肺癌危险因素研究现状

Current status of research on risk factors of lung cancer

目的肺癌目前的发病率、死亡率均居世界癌症中的第一位,是我国人群中最常见的恶性肿瘤。本文探讨肺癌的危险因素,为肺癌的早期预防提供科学依据。方法以"肺癌、危险因素、病例对照研究和Meta分析"作为中文关键词,"lung cancer,risk factors,case-control study and meta-analysis"为英文关键词,检索PubMed、中国知网和万方数据库2009-12-31-2019-01-01发表的相关文献,共检索到中文文献58篇,英文文献280篇。纳入标准:(1)肺癌的危险因素;(2)肺癌的病例对照研究;(3)肺癌危险因素的Meta分析。根据纳入标准分析文献54篇(中文17篇,英文37篇)。结果香烟烟雾产生的尼古丁及其代谢物可通过促进细胞增殖、血管生成、浸润,上皮细胞间质样转化及促肿瘤生长相关的自分泌循环来促进肿瘤的生长;暴露于二手烟者患肺癌的危险是未暴露者的1.31倍;有慢性肺部疾病、哮喘或慢性阻塞性肺疾病史的非吸烟者比没有这些病史的人患非小细胞肺癌的危险性高;PM2.5中含有致癌物多环芳烃的气道暴露诱导人体内的脂质代谢加快肺癌的进展;家庭用煤、建筑材料和室内装修材料释放出的气体氡与肺癌发病有关;有肿瘤家族史发生肺癌的危险性是没有肿瘤家族史的2.47倍;二氧化硅、石棉、无机砷、棉尘等职业暴露使肺癌发病的危险性升高;健康的饮食模式与其风险降低有关;工作强度大、睡眠质量差、性格急躁、缺乏解压途径是肺癌发病的独立危险因素;超重和肥胖与肺癌的发生呈负相关关系。结论肺癌的发生是多因素共同作用造成的结局,其病因结构复杂。对肺癌发生的确切病因仍需结合基因组学、代谢组学、分子流行病学等学科作进一步的研究,为肺癌的防治工作提供科学依据。

OBJECTIVE At present,the incidence and mortality of lung cancer ranks first among the most common cancers in the world.Lung cancer is also the disease that causes the most deaths.Exploring the risk factors of lung cancer can provide a scientific basis for early prevention and control.METHODS With "lung cancer,risk factors,case-control study and meta-analysis" as the key words and "lung cancer with risk factors and case-control or meta-analysis" as the retrieval method,58 Chinese and 280 English literatures were retrieved from the relevant literatures published in PubMed,CNKI and wanfang database 2009-12-31-2019-01-01.Inclusion criteria:(1)Risk factors for lung cancer;(2)Case-control study of lung cancer;(3)Meta-analysis of risk factors for lung cancer.According to the inclusion criteria,a total of54 literatures(17 in Chinese and 37 in foreign languages)were included in the analysis.RESULTS Nicotine and its metabolites produced by cigarette smoke can promote tumor growth by promoting cell proliferation,angiogenesis,infiltration,epithelial cell interstitium transformation and the autocrine cycle related to tumor growth.The risk of lung cancer was 1.31 times higher in those exposed to secondhand smoke than in those not exposed.Nonsmokers with a history of chronic lung disease,asthma,or chronic obstructive pulmonary disease have a higher risk of developing NSCLC than those without such a history.Airway exposure to PAHs,a carcinogen in PM2.5,induces lipid metabolism in the body to accelerate the progression of lung cancer.Household coal,radon that is a gas released from building materials and interior decoration materials,is associated with the incidence of lung cancer.The risk of lung cancer with a family history of cancer is 2.47 times higher than that without a family history of cancer.Occupational exposure to silica,asbestos,inorganic arsenic and cotton dust increases the risk of lung cancer.Healthy eating patterns are associated with reduced risk;high work intensity,poor sleep quality,impatience and lack of stress relief are independent risk factors of lung cancer.Overweight and obesity are negatively correlated with lung cancer.CONCLUSIONS The occurrence of lung cancer is the result of many factors and its etiology is complex.The exact causes of lung cancer still need to be combined with genomics,metabolomics,molecular epidemiology and other disciplines for further research.It can provide scientific basis for the prevention and treatment of lung cancer.