卵巢癌危险因素及其易感基因的研究
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摘要
目的：卵巢癌是妇女常见恶性肿瘤之一，因其预后极差，而居妇科恶性肿瘤死亡率之首，因而控制、减少卵巢癌危险因素，预防卵巢癌的发生有相当重要的意义。本课题从环境、社会心理及遗传三方面综合探讨影响国人卵巢癌发生的危险因素，为保护易感人群、预防卵巢癌的发生提供一定的依据。
方法：采用病例对照研究方法，选取卵巢癌患者102人，对照204人，后者来自病例居住的相应社区的健康人。两组年龄、民族、职业分布相似，并在津居住十年以上。自行设计流行病学问卷及采用艾森克个性问卷和生活事件量表等调查受试对象月经生育情况、哺乳避孕情况、既往史、家族史、膳食习惯、饮食情况及心理因素等。对所得资料进行单因素非条件Logistic回归分析和多因素非条件Logistic回归分析。
结果：单因素分析结果表明，初潮年龄早增加卵巢癌的相对危险性，其OR值为0.7714(0.6418-0.9273)，当初潮年龄≥17岁时，其OR值仅为≤13岁时的0.4693。怀孕次数多、产次多、哺乳、采取避孕措施可以减少卵巢癌发生的相对危险度，OR值分别为0.8317(0.7062-0.9796)，0.7122(0.4505-1.1260)，0.1612(0.0897-0.2895)，0.2893(0.1747-0.4789)。子宫内膜异位症与卵巢癌的发生也存在着统计学联系，其OR值为8.5955(1.7906-41.2612)。饮茶、经常参加体育锻
天津医科人学博1：学位论义
炼可以减少卵巢癌发生的危险性；而大便不规律增加其危险性。另外，
饮食因素中猪肉摄入量大与卵巢癌的危险性呈正相关，OR值为1．4528
（l刀6 14—1．9884）；而绿叶蔬菜、十字花科蔬菜、水果的摄入量增加
可以相对减弱卵巢癌的危险性。
有恶性肿瘤家族史明显增加卵巢癌的危险性，其OR值为6．7375
（2．8799—15．7625）；而母亲或姊妹患乳腺癌或卵巢癌时，OR值可高
达15石374（0．7189．340．1709）。
社会心理因素调查结果表明，抑郁、焦虑和疑心病、负性主活事
件、精神质、神经质与卵巢癌发生的危险性呈正相关，其OR值分别
为 0．5190（0．3058—0．8816）（分值越低，抑郁程度越重），2．6672（l．0435
—6．8145），3．5000（1．4127—8石718），4石789（1．7liZ—12．7876），2．2752
（l石464—3．1437），1．2991（l刀222—l石497）。
多因素分析结果表明，恶性肿瘤家族史、负性生活事件、神经质、
大便不规律为卵巢癌主要的危险因素，OR值分别为 7．1381（3．3269一
15．3155），4．3897（l石079—11．9831），3．1459（0．7998—12．3734），2石541
＊石854—4．1797X 多产、哺乳及放置宫内节育器是主要的保护因素，
OR值分别为0．5 189（．4298—0石264），0．4914（0．3081—0．7832），0．2543
（0刀966—0石69）。
结论：卵巢癌的发病是多因素综合作用的结果，包括内外环境、社会
心理、遗传因素等多方面。本研究结果提示，为预防卵巢癌的发生应
。提倡母乳喂养；采取适当的避孕措施；合理调整膳食结构，减少红肉
类摄入量、多食果蔬；经常参加体育锻炼；保持乐观开朗的心情；对
有肿瘤家族史者可进行定期检查监测，及时采取预防性措施。
(Study on risk factors for ovarian cancer)
Background: Ovarian cancer is one of the most common malignant tumors among women, and is the leading cause of death from gynecological carcinoma because of its very poor prognosis. Therefore, it is of great significance to control or reduce risk factors to prevent ovarian cancer from occurrence.
Objectives: To investigate effects of risk factors in environment, social-psychological, hereditary aspects on development of ovarian cancer in Chinese women. To put forward some evidences on high-risk population protection and prophylaxis of ovarian cancer. Methods: 102 ovarian cancer patients and 204 controls, who were from the same or neighborhood district as cases, were interviewed with epidemiology and psychological questionnaires. The distribution of age, nationality and occupation was similar between the case and control group, and all subjects have been living in Tianjin at least 10 years. Data on demographic, menstrual, reproductive, contraception, personal disease history, family history of cancer, dietary habits and intake, psychological factors etc. was collected, and then, was analyzed with non-conditional logistic regression model.
Results: Single-factor analysis results show that, early age at menarche and late age at first livebirth increase relative risk of ovarian
105
cancer. Odds ratio of menarche age is 0.7714 (95% CI 0.6418-0.9273), and OR at over 17yr is only half of that at below 13yr. Number of pregnancies, high parity, lactation, contraception are all decrease the risk of ovarian cancer, OR of which are 0.8317 (95% CI 0.7062 ?0.9796), 0.7122 ( 95% CI 0.4505-1.1260), 0.1612 (95% CI 0.0897-0.2895), 0.2893 (95% CI 0.1747 ?0.4789, respectively. Endometriosis is also associated with ovarian cancer, and OR is 8.5955 ( 95% CI 1.7906-41.2612) .Drinking tea, physical exercise is reversely correlated to ovarian cancer, while irregular defecation is positively related to the cancer. Among dietary factors, pork intake increase risk(OR=1.4528, 95% CI 1.0614?.9884) , on the other hand, intake of green leafs vegetables, mustard group vegetables, fruit have the contrary effects on ovarian cancer.
Family history of malignant tumor appears strong correlation with risk of
ovarian cancer, OR of which is 6.7375 (95% CI 2.8799-15.7625) .And
the value of OR reaches 15.6374 (95% CI 0.7189-340.1709) when
mother and/or sisters suffered from breast/ovarian cancer.
Results of social-psychological factors indicate that, depression, anxiety,
suspicion, negative life events and high score of P, N are all associated
with ovarian cancer. OR are 0.5190 (95% CI 0.3058-0.8816) ,2.6672
(95% CI 1.0435-6.8145), 3.5000 (95% CI 1.4127-8.6718), 4.6789
(95% CI 1.7112-12.7876), 2.2752 (95% CI 1.6464-3.1437), 1.2991
(95% CI 1.0222-1.6497) , respectively.
Multi-factors logistic regression analysis results demonstrate that, family history of malignant tumor, negative life events, high P score, irregular defecation are the major risk factors for ovarian cancer, OR of which are 7.1381 (95% CI 3.3269- 15.3155), 4.3897 (95% CI 1.6079- 11.9831), 3.1459 (95% CI 0.7998-12.3734), 2.6541 (95% CI 1.6854-4.1797) ;
106
while, high parity, lactation and intrauterine device are the main protective factors. The odds ratio are as following: 0.5189 (95% CI 0.4298-0.6264), 0.4914 (95% CI 0.3081 -0.7832), 0.2543 (95% CI 0.0966-0.6691) respectively.
Conclusions: It is multi-factors including internal & external environment, social-psychology, and hereditary aspects that attribute to ovarian cancer. Some proposal is recommended to women:
1) Mother-self breast-feeding
2) Take contraception measure
3) Reasonable dietary pattern: decrease intake of red meat, increase intake of vegetables and fruit
4) Do physical activity usually
5) Keep mind open and happy
6) Periodic surveillance on women who have cancer family history
方法：采用病例对照研究方法，选取卵巢癌患者102人，对照204人，后者来自病例居住的相应社区的健康人。两组年龄、民族、职业分布相似，并在津居住十年以上。自行设计流行病学问卷及采用艾森克个性问卷和生活事件量表等调查受试对象月经生育情况、哺乳避孕情况、既往史、家族史、膳食习惯、饮食情况及心理因素等。对所得资料进行单因素非条件Logistic回归分析和多因素非条件Logistic回归分析。
结果：单因素分析结果表明，初潮年龄早增加卵巢癌的相对危险性，其OR值为0.7714(0.6418-0.9273)，当初潮年龄≥17岁时，其OR值仅为≤13岁时的0.4693。怀孕次数多、产次多、哺乳、采取避孕措施可以减少卵巢癌发生的相对危险度，OR值分别为0.8317(0.7062-0.9796)，0.7122(0.4505-1.1260)，0.1612(0.0897-0.2895)，0.2893(0.1747-0.4789)。子宫内膜异位症与卵巢癌的发生也存在着统计学联系，其OR值为8.5955(1.7906-41.2612)。饮茶、经常参加体育锻
天津医科人学博1：学位论义
炼可以减少卵巢癌发生的危险性；而大便不规律增加其危险性。另外，
饮食因素中猪肉摄入量大与卵巢癌的危险性呈正相关，OR值为1．4528
（l刀6 14—1．9884）；而绿叶蔬菜、十字花科蔬菜、水果的摄入量增加
可以相对减弱卵巢癌的危险性。
有恶性肿瘤家族史明显增加卵巢癌的危险性，其OR值为6．7375
（2．8799—15．7625）；而母亲或姊妹患乳腺癌或卵巢癌时，OR值可高
达15石374（0．7189．340．1709）。
社会心理因素调查结果表明，抑郁、焦虑和疑心病、负性主活事
件、精神质、神经质与卵巢癌发生的危险性呈正相关，其OR值分别
为 0．5190（0．3058—0．8816）（分值越低，抑郁程度越重），2．6672（l．0435
—6．8145），3．5000（1．4127—8石718），4石789（1．7liZ—12．7876），2．2752
（l石464—3．1437），1．2991（l刀222—l石497）。
多因素分析结果表明，恶性肿瘤家族史、负性生活事件、神经质、
大便不规律为卵巢癌主要的危险因素，OR值分别为 7．1381（3．3269一
15．3155），4．3897（l石079—11．9831），3．1459（0．7998—12．3734），2石541
＊石854—4．1797X 多产、哺乳及放置宫内节育器是主要的保护因素，
OR值分别为0．5 189（．4298—0石264），0．4914（0．3081—0．7832），0．2543
（0刀966—0石69）。
结论：卵巢癌的发病是多因素综合作用的结果，包括内外环境、社会
心理、遗传因素等多方面。本研究结果提示，为预防卵巢癌的发生应
。提倡母乳喂养；采取适当的避孕措施；合理调整膳食结构，减少红肉
类摄入量、多食果蔬；经常参加体育锻炼；保持乐观开朗的心情；对
有肿瘤家族史者可进行定期检查监测，及时采取预防性措施。
(Study on risk factors for ovarian cancer)
Background: Ovarian cancer is one of the most common malignant tumors among women, and is the leading cause of death from gynecological carcinoma because of its very poor prognosis. Therefore, it is of great significance to control or reduce risk factors to prevent ovarian cancer from occurrence.
Objectives: To investigate effects of risk factors in environment, social-psychological, hereditary aspects on development of ovarian cancer in Chinese women. To put forward some evidences on high-risk population protection and prophylaxis of ovarian cancer. Methods: 102 ovarian cancer patients and 204 controls, who were from the same or neighborhood district as cases, were interviewed with epidemiology and psychological questionnaires. The distribution of age, nationality and occupation was similar between the case and control group, and all subjects have been living in Tianjin at least 10 years. Data on demographic, menstrual, reproductive, contraception, personal disease history, family history of cancer, dietary habits and intake, psychological factors etc. was collected, and then, was analyzed with non-conditional logistic regression model.
Results: Single-factor analysis results show that, early age at menarche and late age at first livebirth increase relative risk of ovarian
105
cancer. Odds ratio of menarche age is 0.7714 (95% CI 0.6418-0.9273), and OR at over 17yr is only half of that at below 13yr. Number of pregnancies, high parity, lactation, contraception are all decrease the risk of ovarian cancer, OR of which are 0.8317 (95% CI 0.7062 ?0.9796), 0.7122 ( 95% CI 0.4505-1.1260), 0.1612 (95% CI 0.0897-0.2895), 0.2893 (95% CI 0.1747 ?0.4789, respectively. Endometriosis is also associated with ovarian cancer, and OR is 8.5955 ( 95% CI 1.7906-41.2612) .Drinking tea, physical exercise is reversely correlated to ovarian cancer, while irregular defecation is positively related to the cancer. Among dietary factors, pork intake increase risk(OR=1.4528, 95% CI 1.0614?.9884) , on the other hand, intake of green leafs vegetables, mustard group vegetables, fruit have the contrary effects on ovarian cancer.
Family history of malignant tumor appears strong correlation with risk of
ovarian cancer, OR of which is 6.7375 (95% CI 2.8799-15.7625) .And
the value of OR reaches 15.6374 (95% CI 0.7189-340.1709) when
mother and/or sisters suffered from breast/ovarian cancer.
Results of social-psychological factors indicate that, depression, anxiety,
suspicion, negative life events and high score of P, N are all associated
with ovarian cancer. OR are 0.5190 (95% CI 0.3058-0.8816) ,2.6672
(95% CI 1.0435-6.8145), 3.5000 (95% CI 1.4127-8.6718), 4.6789
(95% CI 1.7112-12.7876), 2.2752 (95% CI 1.6464-3.1437), 1.2991
(95% CI 1.0222-1.6497) , respectively.
Multi-factors logistic regression analysis results demonstrate that, family history of malignant tumor, negative life events, high P score, irregular defecation are the major risk factors for ovarian cancer, OR of which are 7.1381 (95% CI 3.3269- 15.3155), 4.3897 (95% CI 1.6079- 11.9831), 3.1459 (95% CI 0.7998-12.3734), 2.6541 (95% CI 1.6854-4.1797) ;
106
while, high parity, lactation and intrauterine device are the main protective factors. The odds ratio are as following: 0.5189 (95% CI 0.4298-0.6264), 0.4914 (95% CI 0.3081 -0.7832), 0.2543 (95% CI 0.0966-0.6691) respectively.
Conclusions: It is multi-factors including internal & external environment, social-psychology, and hereditary aspects that attribute to ovarian cancer. Some proposal is recommended to women:
1) Mother-self breast-feeding
2) Take contraception measure
3) Reasonable dietary pattern: decrease intake of red meat, increase intake of vegetables and fruit
4) Do physical activity usually
5) Keep mind open and happy
6) Periodic surveillance on women who have cancer family history
引文
第一部分
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