基于倾向性评分匹配法评估血清铬对口腔癌发病的影响

丘薇; 林菁; 罗丽; 姜盈莹; 李瑞强; 沙成敏; 蔡琳; 刘凤琼; 汪靖; 陈法; 何保昌

doi:10.16462/j.cnki.zhjbkz.2020.01.005

基于倾向性评分匹配法评估血清铬对口腔癌发病的影响

doi: 10.16462/j.cnki.zhjbkz.2020.01.005

丘薇¹,
林菁¹,
罗丽¹,
姜盈莹¹,
李瑞强¹,
沙成敏¹,
蔡琳¹,
刘凤琼¹,
汪靖²,
陈法¹,
何保昌^1, ,

1.
350108 福州, 福建医科大学公共卫生学院流行病与卫生统计学系福建省环境因素与肿瘤重点实验室
2.
350108 福州, 福建医科大学公共卫生学院实验中心

丘薇和林菁为共同第一作者

基金项目: 福建医科大学公共卫生学院大学生科研创新项目(201908)

详细信息

通讯作者:
何保昌, E-mail:hbc@fjmu.edu.cn

中图分类号: R739.8
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出版历程
- 收稿日期: 2019-08-13
- 修回日期: 2019-12-01
- 刊出日期: 2020-01-10

Pathogenesis effect of serum chromium on oral cancer based on propensity score matching

1.
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Fuzhou 350108, China
2.
Laboratory Center, School of Public Health, Fujian Medical University, Fuzhou 350108, China

QIU Wei and LIN Jing contributed equally to this article

Funds: Innovative Research Program for Undergraduate of Public Health School of Fujian Medical University(201908)

More Information

Corresponding author: HE Bao-chang, E-mail:hbc@fjmu.edu.cn

摘要

摘要: 目的经倾向性评分匹配法(propensity score matching, PSM)均衡组间协变量后, 评估血清铬(Chromium, Cr)对口腔癌(oral cancer, OC)发病的影响。方法采用病例对照研究, 收集2010年1月-2018年12月在福建医科大学附属第一医院新发确诊的395例OC患者为病例组, 选取同期社区健康人群1 240例为对照组, 并利用PSM设计, 按1:1匹配从对照组中选取与病例随机匹配的309名对照者。采用条件Logistic回归分析模型探讨Cr元素与OC发病的关系。结果病例组血清Cr水平178.91(121.83~284.19)μg/L, 低于对照组324.27(264.82~397.69)μg/L, 差异有统计学意义(P < 0.001)。剂量-反应分析表明, 随着血清Cr含量的增高, 患OC的风险逐渐下降, 呈明显负相关关系。条件Logistic回归分析模型结果显示, 相比于Q1组, Q2、Q3、Q4组血清Cr调整后的OR值分别为0.14(0.08~0.26)、0.15(0.08~0.28)和0.10(0.05~0.20), 且存在血清Cr含量越高保护作用越强的趋势(P_trend < 0.001)。无论是否吸烟、是否饮茶、摄入鱼类、水果、绿色蔬菜频次的多少及不饮酒人群中, 血清Cr与OC发病风险均呈负相关关系。结论高水平血清Cr可能是OC发病的保护因素, 且血清Cr浓度越高, OC的发病风险越低。
- 口腔癌 /
- 铬元素 /
- 倾向性评分 /
- 剂量-反应关系 /
- 分层分析
Abstract: Objective To evaluate the effect of serum chromium on oral cancer after adjusting the covarite between groups based on propensity score matching(PSM). Methods We performed a case-control study in 395 cases of newly diagnosed primary oral cancer from the First Affiliated Hospital of Fujian Medical University and 1 240 controls from the same community from January 2010 to February 2018. Using the PSM to select 309 controls randomly which were matched with the cases by 1 :1 matching. Conditional Logistic regression model was used to explore the association between chromium and oral cancer. Results The level of serum chromium was 178.91(121.83-284.19) μg/L in the case group, which was lower than 324.27(264.82-397.69) μg/L in control group, the difference was statistically significant(P < 0.001). Dose-response analysis showed that the risk of oral cancer gradually decreased with the increase of serum chromium, which presented a negative correlation. There was a negative correlation between serum chromium level and the risk for oral cancer by conditional Logistic regression, the aOR of serum chromium in the Q2, Q3 and Q4 compared with the Q1 were 0.14(0.08-0.26), 0.15(0.08-0.28) and 0.10(0.05-0.20), with significant trend(P_trend < 0.001). Stratified analysis showed the negative correlation between serum chromium and oral cancer by smoking, drinking tea, not drinking alcohol status and fish, fruits and green vegetables intake frequencies. Conclusions The high level of serum chromium is a protective factor for the incidence of oral cancer, and the higher of serum chromium, the lower risk of developing oral cancer.
- Oral cancer /
- Chromium /
- Propensity score matching /
- Dose-response relationship /
- Stratified analysis

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图 1 病例组和对照组血清Cr元素水平

Figure 1. Serum chromium levels in case and control groups

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图 2 血清Cr与OC的剂量-反应关系

注:调整性别、年龄、婚姻状况、肿瘤家族史、民族、文化程度、居住地、吸烟、饮酒、饮茶、膳食因素(畜肉、鱼类、海鲜、水果、绿色蔬菜)。

Figure 2. Dose-response relationship betweenserum chromium and oral cancer

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图 3 血清Cr元素水平与OC的分层分析

注:调整性别、年龄、民族、婚姻状况、肿瘤家族史、文化程度、居住地; 吸烟状况额外调整饮酒、饮茶、鱼类、水果、绿色蔬菜; 饮酒状况额外调整吸烟、饮茶、鱼类、水果、绿色蔬菜; 饮茶状况额外调整吸烟、饮酒、鱼类、水果、绿色蔬菜; 鱼类摄入情况额外调整吸烟、饮酒、饮茶、水果、绿色蔬菜; 水果摄入情况额外调整吸烟、饮酒、饮茶、鱼类、绿色蔬菜; 绿色蔬菜摄入情况额外调整吸烟、饮酒、饮茶、鱼类、水果。

Figure 3. Stratified analysis of serum chromium levels and oral cancer

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表 1 倾向评分配比前后OC病例和对照各协变量的均衡性比较[n(%)]

Table 1. Comparison of the balance of covariates between OC cases and controls before and after PSM[n(%)]

变量	配比前		P值	配比后		P值
变量	病例组(n=395)	对照组(n=1 240)	P值	病例组(n=309)	对照组(n=309)	P值
性别			< 0.001			0.743
男	247(62.53)	615(49.60)		182(58.90)	186(60.19)
女	148(37.47)	625(50.40)		127(41.10)	123(39.81)
年龄(岁)			< 0.001			0.687
< 60	205(51.90)	299(24.11)		142(45.95)	147(47.57)
≥60	190(48.10)	941(75.89)		167(54.05)	162(52.43)
民族			0.063			1.000
汉族	391(98.99)	1 237(99.76)		307(99.35)	306(99.03)
其他	4(1.01)	3(0.24)		2(0.65)	3(0.97)
婚姻状况			0.917			0.754
已婚	367(92.91)	1 154(93.06)		288(93.20)	286(92.56)
未婚及其他	28(7.09)	86(6.94)		21(6.80)	23(7.44)
肿瘤家族史			< 0.001			0.811
无	334(84.56)	1 154(93.06)		270(87.38)	268(86.73)
有	61(15.44)	86(6.94)		39(12.62)	41(13.27)
文化程度			< 0.001			0.097
文盲	33(8.35)	273(22.02)		32(10.36)	42(13.59)
小学及初中	243(61.52)	785(63.31)		199(64.40)	173(55.99)
高中及以上	119(30.13)	182(14.68)		78(25.24)	94(30.42)
居住地			< 0.001			0.867
农村	208(52.66)	1 085(87.50)		196(50.65)	198(49.13)
城市	187(47.34)	155(12.50)		113(29.20)	111(27.54)
吸烟			< 0.001			0.870
无	214(54.18)	904(72.90)		183(47.29)	185(45.91)
有	181(45.82)	336(27.10)		126(32.56)	124(30.77)
饮酒			< 0.001			0.862
无	250(63.29)	1 012(81.61)		215(55.56)	213(52.85)
有	145(36.71)	228(18.39)		94(24.29)	96(23.82)
饮茶			< 0.001			0.679
无	230(58.23)	936(75.48)		189(48.84)	194(48.14)
有	165(41.77)	304(24.52)		120(31.01)	115(28.54)
畜肉类(次/周)			0.167			0.784
< 3	106(26.84)	378(30.48)		83(21.45)	80(19.85)
≥3	289(73.16)	862(69.52)		226(58.40)	229(56.82)
鱼类(次/周)			0.001			0.572
< 3	221(55.95)	579(46.69)		170(43.93)	163(40.45)
≥3	174(44.05)	661(53.31)		139(35.92)	146(36.23)
海鲜(次/周)			0.001			0.518
< 1	226(57.22)	591(47.66)		171(44.19)	163(40.45)
≥1	169(42.78)	649(52.34)		138(35.66)	146(36.23)
绿色蔬菜(次/日)			< 0.001			0.567
< 2	175(44.30)	274(22.10)		124(32.04)	131(32.51)
≥2	220(55.70)	966(77.90)		185(47.80)	178(44.17)
水果(次/周)			< 0.001			0.805
< 3	267(67.59)	451(36.37)		189(48.84)	186(46.15)
≥3	128(32.41)	789(63.63)		120(31.01)	123(30.52)

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表 2 血清Cr元素水平在病例组和对照组中的比较

Table 2. Comparison of serum chromium levels in case group and control group

Cr(μg/L)	病例组(n=309)	对照组(n=309)	OR(95% CI)值	aOR(95% CI)值^a
Q1	221(77.27)	76(33.04)	1.00	1.00
Q2	35(12.24)	77(33.48)	0.14(0.08~0.26)	0.14(0.08~0.26)
Q3	30(10.49)	77(33.48)	0.15(0.09~0.27)	0.15(0.08~0.28)
Q4	24(26.97)	78(33.62)	0.10(0.05~0.19)	0.10(0.05~0.20)
P_trend			< 0.001	< 0.001
注:^a表示调整性别、年龄、婚姻状况、肿瘤家族史、民族、文化程度、居住地、吸烟、饮酒、饮茶、膳食因素(畜肉、鱼类、海鲜、水果、绿色蔬菜)。

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