周月芬 吴敏华 谢艳茹

[摘要] 目的 探討丽水市胃癌发病的危险因素。 方法 收集2012年3月～2015年2月在丽水市县级以上医院住院并经病理确诊的胃癌患者210例，作为病例组，采用1∶1配对的病例对照研究的方法，从丽水市各县区健康人群中随机抽取210名作为对照组。通过《居民生活与健康调查表》的问卷，调查胃癌患者和对照人群的相关因素，分析这些因素与胃癌之间的关系。 结果 通过对两组生活方式和饮食习惯进行单因素方差分析，发现经常饮酒、经常饮绿茶、性格急躁、胃病史、吃饭速度快、经常吃夜宵、经常外出就餐、经常吃腌制食品、经常吃新鲜蔬菜等生活习惯，两组的差异均有统计学意义（P < 0.05）。在控制和考虑其他混杂因素后，通过多因素Logistic分析，发现经常吃腌制食品（OR = 19.662，95%CI：10.000～38.658，P = 0.000）、经常吃夜宵（OR = 2.494，95%CI：1.297～4.807，P = 0.006）、吃饭速度快（OR = 4.329，95%CI：2.273～8.264，P = 0.000）、胃病史（OR = 2.033，95%CI：1.004～4.119，P = 0.049）为丽水市胃癌发病的主要危险因素；经常饮绿茶（OR = 0.330，95%CI：0.169～0.647，P = 0.001）、经常吃新鲜蔬菜（OR = 0.439，95%CI：0.213～0.907，P = 0.026）为其保护性因素。 结论 丽水市胃癌发病与饮食习惯密切相关，改变不良饮食习惯是降低该地区胃癌发病率的重要手段。

[关键词] 胃癌；危险因素；病例对照研究；饮食习惯

[中图分类号] R735 [文献标识码] A [文章编号] 1673-7210（2018）08（c）-0045-06

[Absrtact] Objective To investigate the risk factors of gastric cancer in Lishui City. Methods Two hundred and ten cases of gastric cancer diagnosed by pathology， that were treated in hospitals above the country level in Lishui City were enrolled in this study as case group from March 2012 to February 2015. The method， 1∶1 matched case-control study was used， 2010 healthy people in each country and districts in Lishui City were randomly selected as the control group. By means of “Questionnaire of the Survey of Living and Health of the Population”， the correlation factors of gastric cancer patients and control population were investigated and the relationship between these factors and gastric cancer was analyzed. Results Through the one-way ANOVA， it showed that frequent drinking， frequent green tea drinking， impatience， history of stomach disease， eating fast， often eating midnight snacks， often eating out， often eating salted foods， often eating fresh vegetables were found to be statistically different between the case group and the control group （P < 0.05）. After controlling and considering other confounding factors， via multiple Logistic analysis method often eating salted food （OR = 19.662， 95%CI：10.000-38.658， P = 0.000）， often eating midnight snacks （OR = 2.494， 95%CI：1.297-4.807， P = 0.006）， eating fast （OR = 4.329， 95%CI：2.273-8.264， P = 0.000）， the history of stomach problems （OR = 2.033， 95%CI：1.004-4.119， P = 0.049） were found to be major risk factors of gastric cancer in Lishui； often drinking green tea （OR = 0.330， 95%CI：0.169-0.647， P = 0.001）， often eating fresh vegetables （OR = 0.439， 95%CI：0.213-0.907， P = 0.026） were found to be protective factors. Conclusion The incidence of gastric cancer in Lishui City is closely related to eating habits. Changing unhealthy eating habits is an important way to reduce the incidence of gastric cancer in this area.

[Key words] Gastric cancer； Risk factors； Case control study； Eating habits

中国是胃癌大国，其胃癌发病率和死亡率位居世界第二。中国男性胃癌年发病率为477.7/10万，女性为201.4/10万[1]。多数胃癌患者初诊时已是局部晚期或出现远处转移，失去手术机会[2]。据《2009年丽水市死亡慢病监测年度技术分析报告》[1]显示：丽水市前5位死因顺序依次为恶性肿瘤、脑血管病、呼吸系统疾病、损伤和中毒、心脏病。丽水市2009年报告死亡个案15 567例，监测人群总死亡率为632.29/10万，其中癌症死亡率为158.69/10万，癌症死亡人数已超过我市居民死亡人数的1/4。丽水市恶性肿瘤中死亡率居前5位的依次是胃癌、肺癌、肝癌、食管癌、结直肠肛门癌，其中胃癌死亡846例，死亡率为34.36/10万，明显高于全国平均胃癌死亡率20/10万。丽水市胃癌防治形势严峻。……