2014年至2018年山西省3个城市居民肺癌风险评估及筛查结果分析

Analysis of risk assessment and screening results of lung cancer among residents in 3 cities of Shanxi Province from 2014 to 2018

目的探讨2014年至2018年山西省3个城市居民的肺癌风险及筛查结果。方法采用整群随机抽样法,于2014年1月至2018年12月选取山西省3个城市(太原、晋城、阳泉)40岁以上常住居民进行肺癌风险评估,肺癌高风险人群通过低剂量螺旋CT检查进行筛查,分析筛查结果并通过非条件logistic回归分析肺癌发生的影响因素。结果184539人纳入调查,其中36790人(19.94%)为肺癌高风险人群。男性的肺癌高风险检出率高于女性[29.76%(25690/184539)比11.30%(1100/184539),χ^(2)=10.44,P=0.001]。肺癌高风险人群中参与临床筛查者共12660人(34.41%),肺癌临床筛查阳性3038例(24.00%)。不同性别、民族、学历、婚姻状况、职业、有害物质接触史、生活用燃煤、清洁取暖、室内油烟、肺结核病史高风险人群的临床筛查阳性率比较,差异均无统计学意义(均P>0.05)。不同年龄、吸烟、饮酒、饮茶、体育锻炼、二手烟暴露时间、生活环境大气污染、肺气肿病史、尘肺病史、肺癌家族病史、精神压抑、精神创伤高风险人群的临床筛查阳性率比较,差异均有统计学意义(均P<0.05)。logistic回归分析显示,年龄≥50岁、吸烟、二手烟暴露1~14年、生活环境大气污染、肺气肿病史、肺癌家族病史、精神压抑均是肺癌高风险人群临床筛查阳性的危险因素(均P<0.05),体育锻炼是肺癌高风险人群临床筛查阳性的保护因素(P<0.05)。结论山西省3个城市居民的肺癌高风险人群参与筛查率有待提高,肺癌高风险人群的肺内结节检出率主要受年龄、吸烟、二手烟暴露时间、肺癌家族史、肺气肿病史等因素的影响。

Objective To investigate the risk of lung cancer and screening results of residents in 3 cities of Shanxi Province from 2014 to 2018.Methods Cluster random sampling method was used to select permanent residents from 3 cities(Taiyuan,Jincheng and Yangquan)in Shanxi Province from January 2014 to December 2018 for lung cancer risk assessment.People at high risk of lung cancer were screened by low‑dose spiral CT.The screening results were analyzed and the influencing factors of lung cancer occurrence were analyzed by unconditional logistic regression.Results 184539 people were included in the survey,and 36790 people(19.94%)were at high risk of lung cancer.The detection rate of high‑risk of lung cancer in men was higher than that in women[29.76%(25690/184539)vs.11.30%(1100/184539),χ^(2)=10.44,P=0.001].A total of 12660 people(34.41%)at high risk of lung cancer participated in clinical screening,and 3038 people(24.00%)were positive in clinical screening for lung cancer.There were no statistical differences in the positive rate of clinical screening among people at high risk of lung cancer with different gender,nationality,education,marital status,occupation,history of harmful substance exposure,coal burning,clean heating,indoor oil fumes,and history of pulmonary tuberculosis(all P>0.05).There were statistical differences in the positive rate of clinical screening among people at high risk of lung cancer with different age,smoking,drinking,drinking tea,physical exercise,exposure time of second‑hand smoke,living environment air pollution,history of emphysema,history of pneumoconiosis,family history of lung cancer,mental depression,and history of trauma(all P<0.05).Logistic regression analysis showed that age≥50 years old,smoking,exposure to secondhand smoke for 1-14 years,living environment air pollution,history of emphysema,family history of lung cancer,and mental depression were the risk factors for positive clinical screening in people at high risk of lung cancer(all P<0.05),and physical exercise was the protective factor for positive clinical screening in people at high risk of lung cancer(P<0.05).Conclusions The screening rate of people at high risk of lung cancer in 3 cities of Shanxi Province needs to be improved.The detection rate of intrapulmonary nodules in people at high risk of lung cancer is mainly affected by age,smoking,exposure time of second‑hand smoke,family history of lung cancer,history of emphysema and other factors.