血清叶酸与口腔癌发病关联的病例对照研究

张荣琪; 陈青; 吴雨煊; 林喜钦; 蔡琳; 汪靖; 陈法; 何保昌; 刘凤琼

doi:10.16462/j.cnki.zhjbkz.2020.06.020

血清叶酸与口腔癌发病关联的病例对照研究

doi: 10.16462/j.cnki.zhjbkz.2020.06.020

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

张荣琪与陈青为共同第一作者

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:
刘凤琼, E-mail:meimei20061986@126.com

中图分类号: R181.2
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出版历程
- 收稿日期: 2019-10-24
- 修回日期: 2020-07-21
- 刊出日期: 2020-06-10

Relationship between serum folate and risk of oral cancer: a case-control study

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

ZHANG Rong-qi and CHEN Qing contributed equally to this article

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

More Information

Corresponding author: LIU Feng-qiong, E-mail:meimei20061986@126.com

摘要

摘要: 目的探讨血清叶酸与口腔癌发病的关系。方法采用病例对照的研究方法, 收集福建医科大学附属第一医院2010年9月-2018年1月经病理确诊的口腔癌新发病例225例为病例组, 收集同时期社区和医院体检的健康人群225例为对照组。采用非条件Logistic回归分析模型, 分析血清叶酸与口腔癌发病风险的OR及其95% CI值, 并进行分层分析和相乘交互作用分析。结果病例组血清叶酸中位数为5.7 ng/ml, 低于对照组的8.2 ng/ml(P < 0.001), 差异有统计学意义; 无论性别、吸烟与否及摄入蔬菜水果的频次多少, 血清叶酸水平与口腔癌的发病风险均存在负相关; 叶酸与性别、吸烟、摄入蔬菜、水果在口腔癌的发生中存在相乘交互作用。结论高血清叶酸水平与口腔癌的发病风险呈负相关, 保证适量叶酸摄入、减少烟草消耗和适量增加蔬菜水果可能降低口腔癌的发病风险。
- 口腔癌 /
- 血清叶酸 /
- 分层分析 /
- 交互作用 /
- 病例对照研究
Abstract: Objective To explore the association between serum folate and the risk of oral cancer. Methods A case-control study were performed with 225 cases of newly diagnosed primary oral cancer from the First Affiliated Hospital of Fujian Medical University and 225 controls from the same hospital and nearby community. Unconditional Logistic regression and stratification analysis were used to explore the association between serum folate and oral cancer. Adjusted OR and corresponding 95% CI were calculated. Addition-ally, interaction analysis was conducted between serum folate and gender, smoking status, vegetables and fruit intake Results The level of serum folate was 5.7 ng/ml in the case group, which was lower than 8.2 ng/ml in control(P < 0.001). There was a negative correlation between serum folate level and the risk for oral cancer regardless of gender and smoking status, and vegetables and fruits intake frequencies. Multiplicative interaction was observed between serum folate level and gender, smoking status, vegetable intake and fruit intake. Conclusions High serum folic acid levels are negatively associated with the risk of oral can-cer. Adequate folate intake, reducing tobacco use and increasing the intake of vegetables and fruits can reduce the risk of oral cancer to some extent.
- Oral cancer /
- Serum folate /
- Stratified analysis /
- Interaction /
- Case-control study

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图 1 病例组和对照组血清叶酸水平的比较

Figure 1. Comparison of serum folic acid levels between case group and control group

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表 1 病例组与对照组的一般特征[n(%)]

Table 1. General characteristics of the case group and the control group[n(%)]

变量	对照组	病例组	χ²值	P值
性别			0.04	0.849
男	127(56.44)	129(57.33)
女	98(43.56)	96(42.67)
年龄(岁)			0.01	0.925
< 60	117(49.79)	108(50.23)
≥60	118(50.21)	107(49.77)
居住地			73.75	< 0.001
农村	198(63.46)	27(19.57)
城镇	114(36.54)	111(80.43)
BMI (kg/m²)			30.09	< 0.001
< 18.5	109(48.44)	136(60.44)
18.5~	8(3.56)	30(13.34)
≥24	108(48.00)	59(26.22)
文化程度			8.04	0.005
高中以下	182(80.89)	156(69.33)
高中及以上	43(19.11)	69(30.67)
家族肿瘤史			3.24	0.072
无	206(51.50)	19(38.00)
有	194(48.50)	31(62.00)
吸烟史			9.88	0.002
无	160(71.11)	128(56.89)
有	65(28.89)	97(43.11)
饮酒史			5.86	0.015
无	174(77.33)	151(67.11)
有	51(22.67)	74(32.89)

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表 2 口腔癌因素相关影响因素的单因素和多因素Logistic回归分析

Table 2. Logistic regression analysis and multivariate Logistic regression analysis of related influential factors of oral cancer

变量	单因素分析		多因素分析
变量	OR(95% CI)值	P值	OR(95% CI)值	P值
叶酸(ng/ml)
< 8.2	1.00		1.00
≥8.2	0.37(0.25~0.55)	< 0.001	0.28(0.17~0.46)	< 0.001^a
性别
男	1.00		1.00
女	0.96(0.66~1.40)	0.850	2.20(1.21~3.99)	< 0.001^b
年龄(岁)
< 60	1.00
≥60	0.99(0.69~1.42)	0.930
文化程度
高中以下	1.00
高中及以上	1.87(1.21~2.90)	< 0.001
吸烟史
无	1.00		1.00
有	1.87(1.26~2.76)	< 0.001	2.67(1.46~4.87)	< 0.001^c
饮酒史
无	1.00
有	1.67(1.10~2.54)	0.020
绿色蔬菜(次/d)
< 2	1.00		1.00
≥2	0.42(0.29~0.63)	< 0.001	0.42(0.26~0.68)	< 0.001^d
水果(次/周)
< 3	1.00		1.00
≥3	0.28(0.19~0.42)	< 0.001	0.28(0.17~0.44)	< 0.001^e
注:^a表示调整性别、年龄、居住地、文化程度、BMI、吸烟、饮酒; ^b表示调整年龄、居住地、文化程度、BMI、吸烟、饮酒; ^c表示调整性别、年龄、居住地、文化程度、BMI、饮酒; ^d表示调整性别、年龄、居住地、文化程度、BMI、吸烟、饮酒; ^e表示调整性别、年龄、居住地、文化程度、BMI、吸烟、饮酒。

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表 3 血清叶酸水平与口腔癌关系的分层分析[n(%)]

Table 3. Stratified analysis of the relationship between serum folic acid level and oral cancer[n(%)]

变量	血清叶酸		P值
变量	< 8.2 ng/ml	≥8.2 ng/ml	P值
男^a
对照(n=127)	78(42.39)	49(68.06)
病例(n=129)	106(57.61)	23(31.94)
aOR (95% CI)值	1.00	0.24(0.12~0.49)	< 0.001
女^a
对照(n=98)	34(36.96)	64(62.75)
病例(n=96)	58(63.04)	38(37.25)
aOR (95% CI)值	1.00	0.34(0.17~0.68)	< 0.001
不吸烟^b
对照(n=160)	69(46.00)	91(65.94)
病例(n=128)	81(54.00)	47(34.06)
aOR (95% CI)值	1.00	0.36(0.20~0.63)	< 0.001
吸烟^b
对照(n=65)	43(34.13)	22(61.11)
病例(n=97)	83(65.87)	14(38.89)
aOR (95% CI)值	1.00	0.15(0.05~0.40)	< 0.001
绿色蔬菜(< 2次/天)^c
对照(n=61)	33(28.70)	28(54.90)
病例(n=105)	82(71.30)	23(45.10)
aOR (95% CI)值	1.00	0.26(0.11~0.60)	< 0.001
绿色蔬菜(≥2次/天)^c
对照(n=164)	79(49.07)	85(69.11)
病例(n=120)	82(50.93)	38(30.89)
aOR (95% CI)值	1.00	0.36(0.19~0.68)	< 0.001
水果(< 3次/周)^c
对照(n=90)	46(27.71)	44(53.66)
病例(n=158)	120(72.29)	38(46.34)
aOR (95% CI)值	1.00	0.32(0.17~0.63)	< 0.001
水果(≥3次/周)^c
对照(n=135)	66(60.00)	69(75.00)
病例(n=67)	44(40.00)	23(25.00)
aOR (95% CI)值	1.00	0.22(0.09~0.50)	< 0.001
注:aOR:adjust OR; ^a:调整年龄、居住地、文化程度、BMI、饮酒、吸烟; ^b:调整年龄、性别、居住地、文化程度、BMI、饮酒; ^c:调整年龄、性别、居住地、文化程度、BMI、饮酒、吸烟。

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表 4 血清叶酸与性别、吸烟、绿叶蔬菜、水果的相乘交互作用分析

Table 4. Analysis of the interaction between serum folic acid and sex, smoking, leafy vegetables and fruit

变量	对照[n(%)]	病例[n(%)]	aOR (95% CI)值	P值
性别^a
女(-)	78(34.67)	106(47.11)	1.00
男(-)	34(15.11)	58(25.78)	0.40(0.19~0.82)	0.012
女(+)	49(21.78)	23(10.22)	0.33(0.17~0.65)	0.001
男(+)	64(28.44)	38(16.89)	0.09(0.04~0.22)	< 0.001
叶酸×性别			0.21(0.10~0.41)	< 0.001
吸烟^b
有(-)	43(19.11)	83(36.89)	1.00
无(-)	69(30.67)	81(36.00)	0.37(0.19~0.72)	< 0.001
有(+)	22(9.78)	14(6.22)	0.16(0.06~0.39)	< 0.001
无(+)	91(40.44)	47(20.89)	0.13(0.06~0.27)	< 0.001
叶酸×吸烟			0.31(0.18~0.52)	< 0.001
绿色蔬菜(次/d)^c
< 2 (-)	33(14.67)	82(36.44)	1.00
≥2 (-)	79(35.11)	82(36.44)	0.35(0.19~0.63)	< 0.001
< 2 (+)	28(12.44)	23(10.23)	0.16(0.07~0.38)	< 0.001
≥2 (+)	85(37.78)	38(16.89)	0.14(0.07~0.27)	< 0.001
叶酸×绿色蔬菜			0.33(0.20~0.55)	< 0.001
新鲜水果(次/周)^c
< 3(-)	46(20.44)	120(53.33)	1.00
≥3(-)	66(29.33)	44(19.56)	0.26(0.14~0.48)	< 0.001
< 3(+)	44(19.56)	38(16.89)	0.26(0.14~0.51)	< 0.001
≥3(+)	69(30.67)	23(10.22)	0.07(0.03~0.15)	< 0.001
叶酸×新鲜水果			0.17(0.09~0.32)	< 0.001
注:括号内“+”表示对象血清叶酸水平较高, 括号内“-”表示对象血清叶酸水平较低; aOR表示adjust OR; ^a:调整年龄、居住地、文化程度、BMI、饮酒、吸烟; ^b表示调整年龄、性别、居住地、文化程度、BMI、饮酒; ^c表示调整年龄、性别、居住地、文化程度、BMI、饮酒、吸烟。

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