青海地区胃癌发病危险因素的病例对照研究*

A case-control study on risk factors of gastric cancer in Qinghai area*

摘要:

目的 分析青海地区胃癌发病的危险因素和保护因素，为该地区胃癌的一级预防提供科学依据。 方法 选取2014年9月—2018年6月于青海省人民医院肿瘤内科住院并经病理活检明确诊断为胃癌的患者389例 作为病例组。选取同期该院健康体检者作为对照组。采用单因素及多因素Logistic回归分析胃癌发病的危险因素 和保护因素。结果 单因素分析显示，职业、文化程度、经济收入、慢性食管炎、胃炎、胃溃疡、胃出血、胃息肉、肝炎、 胆囊炎/结石、HP感染、吸烟、饮酒、饮茶、油腻饮食、吃饭速度、重盐饮食、腌晒食物、油炸食物、酥油、饮食规律、新鲜 蔬菜、新鲜水果、饮用自来水、肿瘤家族史、工作压力大及性格急躁是胃癌的保护或危险因素（P <0.05）。多因素Logistic 回归分析发现，食管炎［O＾R=13.692（95% CI：1.573，119.162）］、胃炎［O＾R=6.005（95% CI：1.812，19.894）］、胃溃 疡［O＾R=23.623（95% CI：3.595，155.245）］、胆囊炎/结石［O＾R=6.465（95% CI：1.191，35.089）］、幽门螺杆菌感染［O＾R= 18.712（95% CI：5.041，69.451）］、吸烟［O＾R=5.174（95% CI：2.092，12.797）］、饮酒［O＾R=9.030（95% CI：3.725， 21.892）］、油腻饮食［O＾R=3.068（95% CI：1.338，7.0360）］、吃饭速度快［O＾R=5.349（95% CI：2.412，11.866）］、重盐饮食 ［O＾R=2.825（95% CI：1.321，6.041）］、常吃腌晒食物［O＾R=2.643（95% CI：1.081，6.459）］是该地区胃癌发生的主要危 险因素；而非农牧民［O＾R=0.260（95% CI：0.112，0.602）］、文化程度高［O＾R=0.084（95% CI：0.033，0.216）］、经济收入高 ［O＾R=0.179（95% CI：0.075，0.430）］、饮食规律［O＾R=0.246（95% CI：0.740，0.826）］、常吃新鲜蔬菜［O＾R=0.199（95% CI：0.087，0.452）］、饮用自来水［O＾R=0.042（95% CI：0.009，0.185）］是胃癌发生的主要保护因素。结论 青海地区胃 癌发病率高可能与不良的生活及饮食习惯、慢性胃病史有关，建议制定科学的预防措施进行干预。

Abstract:

Objective To analyze the risk factors and protective factors of gastric cancer in Qinghai area, and to provide evidence for primary prevention of gastric cancer in this area. Methods We enrolled 389 gastric cancer patients with pathological diagnosis hospitalized in the Department of Medical Oncology of Qinghai Provincial People's Hospital from September 2014 to June 2018. Another 389 healthy physical examinees in our hospital at the same period were selected as control group. Univariate and multivariate conditional Logistic regression analysis was performed using SPSS 20.0 statistical software. Results Univariate analysis found that occupation, educational degree, economic income, history of chronic esophagitis, history of gastritis, history of gastric ulcer, history of gastric bleeding, history of gastric polyp, history of hepatitis, history of cholecystitis/cholelithiasis, Helicobacter pylori infection, smoking, alcohol consumption, drinking tea , greasy diet, fast eating, salt-heavy diet, often eating pickled food, fried food, and ghee, regular diet, eating fresh vegetables and fruits, drinking tap water, family history of cancer, heavy pressure of work, and short-tempered personality were either risk factors or protective factors for gastric cancer (P < 0.05). Furthermore, multivariate Logistic regression analysis indicated that esophagitis [O^R = 13.692, (95% CI: 1.573, 119.162)], gastritis [O^R = 6.005, (95% CI: 1.812, 19.894)], gastric ulcer [O^R = 23.623 (95% CI: 3.595, 155.245)], cholecystitis/cholelithiasis [O^R = 6.465 (95% CI: 1.191, 35.089)], Helicobacter pylori infection [ O^R = 18.712 (95% CI: 5.041, 69.451)], smoking [ O^R = 5.174 (95% CI: 2.092, 12.797)], alcohol consumption [O^R =9.030 (95% CI: 3.725, 21.892)], greasy diet [O^R = 3.068 (95% CI: 1.338, 7.0360)], fast eating [O^R = 5.349 (95% CI: 2.412, 11.866)], salt-heavy diet [O^R = 2.825, (95% CI: 1.321, 6.041)], and often eating pickled food [O^R = 2.643 (95% CI: 1.081, 6.459)] were risk factors for gastric cancer, and that non-peasant and nonherdsman [O^R = 0.260 (95% CI: 0.112, 0.602)], high educational degree [O^R = 0.084 (95% CI: 0.033, 0.216)], high economic income [O^R =0.179 (95% CI: 0.075, 0.430)], regular diet [O^R = 0.246 (95% CI: 0.740, 0.826)], eating fresh vegetables [O^R =0.199 (95% CI: 0.087, 0.452)] and drinking tap water [O^R = 0.042 (95% CI: 0.009, 0.185)] were protective factors for gastric cancer. Conclusions The high incidence of gastric cancer in Qinghai area may be related to poor living and eating habits and history of chronic gastropathy. It is recommended to develop scientific preventive measures for intervention of the relevant factors.