基于英国生物样本数据库的胰腺癌发病危险因素分析

Risk factors for pancreatic cancer:a UK Biobank-based matched case-control study

目的基于英国生物样本数据库(UKB)的前瞻性队列探讨胰腺癌发病的危险因素。方法从2006—2010年UKB招募的约50万名参与者中选取研究对象(根据胰腺癌患者的年龄、性别1∶10匹配无胰腺癌对照者),采用多因素二元Logistic逐步回归分析法分析胰腺癌发病的危险因素,并评估各危险因素的人群归因危险度。结果本研究共纳入1538例胰腺癌患者与15380例对照者进行分析。多因素二元Logistic逐步回归分析结果显示,Townsend剥夺指数高(OR=1.020,95%CI:1.001~1.040)、吸烟史(OR=1.182,95%CI:1.048~1.333)、1型糖尿病病史(OR=1.890,95%CI:1.228~2.910)、2型糖尿病病史(OR=2.109,95%CI:1.794~2.481)、急性胰腺炎病史(OR=5.266,95%CI:3.679~7.538)、慢性胰腺炎病史(OR=17.345,95%CI:8.820~34.111)、兼有急性胰腺炎与慢性胰腺炎病史(OR=4.787,95%CI:1.989~11.522)是胰腺癌发病的独立危险因素。经多因素调整后,有吸烟史、1型糖尿病病史、2型糖尿病病史、急性胰腺炎病史、慢性胰腺炎病史和兼有急性胰腺炎与慢性胰腺炎病史的人群归因危险度分别为8.40%、19.86%、12.37%、6.50%、7.30%和7.13%。结论Townsend剥夺指数高、吸烟史、1型糖尿病和2型糖尿病病史、急性胰腺炎病史、慢性胰腺病史是胰腺癌发病的独立危险因素,而有效识别危险因素有利于降低胰腺癌的发病率。

Objective To investigate the risk factors of pancreatic cancer based on the prospective cohort of UK Biobank(UKB).Methods The study objects from 500,000 participants were recruited by UKB from 2006 to 2010(the age and gender of pancreatic cancer patients were matched with controls without pancreatic cancer at a ratio of 1∶10),and multivariate binary Logistic regression model was used to analyze the risk factors of pancreatic cancer.The population-attributable risk for each risk factor was estimated.Results A total of 1,538 cases of pancreatic cancer were included and were compared with 15,380 controls.Multivariate binary Logistic regression analysis results showed that higher Townsend index(OR=1.020,95%CI,1.001 to 1.040),smoking history(OR=1.182,95%CI,1.048 to 1.333),history of typeⅠdiabetes(OR=1.890,95%CI,1.228 to 2.910),typeⅡdiabetes(OR=2.109,95%CI,1.794 to 2.481),acute pancreatitis(OR=5.266,95%CI,3.679 to 7.538),chronic pancreatitis(OR=17.345,95%CI,8.820 to 34.111)and a history of acute and chronic pancreatitis(OR=4.787,95%CI,1.989 to 11.522)were all significant independent risk factors for pancreatic cancer(P<0.05).After multivariate adjustment,the population attributable risk of smoking history,typeⅠdiabetes,typeⅡdiabetes,acute pancreatitis,chronic pancreatitis,and both acute and chronic pancreatitis history were 8.40%,19.86%,12.37%,6.50%,7.30%and 7.13%,respectively.Conclusion Higher Townsend index,smoking history,typeⅠand typeⅡdiabetes history,acute pancreatitis history and chronic pancreatic history are independent risk factors for pancreatic cancer.Effective identification of risk factors is conducive to reducing the incidence of pancreatic cancer.