空气污染混合暴露与相对端粒长度对非吸烟女性肺癌的影响研究

Influence of mixed air pollution exposure and relative telomere length on lung cancer in non-smoking women

目的分析空气污染混合暴露与相对端粒长度(relative telomere length,TL)对非吸烟女性肺癌(non-smoking female lung cancer,NFLC)患病风险的影响,及其对NFLC患病风险的交互作用。方法自2017年8月至2021年8月,在我国安徽、江苏、辽宁和青海省收集18~79岁NFLC及对照组,通过结构化问卷收集研究对象的一般人口学特征、暴露因素、家庭史等,并根据问卷信息计算空气污染暴露(包括被动吸烟、煤烟油烟暴露、燃香暴露、职业暴露、户外作业等)情况;采用实时定量聚合酶链式反应相对定量法检测TL。利用加权分位数和回归(WQS)评估空气污染混合暴露水平对NFLC患病风险的影响,利用多因素Logistic回归评估空气污染及TL对NFLC患病风险的交互作用。结果最终纳入1315例研究对象(对照组634人,病例组681人)。病例组和对照组间的地区、体质指数、妊娠次数、癌症家族史、被动吸烟等差异有统计学意义(P<0.05);病例组和对照组间的年龄、民族、最高学历水平、TL等差异无统计学意义(P>0.10)。肺鳞癌、小细胞肺癌患者和对照组的TL差异有边缘统计学意义(P<0.10)。WQS显示空气污染混合暴露对NFLC、肺腺癌和非小细胞肺癌患病风险存在统计学意义(P<0.001),空气污染混合暴露每增加1个10分位数,NFLC、肺腺癌和非小细胞肺癌患病风险分别增加60%(校正OR=1.60,95%CI:1.17~2.22)、82%(校正OR=1.82,95%CI:1.21~2.75)和121%(校正OR=2.21,95%CI:1.39~3.56)。多因素Logistic回归分析显示空气污染混合暴露与TL对NFLC患病风险影响无相乘、无相加交互作用。结论空气污染混合暴露及TL均与NFLC患病风险相关,本研究未发现空气污染与TL对NFLC患病风险存在交互作用。

Objective To investigate the influence and interaction of mixed air pollution exposure and relative telomere length(TL)on the risk of non-smoking female lung cancer(NFLC).Methods From August 2017 to August 2021,non-smoking women,aged 18-79 years,who were newly diagnosed with lung cancer were enrolled as case group,and a control group was also established.A structured questionnaire was used to collect the general demographic features,exposure factors,and family history of the subjects,and air pollution exposure(including passive smoking,soot and oil smoke exposure,incense burning exposure,occupational exposure,and outdoor work)was calculated based on the information collected through the questionnaire.Real-time quantitative polymerase chain reaction and the relative quantitative method were used to measure TL.Weighted quantile sum(WQS)regression was used to evaluate the impact of mixed air pollution exposure on the risk of NFLC,and a logistic regression analysis was used to investigate the interaction between air pollution and TL on the risk of NFLC.Results A total of 1315 subjects were finally included,with 634 in the control group and 681 in the case group.Compared with the control group,the case group had a significantly higher risk of lung cancer due to passive smoking(adjusted odds ratio[OR]=1.55,95%confidence interval[CI]:1.20-1.99).There was no significant difference in relative telomere length between the case group and the control group(z=-0.08,P>0.10);the patients with squamous lung cancer had a significantly longer relative telomere length than the control group(z=1.83,P<0.10),and there was no significant difference in relative telomere length between the patients with lung adenocarcinoma and the control group(z=-0.17,P>0.10).There were statistically significant differences in area,body mass index,number of pregnancies,family history of cancer,and passive smoking between the case group and the control group(P<0.05).There were no statistically significant differences in age,ethnicity,highest level of education,and TL between the case group and the control group(P>0.10).Compared with the control group,the difference in TL was marginally statistically significant in both squamous lung cancer group and small cell lung cancer group(P<0.10).WQS regression showed that mixed air pollution exposure was significantly associated with the risk of lung cancer(z=3.38,P<0.001),and the risk of lung cancer was increased by 60%for every decile increase in mixed air pollution exposure(adjusted OR=1.60,95%CI:1.17-2.22).statistically significant effects of mixed air pollution exposure on the risk of NFLC,lung adenocarcinoma,and non-small cell lung cancer(P<0.001).For every 1 decile increase in mixed air pollution exposure the risk of NFLC,lung adenocarcinoma and non-small cell lung cancer increased by 60%(adjusted OR=1.60,95%CI:1.17-2.22),82%(adjusted OR=1.82,95%CI:1.21-2.75)and 121%(adjusted OR=2.21,95%CI:1.39-3.56),respectively.The multiple logistic regression analysis showed no multiplicative and additive interaction between mixed air pollution exposure and TL on the risk of NFLC.Conclusion Both mixed air pollution exposure and TL are associated with the risk of NFLC,and this study does not find the interaction between air pollution and TL on the risk of NFLC.