上海市肝细胞癌防治40年

俞顺章; 郑莹; 吴春晓; 郑英杰

Abstract

俞顺章,郑莹,吴春晓,郑英杰.上海市肝细胞癌防治40年[J].Chinese journal of Epidemiology,2013,34(6):637-641

上海市肝细胞癌防治40年

Prevention and control hepatocellular carcinoma in Shanghai during 40 years

Received:January 18, 2013 Revised:June 18, 2012

DOI：

KeyWord: 肝细胞癌生存率和相对生存率危险因素饮水污染乙型肝炎疫苗

English Key Word: Hepatocellular carcinoma Survival and relative survival rate Risk factors Polluted drinking water Hepatitis B vaccination

FundProject:河北省医学科学研究重点课题计划(08009)

Author Name	Affiliation	E-mail
YU Shun-zhang	Institute of Preventive Medicine,the Key Laboratory on Public Health Safety,Ministry of Education,Urziversity,Shanghai 200032. Municipal Center for Disease Control and China	szyu@shmu.edu.cn
ZHENG Ying	Shanghai Municipal Center for Disease Control and Prevention
WU Chun-xiao	Shanghai Municipal Center for Disease Control and Prevention
ZHENG Ying-jie	Institute of Preventive Medicine,the Key Laboratory on Public Health Safety,Ministry of Education,Urziversity,Shanghai 200032. Municipal Center for Disease Control and China

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Abstract:

一、全球肝细胞癌流行情况原发性肝癌90%以上为肝细胞癌(肝癌).根据WHO癌症研究中心(IARC)2008年报道,全世界肝癌发病率位于常见癌症的第5位,每年男性肝癌新发病例为523 432例(占所有部位癌症发病的7.9%),女性肝癌226 312例(6.5%),男女发病比例为2.3:1.肝癌主要发生在>40岁人群中.肝癌死亡人数男女分别为478 134例和217 592例(分别占所有癌症死亡的14.6%和5.7%),为所有癌症死亡人数的第3位^[1].全世界约有20多个国家和地区肝癌发病率>20/10万,发病愈严重地区发病年龄高峰愈接近青少年.肝癌主要发生在欠发达地区,男女性发病人数分别为440 549例和185 999例;其中发生在东南亚和西太地区的肝癌男女性分别为410 297例和1 63 754例;发生在非洲的肝癌病例主要分布在撒哈拉以南地区,男性为34 612例,女性为16 947例.肝癌发病率或死亡率在美国略有上升,在日本略有下降^[2,3].中国肝癌男女性发病例数分别占世界肝癌发病例数的56.1%和48.6%,肝癌死亡例数分别占55.8%和48.5%,死亡和发病之比值为0.92.全国和上海市肝癌的流行情况见表1.

English Abstract:

Objective To determine the efficient cut-ofF points of fasting fingertip blood glucose test for undiagnosed diabetes meilitus(DM)。impaired glucose tolerance(IGT)，and impaired fasting glucose(IFG)in community-based residents aged above 45 years old.Methods A cluster-randomized study was conducted from May 2008 to January 2009.A total of 3250 subjects aged above 45 years in two communities of Baoding city received questionnaire investigation and tested for fingertip blood glucose.Those subjects whose capillary blood glucose level≥5.1 m.moFL were subjected to 75 g ol-al glucose tolerance test.Undiagnosed diabetes mellitus and pre-diabetes WgTe identified by fasting plasma glucose and OGTT.In this study.the cut-ofr points of fasting capillary blood glucose for detecting undiagnosed diabetes and pre-diabetes were evaluated，using receiver operator characteristic curve(ROC).Results Of l 35 l subjects that having had oral glucose tolerance test，230 cases were diagnosed as diabetes mellitus(7.3％)，166 cases(5.2％)as IFG，and 204(6.7％)as IGT under fasting capillary blood glucose as test variable and state vailables according to the following criteria.(1)FPG≥7.0 inmol／L or／and 2hPG≥11.1 mnloI／L(2)FPG<5.6 mmol／L (3)FPG<7.0 mmoi／L and 7.8 mnlo儿≤2hPG≤11.1 mlnoI／L。al'eas under three ROC cul'ves were 0.905，0.633 and 0.719。respectively.The cut.0ffvalues ofscreening for undiagnosed DM，IGT and IFG were 6.0 mmol／L。5.7 mmoI／L，and 5.7 mmol／L。respectively.When cut.0ff value of screening for undiagnosed DM was 6.0 mmoI／L.the maximal sensitivity Was 78.0％and specificity Was 89.3％. BUt there were both lower sensitivity and specificity in screening for IFG and IGT according to the best predicting value(5.7 mmoI／L)from the ROC curves(50.3％and 28.O％115.60.8％and 28.O％).Conclusion Fasting capillary blood glucose with the lower cut.point of 6.0 mmoⅥ。in screening for tmdiagnosed diabetes mellitus alone，was relatively reliable。whereas for both IFG and IGT the fasting fingertip blood glucose tests were fallible.It Was convenient and could be used in screening the DM at the community level.

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