BMI与恶性肿瘤发病风险的前瞻性队列研究

郭兰伟; 李霓; 王刚; 苏凯; 李放; 杨琳; 任建松; 昌盛; 陈朔华; 吴寿岭; 赫捷; 代敏

Abstract

郭兰伟,李霓,王刚,苏凯,李放,杨琳,任建松,昌盛,陈朔华,吴寿岭,赫捷,代敏.BMI与恶性肿瘤发病风险的前瞻性队列研究[J].Chinese journal of Epidemiology,2014,35(3):231-236

BMI与恶性肿瘤发病风险的前瞻性队列研究

Body mass index and cancer incidence：a prospective cohort study in northern China

Received:November 12, 2013 Revised:June 12, 2012

DOI：

KeyWord: 体重指数恶性肿瘤队列研究流行病学

English Key Word: Body mass index Neoplasia Cohort study Epidemiology

FundProject:国家"十一五"科技重大专项

Author Name	Affiliation	E-mail
Guo lanwei	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China	daiminlyon@gma1.com
Li xia	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China
Wang gang	Kailuan Generaf Hospital in Tangshan of Hebei Province
Su kai	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China
Li fang	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China
Yang lin	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China
Ren jiansong	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China
Chang sheng	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China
Chen shuohua	Kailuan Generaf Hospital in Tangshan of Hebei Province
Wu shouling	Kailuan Generaf Hospital in Tangshan of Hebei Province
He jian	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China
Dai min	Peking Union Medical College, Chinese Academ of Medica Sciences. Cancer HospitalInstitute, Beijng 100021, China

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Abstract:

目的利用大规模人群队列研究，探讨BMI与恶性肿瘤发病的关联性及其强度。方法采用2006年开滦集团体检人群队列(收集基线调查时人口学、生活方式和身高、体重等测量指标信息).通过主动和被动随访相结合方式，收集肿瘤发病、死亡等结局信息。排除随访时问<1年的新发病例后，采用多因素Cox比例风险回归模型分析低体重、超重和肥胖与肿瘤发病的风险比(HR)和95%CI，调整变量包括年龄、受教育程度、吸烟、饮酒和HBsAg(仅在肝癌中调整)：对男性肺癌、肝癌和女性乳腺癌分别按吸烟、HBsAg和绝经状态分层后纳入模型重新分析。结果至2011年12月31 Et，随访人群纳入队列133 273人，其中男性106 630人(80.0l%)、女性26 643人(19.99%)，共随访570 531.02人年，平均随访时间为4.28年。男性低体重(BMI<18.5kg／m2)2 387人(2.24%)，正常体重(BMI 18.5～23.9 kg／m2)45 090人(42.29%)，超重(BMI 24.0-27.9 kg／m2)43 774人(41.05%)，肥胖(BMI≥28.0 kg／m2)15 379人(14.42%)；女性低体重858人(3.22%)，正常体重14 037人(52.69%)，超重8 507人(31.93%)，肥胖3 241人(12.16%)。共收集肿瘤新发病例1 647例，其中男性1 348例，女性299例。多因素Cox比例风险回归模型分析表明，与正常体重者相比，男性低体重者胃癌(a／／R=3.82，95%CI：1.97。7.38)和肝癌(棚月=3.00，95%C1：1.36～6.65)的发病风险增加；男性肥胖(aHR=2.75，95%C1：1.25.6.06)和超重(a／／R=1.98，95%CI：1.03，3.82)者结肠癌发病风险增加；男性膀胱癌病例中，超重为保护性因素(aHR=0.44，95%CI：0.23-0，84)；男性肺癌病例中，超重和肥胖均为保护性因素(超重：aHR=0.59，95%Cl：O.46一O.76；肥胖：aHR=0.64，95%CI：O.44。O.92)。而较之体重正常女性，女性肥胖者乳腺癌(aHR=1.86，95%C1：1.05～3.31)的发病风险增加：分层分析显示：刘‘于男性肺癌，超重对不吸烟者和吸烟者均起保护作用(小吸烟者：aHR=0.50，95%C1：O.35-0.72；吸烟者：aHR=0.70，95%CI：0.50一O.98)，肥胖仅对男性不吸烟者起保护作用(a／／R=0 57，95%CI：O.33～O.97)，而男性吸烟者与肺癌发病风险不存在相关性(aHR=0.72，95%C1：0.43～1.21)。按女性绝经状态分层后，肥胖增加了绝经后乳腺癌的发病风险(aHR=1.97，95%CI：1.01～3.82)，而与绝经前乳腺癌的发病风险之间的关联无统计学意义：结论BMI与恶性肿瘤发病风险的相关性因肿瘤不同而存在差异。低体重与男性胃癌和肝癌的发病风险存在相关性，肥胖与男性结肠癌、女性绝经后乳腺癌和卵巢癌的发病风险存在相关性，而超重可能刘‘于男性肺癌和膀胱癌发病起到保护作用，肥胖可能对于非吸烟男性肺癌发病起到保护作用。

English Abstract:

Objective To determine the incidence and risk factors of HCV infection among heroin addicts who were receiving methadone maintenance treatment (MMT) in Dehong prefecture,Yunnan province.Methods All heroin addicts who were HCV negative at the initiation of MMT in June 2005 through March 2012,in Dehong prefecture,were included in this cohort analysis.HCV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.Results A total of 2390 MMT clinic attendants were qualified for this cohort study by March 2012.731 (30.6%) of them had never received any follow-up HCV testing so were recognized as loss to follow-up.The other 1659 (69.4%) participants had received at least one follow-up HCV testing and were observed for a total of 3509.12 person-years (py).During this period 99 new HCV infections or HCV sero-converters were identified.The overall HCV incidence was 2.82/ 100 py and was 3.62/100 py for 2006,5.36/100 py for 2007,6.71/100 py for 2008,2.56/100 py for 2009,1.90/100 py for 2010,and 0.44/100 py for 2011,respectively.Results from multiple regression analysis,using Cox proportional hazard model,indicated that after controlling for confounding variables,those who were unemployed,being injecting drug users (IDUs) or HIV positive at entry into the MMT program were more likely to be newly infected with HCV or HCV sero-converted during the follow-up period than those who were peasants,non-IDUs or HIV negative at entry into the MMT program (HR=2.02,95% CI:1.18-3.48; HR=9.05,95% CI:5.49-14.93; HR=2.12,95% CI:1.37-3.56),respectively.Conclusion The incidence of HCV infection among MMT clinic attendants was decreasing since 2009 in Dehong prefecture.Those who were unemployed,injecting drug users and HIV positive were at higher risk of HCV infection.

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