福建沿海地区甲状腺癌危险因素配对病例对照研究

The matched case-control study of thyroid carcinoma risk factors in Fujian coastal region

目的探讨福建沿海地区甲状腺癌发病的危险因素,为甲状腺癌的防治提供科学依据。方法于2018年1月至2020年7月,采用1∶1配对的病例对照研究方法,选取福建省肿瘤医院术后病理确诊为甲状腺癌的患者为病例组,无甲状腺疾病的健康体检人群为对照组。匹配条件为同性别,年龄相差±3岁,福建沿海地区的常住居民。共纳入154对研究对象,对其进行问卷调查,内容包括一般情况、饮食习惯、辐射暴露、外源性化学物质接触、家族史、压力和女性生理情况等。采用SPSS 22.0软件进行单因素和多因素条件logistic回归分析。结果154对研究对象中男性36对,女性118对,男女性别比为1∶3.3,病例组平均年龄为(44.8±10.7)岁,对照组平均年龄为(44.6±10.9)岁。多因素条件logistic回归分析结果显示,体质指数>25.0 kg/m~2(OR=10.503,95%CI:2.576~42.828)、压力较大或很大(OR=10.416,95%CI:2.770~39.171)、CT检查≥3次(OR=4.622,95%CI:1.498~14.260)、一级亲属有甲状腺癌病史(OR=18.533,95%CI:3.455~99.402)和染发(OR=7.021,95%CI:2.685~18.360)增加甲状腺癌发病风险;文化程度高(OR=0.191,95%CI:0.061~0.595)和较常食用紫菜、海带(OR=0.375,95%CI:0.146~0.964)降低甲状腺癌发病风险。女性研究对象的多因素logistic回归分析结果显示,初潮年龄≤13岁(OR=2.611,95%CI:1.017~6.705),压力较大或很大(OR=5.991,95%CI:1.547~23.208)、一级亲属有甲状腺癌病史(OR=23.914,95%CI:3.569~160.228)和染发(OR=6.540,95%CI:2.421~17.665)增加甲状腺癌发病风险,体育锻炼(OR=0.313,95%CI:0.135~0.726)和较常食用紫菜、海带(OR=0.236,95%CI:0.085~0.652)降低甲状腺癌发病风险。结论福建沿海地区甲状腺癌发病可能与体质指数、压力、电离辐射、遗传、外源性化学物质接触及饮食习惯等多因素综合作用有关。

Objective To explore the risk factors of thyroid carcinoma in Fujian coastal region,and provide the scientific basis for treatment and prevention of thyroid carcinoma.Methods From January 2018 to July 2020,the 1∶1 matched case-control study was conducted,the patients with thyroid carcinoma after operation and pathological examination in Fujian Cancer Hospital served as the case group,healthy residents without thyroid carcinoma served as control group.The matched conditions were same gender,similar age(±3 years old),residents from same coastal regions,154 pairs of subjects were included,the investigation was performed with the questionnaire(including general information,diet habits,radiation exposure,exogenous exposure to chemicals,family history,stress and physiological conditions of female subjects and so on).The single factor conditional logistic regression and multivariate conditional logistic regression analysis were used to analyze the data,the used software was SPSS 22.0.Results There were 154 pairs of subjects(36 pairs of male subjects and 118 pairs of female subjects,with 1∶3.3 sex ratio);the average ages of the case group and the control group were(44.8±10.7)and(44.6±10.9)years old.Multivariate conditional logistic regression analysis showed that BMI>25.0 kg/m~2(OR=10.503,95%CI:2.576-42.828),high stress(OR=10.416,95%CI:2.770-39.171),CT scanning≥3 times(OR=4.622,95%CI:1.498-14.260),the first degree relatives with thyroid cancer(OR=18.533,95%CI:3.455-99.402),and hair dye(OR=7.021,95%CI:2.685-18.360)were the increasing risk factors of thyroid carcinoma;while higher educational level(OR=0.191,95%CI:0.061-0.595)and high frequency intake of seaweed(OR=0.375,95%CI:0.146-0.964)were the decreasing risk factors of thyroid carcinoma.For the female subjects,multivariate conditional logistic regression analysis showed that the menarche age≤13 years old(OR=2.611,95%CI:1.017-6.705),high stress(OR=5.991,95%CI:1.547-23.208),the first degree relatives with thyroid cancer(OR=23.914,95%CI:3.569-160.228),and hair dye(OR=6.540,95%CI:2.421-17.665)were the increasing risk factors of thyroid carcinoma;while physical exercise(OR=0.313,95%CI:0.135-0.726)and high frequency intake of seaweed(OR=0.236,95%CI:0.085-0.652)were the decreasing risk factors of thyroid carcinoma.Conclusion The occurrence of thyroid carcinoma in Fujian coastal region may be related to body mass index,stress,radiation,genetics,exogenous chemicals and eating habits.