顺德地区不同性别人群的肝癌影响因素分析

周新凤; 魏志梅; 周成宇; 钟旋; 刘晴; 刘桂炎; 郜艳晖; 于新发; 陈思东; 刘丽

doi:10.16462/j.cnki.zhjbkz.2019.002

顺德地区不同性别人群的肝癌影响因素分析

doi: 10.16462/j.cnki.zhjbkz.2019.002

1.
510310 广州, 广东药科大学公共卫生学院流行病与卫生统计学系
2.
528300 佛山, 南方医科大学顺德医院肿瘤科

基金项目:

国家自然科学基金 81302493

广东省高等学校优秀青年教师培养计划 YQ2015098

广州市科技计划项目珠江科技新星专题 201806010103

详细信息

通讯作者:
刘丽, E-mail: pupuliu919@163.com

中图分类号: R181.2
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出版历程
- 收稿日期: 2018-07-11
- 修回日期: 2018-10-11
- 刊出日期: 2019-02-10

Analysis of influencing factors for liver cancer by gender in Shunde region

1.
Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
2.
Department of Oncology, Shunde Hospital of Southern Medical University, Foshan 528300, China

Funds:

National Natural Science Foundations of China 81302493

The Training Program for Outstanding Young Teachers in Higher Education Institutions of Guangdong Province YQ2015098

Pearl River Nova Program of Guangzhou Science and Technology Project 201806010103

More Information

Corresponding author: LIU Li, E-mail: pupuliu919@163.com

摘要

摘要: 目的探讨顺德地区不同性别人群肝癌的影响因素，并了解男性肝癌影响因素的交互作用。方法应用交互效应超额相对危险度（relative excess risk of interaction，RERI）等指标评价两因素的交互作用，应用分类回归树（classification and regression tree，CART）模型评价多因素的交互作用。结果共纳入1 037例男性病例、1 069男性对照以及166例女性病例、185例女性对照。乙型肝炎病毒（hepatitis B virus，HBV）慢性感染和肝癌家族史均与男女性肝癌发病风险增高有统计学关联（均有P<0.001）。男性中，HBV慢性感染与吸烟、饮酒以及吸烟与饮酒之间存在正相加交互作用，其中HBV慢性感染与吸烟的RERI为121.90（95%CI：52.85%~190.95%）。运动与HBV慢性感染、吸烟之间有负相加交互作用。CART分析表明吸烟且饮酒的HBV慢性感染男性的肝癌风险最高。结论 HBV慢性感染和肝癌家族史是男女性肝癌的共同危险因素。HBV慢性感染、吸烟和饮酒协同促进男性肝癌发病。运动可拮抗HBV慢性感染和吸烟的促肝癌效应。
- 肝癌 /
- 影响因素 /
- 交互作用 /
- 流行病学研究方法
Abstract: Objective To investigate the influencing factors for liver cancer by gender in Shunde region, and to explore the potential interactions among influencing factors for liver cancer in males. Methods The relative excess risk of interaction (RERI) and other indices were used to evaluate the pair-wise interaction, and the classification and regression tree (CART) model was applied to explore the potential multi-factors interaction. Results This study included 1 037 male cases and 1 069 controls, together with 166 female cases and 185 controls. Chronic hepatitis B virus infection (CHB) and family history of liver cancer were significantly associated with increased risk of liver cancer both in males and females (both P<0.001). In males, positive additive interactions were observed between CHB and smoking or alcohol drinking, as well as between smoking and drinking. The RERI for CHB and smoking was 121.90(95% CI: 52.85%-190.95%). Negative additive interactions were observed between exercise and CHB or smoking. Further, the CART analysis suggested that the CHB males who smoked and drank alcohol had the highest risk of liver cancer. Conclusions CHB and family history of liver cancer are important risk factors for liver cancer in both males and females. CHB, smoking, and alcohol drinking synergistically promote the incidence of liver cancer for males. Exercise can antagonize the hepatocarcinogenic effect of CHB and smoking.
- Liver cancer /
- Influencing factors /
- Interaction effect /
- Epidemiological research method

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图 1 男性肝癌的CART交互作用分析

Figure 1. CART analysis of multi-factor interaction for liver cancer in males

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表 1 不同性别研究对象的人口学特征[n(%)]

Table 1. The demographic characteristics of subjects by gender[n(%)]

人口学特征	男性			女性
人口学特征	病例(n=1 037)	对照(n=1 069)	P值	病例(n=166)	对照(n=185)	P值
年龄(岁)	55.97±11.57	55.11±9.53	0.063	58.70±12.50	58.35±9.24	0.762
年龄组(岁)			0.703			0.670
<45	178(17.16)	169(15.81)		23(13.86)	20(10.81)
45~	486(46.87)	510(47.71)		65(39.16)	77(41.62)
>60	373(35.97)	390(36.48)		78(46.99)	88(47.57)
文化程度^a			<0.001			0.396
小学及以下	481(46.47)	339(31.74)		113(68.48)	129(69.73)
初中/高中	510(49.28)	633(59.27)		48(29.09)	47(25.41)
大专及以上	44(4.25)	96(8.99)		4(2.42)	9(4.86)
婚姻状况^a			0.238			0.966
已婚/同居	969(93.53)	1 009(94.74)		137(82.53)	153(82.70)
未婚/分居/离异/丧偶	67(6.47)	56(5.26)		29(17.47)	32(17.30)
注：^a文化程度、婚姻状况数据缺失。

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表 2 男性肝癌的影响因素分析

Table 2. Analysis of influencing factors for liver cancer in males

研究因素	病例(%)(n=1 037)	对照(%)(n=1 069)	P值	粗OR (95% CI) 值	调整OR (95% CI)^a值	调整OR (95% CI)^b值
文化程度^c			< 0.001
小学及以下	481(46.47)	339(31.74)		1.00	1.00	1.00
初中/高中	510(49.28)	633(59.27)		0.57(0.47~0.68)	0.59(0.48~0.74)	0.57(0.43~0.75)
大专及以上	44(4.25)	96(8.99)		0.32(0.22~0.47)	0.39(0.25~0.61)	0.41(0.23~0.75)
吸烟^c			< 0.001
否	236(22.76)	573(54.47)		1.00	1.00	1.00
是	801(77.24)	479(45.53)		4.06(3.36~4.91)	3.49(2.81~4.34)	3.65(2.72~4.90)
吸烟指数^c			< 0.001
非吸烟	236(23.21)	573(55.52)		1.00	1.00	1.00
轻度	83(8.16)	122(11.82)		1.65(1.20~2.27)	1.69(1.19~2.39)	1.71(1.07~2.74)
中度	95(9.34)	51(4.94)		4.52(3.12~6.56)	4.69(3.14~7.03)	3.76(2.15~6.57)
重度	603(59.29)	286(27.71)		5.12(4.16~6.30)	4.28(3.36~5.46)	4.79(3.45~6.66)
饮酒^c			< 0.001
否	378(36.45)	624(58.43)		1.00	1.00	1.00
是	659(63.55)	444(41.57)		2.45(2.06~2.92)	1.71(1.39~2.11)	2.32(1.75~3.08)
喝茶^c			0.024
否	384(37.03)	345(32.33)		1.00	1.00	1.00
是	653(62.97)	722(67.67)		0.81(0.68~0.97)	0.67(0.54~0.83)	0.73(0.55~0.95)
食用鱼生类食物^c			0.024
<1次/月	846(81.82)	944(90.25)		1.00	1.00	1.00
≥1次/月	188(18.18)	102(9.75)		2.06(1.59~2.66)	1.47(1.09~1.98)	1.82(1.27~2.61)
运动^c			0.024
否	643(62.07)	435(40.81)		1.00	1.00	1.00
是	393(37.93)	631(59.19)		0.42(0.35~0.50)	0.52(0.43~0.63)	0.48(0.37~0.62)
糖尿病^c			0.026
无	940(90.91)	995(93.52)		1.00	1.00	1.00
有	94(9.09)	69(6.48)		1.44(1.04~1.99)	1.84(1.26~2.67)	1.47(0.92~2.37)
HBV慢性感染			0.024
无	278(26.81)	962(89.99)		1.00	-	1.00
有	759(73.19)	107(10.01)		24.55(19.26~31.28)	-	40.10(29.10~55.26)
肝癌家族史^c			< 0.001
无	919(88.71)	1029(97.08)		1.00	1.00	1.00
有	117(11.29)	31(2.92)		4.23(2.82~6.34)	5.05(3.21~7.95)	3.94(2.18~7.11)
注：^a模型纳入年龄、文化程度、婚姻状况、吸烟(或吸烟指数)、饮酒、喝茶、食用鱼生类食物、运动、糖尿病和肝癌家族史；^b模型纳入年龄、文化程度、婚姻状况、吸烟(或吸烟指数)、饮酒、喝茶、食用鱼生类食物、运动、糖尿病、HBV慢性感染和肝癌家族史; ^c数据缺失。

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表 3 影响男性肝癌的交互作用分析

Table 3. Interactions analysis for liver cancer in males

因素1^a	因素2^a	病例/对照	调整OR (95% CI)^b值	P值	RERI(95% CI)	API (95% CI)	S (95% CI)
HBV慢性感染	吸烟^c			< 0.001	121.90(52.85~190.95)	0.79(0.69~0.89)	4.86(2.56~7.16)
0	0	52/499	1.00
0	1	226/448	3.15(2.20~4.50)
1	0	184/74	27.80(18.15~42.58)
1	1	575/31	148.54(91.95~239.96)
	饮酒^c			0.004	76.86(24.11~129.61)	0.70(0.55~0.85)	3.40(1.66~5.15)
0	0	78/543	1.00
0	1	200/418	2.02(1.45~2.81)
1	0	300/81	31.94(21.61~47.21)
1	1	459/26	109.83(65.60~183.86)
	运动^c			0.002	-33.08(-54.08~-12.09)	-1.91(-3.28~-0.55)	0.33(0.17~0.49)
0	0	173/397	1.00
0	1	105/562	0.56(0.41~0.76)
1	0	470/38	51.95(33.09~81.55)
1	1	288/69	19.94(12.09~26.63)
吸烟^c	饮酒^c			0.002	3.80(1.37~6.23)	0.43(0.24~0.62)	1.96(1.16~2.76)
0	0	144/411	1.00
0	1	92/162	2.32(1.46~3.69)
1	0	234/209	3.65(2.46~5.41)
1	1	567/270	8.77(6.07~12.67)
	运动^c			0.012	-1.62(-2.87~-0.36)	-0.92(-1.59~-0.24)	0.32(0.11~0.53)
0	0	131/203	1.00
0	1	105/368	0.52(0.34~0.81)
1	0	512/219	3.88(2.61~5.77)
1	1	288/259	1.79(1.18~2.70)
注：^a0表示无或否；1表示有或是；^b模型纳入年龄、文化程度、吸烟、饮酒、运动、喝茶、食用鱼生类食物、糖尿病、HBV慢性感染和肝癌家族史；^c数据缺失。

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