我国北方地区成人急性白血病发病的生活及环境危险因素分析

Associations between life and environmental factors and adult acute leukemia in Northern China

背景急性白血病(acute leukemia,AL)是一类危及生命的血液系统恶性肿瘤,病情进展快、自然病程短、治疗费用高,已经成为全球关注的重大公共卫生问题之一。时至今日,AL的病因尚未完全阐明,流行病学病因研究的结果仍存争议;我国尚缺乏近年来与现实生活接轨的最新数据。目的探讨成人AL发病相关的生活及环境危险因素。方法采用1∶1病例对照研究的流行病学方法,以我国北方地区(北京、天津、沈阳、郑州、菏泽)五家三级甲等医院为研究现场,通过面对面问卷调查的方式收集2020年1-12月在上述五家医院住院诊治的AL患者和非肿瘤患者的相关信息。以新确诊的成人AL患者为病例组,非肿瘤患者为对照组,按照年龄、性别、民族、居住地、来源医院进行1∶1配比,患者入院时间相近,纳入12个危险因素,通过单因素分析和多因素logistic回归模型,筛选成人AL发病相关危险因素。结果病例组和对照组各纳入175例患者,中位年龄分别为46(33-58)岁、46(31-60)岁(P=0.915),男女比例均约为1.5∶1。单因素分析显示,两组的房屋装修3个月内入住史(χ^(2)=10.002,P=0.002)、居住地附近300 m范围内电磁辐射暴露史(χ^(2)=4.010,P=0.045)差异有统计学意义。多因素logistic回归分析发现,房屋装修后3个月内入住史(OR=2.801,95%CI:1.400-5.607,P=0.004)、居住地附近300 m范围内电磁辐射暴露史(OR=2.330,95%CI:1.099-4.938,P=0.027)可增加成人AL的患病风险。结论房屋装修3个月内入住史、居住地附近300 m范围内电磁辐射暴露史为成人AL的可疑危险因素。

Background Acute leukemia(AL)is a group of life-threatening hematological malignancies,and has been considered a major public health issue of global concern due to its rapid progression,short natural course and high cost of treatment.To date,the etiology of AL has not been fully elucidated,and the results of epidemiological etiological studies are still controversial.Recent data on risk factors for the development of AL are still lacking in China.Objective To investigate potential lifestyle and environmental risk factors associated with the development of AL in adults.Methods A multicenter 1∶1 case-control study was conducted in five 3A grade hospitals in Northern China(Beijing,Tianjin,Shenyang,Zhengzhou,Heze).Information about patients with AL and nononcology patients who were hospitalized from January to December in 2020 were sought from face-to-face interviews using a structured questionnaire.Newly diagnosed adult AL patients were taken as the case group while non-oncology patients were used as the control group.Matching criteria for each pair of cases and controls included age,gender,nationality,location of residence and hospital of origin.Besides,hospital admission date of each matched case was quite similar.Univariate analysis and multivariate logistic regression models were used to estimate the relationship between twelve risk factors and adult AL.Results Totally 175 cases with AL and 175 matched controls were enrolled in the study.The median age of cases and controls were 46(33-58)years and 46(31-60)years(P=0.915),respectively.And the male to female ratio was about 1.5∶1.In univariate analysis,there were significant differences in exposure to house decoration within 3 months(χ^(2)=10.002,P=0.002)and exposure to electromagnetic radiation within 300 meters of the residence(χ^(2)=4.010,P=0.045)between the two groups.In multivariate analysis,exposure to house decoration within 3 months and exposure to electromagnetic radiation within 300 meters of the residence were related to the increased risk of adult AL,of which the odds ratios(ORs)were 2.801(95%CI,1.400-5.607,P=0.004)and 2.330(95%CI,1.099-4.938,P=0.027),respectively.Conclusion Our results suggest that exposure to home decoration within 3 months and exposure to electromagnetic radiation within 300 meters of the residence may be risk factors for adult AL.