group).Then,both groups participated in a face-to-face survey with a questionnaire named Screening for the Risk Factors of Colorectal Cancer in Shanghai's Residents conducted by the workers from Songjiang Center for disease control and prevention and medical professionals from Songjiang District Zhongshan Community Health Center.The questionnaire consists of demographic data such as age,marital status,educational level,BMI(underweight:<18.5 kg/m2,normal weight:18.5-23.9 kg/m2,overweight:24.0-27.9 kg/m2,obese:≥28.0 kg/m2),past medical history,life habits(active smoking and passive smoking in everyday life or at work,alcohol consumption)and employment status.And the risk factors of colorectal cancer were investigated.Results Univariate analysis revealed that obesity,chronic diarrhea,mucus/blood stool,chronic appendicitis/appendectomy,history of tuberculosis,hypertension,history of intestinal polyps and passive smoking in everyday life or at work were the risk factors of colorectal cancer(P<0.05).The result of multivariate Logistic regression analysis showed that age,chronic diarrhea,tuberculosis history,intestinal polyp history,smoking were risk factors for colorectal cancer(P<0.05);after adjusting for the variable of active smoking,age,chronic diarrhea,intestinal polyp history,and passive smoking in everyday life or at work were risk factors for colorectal cancer(P<0.05).Conclusion Age,history of chronic diarrhea,history of intestinal polyps,history of tuberculosis,and smoking are risk factors for colorectal cancer in residents of Songjiang District,Shanghai,suggesting targets for improved preventive care.