结肠癌危险因素的病例对照研究
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摘要
目的：探讨结肠癌发生的主要危险因素，为制定结肠癌的防制措施提供科学依据。
方法：采用以医院为基础的1：1配对病例-对照研究方法，选择2006年5月1日～2007年9月1日期间入住中南大学湘雅医院、湘雅二医院、湘雅三医院经病理切片确诊的新发结肠癌病人作为病例，选择性别相同、年龄相差3岁以内，同期住院的非癌症病人作为对照，对研究对象进行问卷调查，内容包括：一般情况、生活饮食习惯、疾病史、家族恶性肿瘤史等。采用配对四格表χ~2检验和条件logistic回归对资料进行单因素及多因素分析，计算比值比((?)值)及OR值的95％可信区间(95％CI)。
结果：单因素分析结果表明：文化程度低(χ~2=8．791，P=0．003)、职业为农民(χ~2=4．914，P=0．027)、收入水平低(χ~2=8．594，P=0．003)、不经常锻炼(χ~2=11．571，P=0．001)、常处于坐位状态(χ~2=10．983，P=0．001)、便秘(χ~2=7．321，P=0．007)、蔬菜摄入频率较低(8～13次／周χ~2=4．648，P=0．043；≤7次／周χ~2=28．372，P=0．000)、家畜肉摄入频率较高(χ~2=4．366，P=0．037)、口味偏咸(χ~2=6．195，P=0．013)、食用油以动物油为主(χ~2=15．284，P=0．000)、动物内脏摄入频率高(χ~2=20．645，P=0．000)、胃肠溃疡史(χ~2=4．654，P<0．05)、胆囊疾病史(χ~2=5．565，P=0．018)、阑尾炎史(χ~2=13．885，P<0．01)、一级亲属恶性肿瘤史(χ~2=13．829，P<0．01)与结肠癌的发病有关；而吸烟史(χ~2=1．221，P=0．267)、饮酒史(χ~2=0．860，P=0．354)、吃槟榔(χ~2=2．064，P>0．10)和腌菜酱菜(χ~2=3．571，P=0．059)等则与结肠癌的发病无关。多因素条件logistic回归分析结果显示：家畜肉摄入频率较高((?)=2．854，95％CI：1．269-6．419)，动物内脏摄入过多((?)=2．869，95％CI：1．364～6．034)，蔬菜摄入频率过低((?)=4．663，95％CI：2．049～10．661)、不经常锻炼((?)=4．480，95％CI：1．602～12．524)、常处于坐位状态((?)=6．110，95％CI：2．774～13．457)、食用油以动物油为主((?)=6．378，95％CI：2．716～14．981)、阑尾炎史((?)=8．338，95％CI：1．237～56．215)、一级亲属恶性肿瘤史((?)=15．833，95％CI：2．653～95．090)是结肠癌发病的危险因素。
结论：蔬菜摄入频率过低、家畜肉和动物内脏摄入频率过高、缺乏锻炼、常处于坐位状态、食用油以动物油为主、阑尾炎史、一级亲属恶性肿瘤史是结肠癌发病的危险因素。吸烟、饮酒、吃槟榔、腌菜酱菜等因素与结肠癌发病无关联。
Objective: To explore the major risk factors of colonic cancer and provide a scientific basis for strategies of colonic cancer prevention.
Methods: A hospital-based 1:1 matched case-control study was adopted. 219 cases of colonic cancer that pathological diagnoised during May 1~(th),2006 and Sep 1~(th),2007 at the first, the second and the third affilfated hospital of XiangYa college were enrolled. Patients without colonic cancer or other cancer, however have the same gender, the same age (differ within 3 years) and receiving treatment at the same hospital as cases were selected as controls. Face-to-face interviews were carried out and the investigation involved the life style ,dietary habits, history of diseases and family history of cancer. Matched Chi-square test and conditioned logistic regression model were used for univariate andmultivariate analysis to estimate odds ratios (?) and the 95% confidence interval (95%C1).
Results: Univariate analysis showed that colonic cancer was associated with low education level (χ~2=8.791 ,P=0.003 ), peasantry (χ~2=4.914,P=0.027), low-income levels (χ~2=8.594,P=0.003), lack of exercise (χ~2=11.571,P=0.001), sedentary lifestyle (χ~2=10.983,P=0.001)、constipation (χ~2=7.321,P=0.007), low vegetable intake (8-13times /week:χ~2=4.648,P<0.043;≤7 times/week:χ~2=28.372,P=0.000), high meat intake (χ~2=4.366,P=0.037), high-salty foods intakes (χ~2=6.195, P=0.013), animal fats used cooking oil (χ~2=15.284,P=0.000), high animal bowels intake (χ~2=20.645,P=0.000), history of gastric and intestinal ulcer (χ~2=4.654,P<0.05), history of cystic disease (χ~2=5.565, P=0.018), history of appendicitis (χ~2=13.885,P<0.01), cancer history in the first degree relatives (χ~2=13.829,P<0.01) . Meanwhile, colonic cancer was not associated with smoking (χ~2=1.221, P=0.267), drinking (χ~2=0.860,P=0.354), areca (χ~2=2.064,P>0.10) and pickle (χ~2=3.571, P=0.059) . Multivariate logistic regression analysis showed that high meat intake((?)=2.854,95%CI: 1.269-6.419), high animal bowels intake ((?)=2.869, 95%CI: 1.364-6.034), low vegetable intake ((?)=4.663, 95%CI:2.049-10.661), lack of exercise ((?) =4.480, 95 %CI:1.602-12.524), sedentary lifestyle((?) =6.110, 95%CI: 2.774 -13.457), animal fats used cooking oil ((?)=6.378, 95%CI: 2.716- 14.981), history of appendicitis ((?)=8.338, 95%CI:1.237-56.215), cancer history of first degree relatives ((?)=15.833, 95%C7: 2.653-95.090) were the risk factors of colonic cancer.
Conclusion: Colonic cancer could be affected by multi-factors, including low vegetable intake, high meat and animal bowels intake, lack of exercise, sedentary lifestyle, animal fats used cooking oil, history of appendicitis and cancer history in the first degree relatives. Meanwhile, colonic cancer was not associated with smoking, drinking, areca and pickle.
方法：采用以医院为基础的1：1配对病例-对照研究方法，选择2006年5月1日～2007年9月1日期间入住中南大学湘雅医院、湘雅二医院、湘雅三医院经病理切片确诊的新发结肠癌病人作为病例，选择性别相同、年龄相差3岁以内，同期住院的非癌症病人作为对照，对研究对象进行问卷调查，内容包括：一般情况、生活饮食习惯、疾病史、家族恶性肿瘤史等。采用配对四格表χ~2检验和条件logistic回归对资料进行单因素及多因素分析，计算比值比((?)值)及OR值的95％可信区间(95％CI)。
结果：单因素分析结果表明：文化程度低(χ~2=8．791，P=0．003)、职业为农民(χ~2=4．914，P=0．027)、收入水平低(χ~2=8．594，P=0．003)、不经常锻炼(χ~2=11．571，P=0．001)、常处于坐位状态(χ~2=10．983，P=0．001)、便秘(χ~2=7．321，P=0．007)、蔬菜摄入频率较低(8～13次／周χ~2=4．648，P=0．043；≤7次／周χ~2=28．372，P=0．000)、家畜肉摄入频率较高(χ~2=4．366，P=0．037)、口味偏咸(χ~2=6．195，P=0．013)、食用油以动物油为主(χ~2=15．284，P=0．000)、动物内脏摄入频率高(χ~2=20．645，P=0．000)、胃肠溃疡史(χ~2=4．654，P<0．05)、胆囊疾病史(χ~2=5．565，P=0．018)、阑尾炎史(χ~2=13．885，P<0．01)、一级亲属恶性肿瘤史(χ~2=13．829，P<0．01)与结肠癌的发病有关；而吸烟史(χ~2=1．221，P=0．267)、饮酒史(χ~2=0．860，P=0．354)、吃槟榔(χ~2=2．064，P>0．10)和腌菜酱菜(χ~2=3．571，P=0．059)等则与结肠癌的发病无关。多因素条件logistic回归分析结果显示：家畜肉摄入频率较高((?)=2．854，95％CI：1．269-6．419)，动物内脏摄入过多((?)=2．869，95％CI：1．364～6．034)，蔬菜摄入频率过低((?)=4．663，95％CI：2．049～10．661)、不经常锻炼((?)=4．480，95％CI：1．602～12．524)、常处于坐位状态((?)=6．110，95％CI：2．774～13．457)、食用油以动物油为主((?)=6．378，95％CI：2．716～14．981)、阑尾炎史((?)=8．338，95％CI：1．237～56．215)、一级亲属恶性肿瘤史((?)=15．833，95％CI：2．653～95．090)是结肠癌发病的危险因素。
结论：蔬菜摄入频率过低、家畜肉和动物内脏摄入频率过高、缺乏锻炼、常处于坐位状态、食用油以动物油为主、阑尾炎史、一级亲属恶性肿瘤史是结肠癌发病的危险因素。吸烟、饮酒、吃槟榔、腌菜酱菜等因素与结肠癌发病无关联。
Objective: To explore the major risk factors of colonic cancer and provide a scientific basis for strategies of colonic cancer prevention.
Methods: A hospital-based 1:1 matched case-control study was adopted. 219 cases of colonic cancer that pathological diagnoised during May 1~(th),2006 and Sep 1~(th),2007 at the first, the second and the third affilfated hospital of XiangYa college were enrolled. Patients without colonic cancer or other cancer, however have the same gender, the same age (differ within 3 years) and receiving treatment at the same hospital as cases were selected as controls. Face-to-face interviews were carried out and the investigation involved the life style ,dietary habits, history of diseases and family history of cancer. Matched Chi-square test and conditioned logistic regression model were used for univariate andmultivariate analysis to estimate odds ratios (?) and the 95% confidence interval (95%C1).
Results: Univariate analysis showed that colonic cancer was associated with low education level (χ~2=8.791 ,P=0.003 ), peasantry (χ~2=4.914,P=0.027), low-income levels (χ~2=8.594,P=0.003), lack of exercise (χ~2=11.571,P=0.001), sedentary lifestyle (χ~2=10.983,P=0.001)、constipation (χ~2=7.321,P=0.007), low vegetable intake (8-13times /week:χ~2=4.648,P<0.043;≤7 times/week:χ~2=28.372,P=0.000), high meat intake (χ~2=4.366,P=0.037), high-salty foods intakes (χ~2=6.195, P=0.013), animal fats used cooking oil (χ~2=15.284,P=0.000), high animal bowels intake (χ~2=20.645,P=0.000), history of gastric and intestinal ulcer (χ~2=4.654,P<0.05), history of cystic disease (χ~2=5.565, P=0.018), history of appendicitis (χ~2=13.885,P<0.01), cancer history in the first degree relatives (χ~2=13.829,P<0.01) . Meanwhile, colonic cancer was not associated with smoking (χ~2=1.221, P=0.267), drinking (χ~2=0.860,P=0.354), areca (χ~2=2.064,P>0.10) and pickle (χ~2=3.571, P=0.059) . Multivariate logistic regression analysis showed that high meat intake((?)=2.854,95%CI: 1.269-6.419), high animal bowels intake ((?)=2.869, 95%CI: 1.364-6.034), low vegetable intake ((?)=4.663, 95%CI:2.049-10.661), lack of exercise ((?) =4.480, 95 %CI:1.602-12.524), sedentary lifestyle((?) =6.110, 95%CI: 2.774 -13.457), animal fats used cooking oil ((?)=6.378, 95%CI: 2.716- 14.981), history of appendicitis ((?)=8.338, 95%CI:1.237-56.215), cancer history of first degree relatives ((?)=15.833, 95%C7: 2.653-95.090) were the risk factors of colonic cancer.
Conclusion: Colonic cancer could be affected by multi-factors, including low vegetable intake, high meat and animal bowels intake, lack of exercise, sedentary lifestyle, animal fats used cooking oil, history of appendicitis and cancer history in the first degree relatives. Meanwhile, colonic cancer was not associated with smoking, drinking, areca and pickle.
引文
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[1] WHO. Facts about cancer. Available t:http://www.who. int/mediacentre/factsheets/fs297. Accessed at: Sep 10,2007.
[2] American Cancer Society [Online]. Colorectal Cancer Facts and Figures- Special Edition 2005.
[3]郑树，蔡善荣．中国大肠癌的病因学及人群防治研究．中华肿瘤杂志， 2004，26(1)：1-3．
[4]戴颖秀，王建华，叶苗凉，等．上海市杨浦区1992年～2001年结肠癌流行特 征和趋势．中国肿瘤，2003，12(8)：452-454．
[5] Sheila A Bingham, Nicholas E Day, Robert Luben, et al. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. The Lancet,2003,361(9368):1496-1501.
[6] Ulrike Peters, Rashmi Sinha, Nilanjan Chatterjee,et al. Dietary fibre and colorectal adenoma in a colorectal cancer early detection programme. The Lancet, 2003, 361(9368):1491-1495.
[7] F. Levi, C. Pasche, F. Lucchinia, et al. Dietary fibre and the risk of colorectal cancer. European Journal of Cancer, 2001, 37(16): 2091-2096.
[8] Edward D. Gorham, Cedric F. Garland, Frank C. Garland, et al. Vitamin D and prevention of colorectal cancer. Journal of Steroid Biochemistry & Molecular Biology, 2005,97(1-2):179-194.
[9] L. Joseph SU, Lenore ARAB. Nutritional Status of Folate and Colon Cancer Risk: Evidence from NHANES I Epidemiologic Follow-up Study. Ann Epidemiol, 2001,11(1):65-72.
[10] Qinting Jiang, Kun Chen, Xinyuan Ma, et al. Diets, polymorphisms of methylenetetrahydrofolatereductase, and the susceptibility of colon cancer and rectal cancer. Cancer Detection and Prevention, 2005,29(2): 146-154.
[11] F. Levi, C. Pasche, F. Lucchini, et al. Selected micronutrients and colorectal cancer: a case-control study from the Canton of Vaud, Switzerland. European Journal of Cancer, 2000, 36(16):2115-2119.
[12]周伦，鱼达，余海，等．饮用水源中的微囊藻毒素与大肠癌发病的关系．中 华预防医学杂志，2000，34(4)：224-226．
[13]陈坤，俞维萍，马新源，等．饮水类型与结直肠癌发病率关系的前瞻性队 列研究．Chinese Journal of Cancer，2004，23(5)：550-554．
[14]陈坤，裘炯良，张扬．大肠癌危险因素的Meta分析．浙江大学学报(医 学版)，2002，31(4)：254-258．
[15]聂绍发，姚璇，朱桂宝，等．武汉市大肠癌危险因素的1：2配比病例对照 研究．中国公共卫生，2002，18(12)：1482-1484．
[16] Alicia Navarro, Maria P. Diaz, Sonia E. Munoz, et al.Characterization of Meat Consumption and Risk of Colorectal Cancerin Cordoba, Argentina. Nutrition,2003,19(1):7-10.
[17] D. W. Voskuil, E. Kampman, M. J. A. L. Grubben,et al. Meat consumptionand meat preparation in relation to colorectal adenomas amongsporadic and HNPCC family patients in The Netherlands. EuropeanJournal of Cancer, 2002,38(17):2300-2308.
[18] Martha L. Slattery, Sandra L. Edwards, KHE NI MA, et al.PhysicalActivity and Colon Cancer: A Public Health Perspective.AEP, 1997, 7(2): 137-145.
[19]马恒太，余佩武，葛海燕，等．体力活动对结直肠癌发病影响的重庆地区 大样本病例2对照研究．第三军医大学学报，2005，27(22)：2276-2279．
[20]温素莲，张晓慧．大肠肿瘤与体力活动关系的病例对照研究．海南医学，2006， 17(4)：21-22．
[21] Tetsuya Mizoue, Manami Inoue, Keitaro Tanaka,et al. Tobacco Smoking and Colorectal Cancer Risk: An Evaluation Based on a Systematic Review of Epidemiologic Evidence among the Japanese Population. Jpn J Clin Oncol, 2006, 36(1):25-39.
[22] Barbara D Avanzo, Carlo La Vecchia, Silvia Franceschi, et al.Cigarette Smoking and Colorectal Cancer: A Study of 1, 584 Cases and 2,879 Controls. Preventive Medicine, 1995,24(6):571-579.
[23] Brian C. -H. CHIU, Charles F. LYNCH, James R. CERHAN, et al. Cigarette Smoking and Risk of Bladder, Pancreas, Kidney, and Colorectal Cancers in Iowa. AEP, 2001,11(1):28-37.
[24]朱丽萍，梅家模，赵军，等．江西省308例大肠癌危险因素的病例对照研 究．中国慢性病预防与控制，2001，9(3)：117-118．
[25]汪祥辉，雷通海，马新源，等．结肠癌危险因素的病例对照研究．癌症，2001， 20(9)：977-980．
[26] T. Watanabe, N. Nakaya, K. Kurashima, et al. Constipation, laxativeuse and risk of colorectal cancer: The Miyagi Cohort Study. EuropeanJournal of Cancer, 2004,40(14):2109-2115.
[27] Kari Hemminki, Bowang Chen. Familial association of colorectaladenocarCInoma with cancers at other sites. European Journal ofCancer, 2004,40(16):2480-2487.
[28] N. Andrieu, G. Launoy, R. Guillois, et al. Familial relative riskof colorectal cancer: a population-based study. European Journal ofCancer, 2003, 39(13): 1904-1911.
[29] Temitope 0. Keku, Robert C. Millikan, Chris Martin, et al. FamilyHistory of Colon Cancer What Does It Mean and How Is It Useful? AmJ Prev Med, 2003, 24(2): 170-176.
[30] Johan Askling, Paul W Dickman, Per Karlen, et al. Colorectal cancerrates among first-degree relatives of patients with inflammatorybowel disease:a population-based cohort study. Lancet, 2001,357 (9252): 262-266.
[31] H. Nakama , B. Zhang, K. Fukazawa, et al. Family history of colorectaladenomatous polyps as a risk factor for colorectal cancer. EuropeanJournal of Cancer, 2000, 36(16):2111-2114.
[32]陈功，万德森，潘志忠，等．广州市结肠癌危险因素的病例对照研究．癌症， 2001，20(10)：1086-1088．
[33]汪祥辉，雷通海，马新源，等．大肠癌高发区居民结肠癌危险因素研究．中 华肿瘤杂志，2001，23(6)：480-482．
[34]高雪芹，孙素玲，孙方利，等．非甾体类抗炎药对肠息肉及结、直肠癌保护 作用的病例对照研究．中华预防医学杂志，2002，36(5)：332-335．
[35] Til Sturmer, Julie E. Buring, I-Min Lee, et al. Colorectal cancer after start of onsteroidal anti-inflammatory drug use. The American Journal of Medicine, 2006,119(6), 494-502.
[36]王坚，施维锦，仇宗江．等．胆囊切除、胆囊结石与大肠癌．肝胆胰外科杂 志，1999，11(3)：114-115．
[37]黄杰安，沈志祥，于皆平．粪胆汁酸与大肠癌．国外医学内科学分册，1994， 21(5)：206-208．
[38]岳正学，蔡元坤，刘俊钧，等．上海闵行区胆囊结石与大肠癌相关性流行病学 调查．中华普通外科杂志，2001，16(6)：336-337．
[39]李军，张吉翔，李孟英，等．胆结石、胆囊切除术与大肠癌关系的探讨．江西 医学院学报，2003，43(6)：100-101．
[40]赵立明，张钧书，俞泳．胆囊结石胆囊切除与大肠癌关系．肿瘤学杂 志，2006，12(2)：151-152．
[41]陈坤，舒国通，马新源，等．阑尾炎史与结直肠癌发病关系的研究．浙江预 防医学，2004，16(3)：6-8．
[42]陈坤，舒国通，马新源，等．肠息肉与结直肠癌发病关系队列研究．中国公共 卫生，2004，20(2)：168-170．
[43] Francine Grodstein, Polly A. Newcomb, Meir J. Stampfer.Postmenopausal Hormone Therapy and the Risk ofColorectal Cancer: A Review andMeta-analysis. The American Journal of Medicine, 1999, 106(5): 574-582.
[44] Pamela M. Marcus, Polly A. Newcomb, Terry Young, et al. The Association of Reproductive and Menstrual Characteristics and Colon and Rectal Cancer Risk in Wisconsin Women. AEP, 1995, 5(4):303-309.
[45] K. A. Rosenblatt, D. Li. Gao, R. M. Ray, et al. Contraceptive methods and induced abortions and their association with the risk of colon cancer in Shanghai, China. European Journal of Cancer, 2004, 40 (4): 590-593.
[46] R. Talamini, S. Franceschi,L. Dal Maso, et al. The Influence of Reproductive and Hormonal Factors on the Risk of Colon and Rectal Cancer in Women. European Journal of Cancer, 1998, 34(7):1070-1076.
[2] WHO. Facts about cancer. Available at:http: //www.who. int/ mediacentre/factsheets/fs297. Accessed at: Sep 10,2007.
[3] American Cancer Society [Online]. Colorectal Cancer Facts and Figures -Special Edition 2005.
[4]郑树，蔡善荣．中国大肠癌的病因学及人群防治研究．中华肿瘤杂志，2004， 26(1)：1-3．
[5]戴颖秀，王建华，叶苗凉，等．上海市杨浦区1992年～2001年结肠癌流行特 征和趋势．中国肿瘤，2003，12(8)：452-454．
[6] Sheila A Bingham, Nicholas E Day, Robert Luben, et al. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. The Lancet, 2003, 361(9368):1496-1501.
[7] Ulrike Peters, Rashmi Sinha, Nilanjan Chatterjee,et al. Dietary fibre and colorectal adenoma in a colorectal cancer early detection programme. The Lancet, 2003, 361(9368):1491-1495.
[8] F. Levi, C. Pasche, F. Lucchinia, et al.Dietary fibre and the risk of colorectal cancer. European Journal of Cancer, 2001, 37(16): 2091-2096.
[9] L. Joseph Su, Lenore Arab. Nutritional Status of Folate and Colon Cancer Risk: Evidence from NHANES I Epidemiologic Follow-up Study. Ann Epidemiol, 2001,11(1): 65-72.
[10] F. Levi, C. Pasche, F. Lucchini, et al. Selected micronutrients and colorectal cancer: a case-control study from the Canton of Vaud, Switzerland. European Journal of Cancer, 2000, 36(16):2115-2119.
[11] Marthal. Slattery, Sandral. Edwards, Kneni Ma, et al.Physical Activity and Colon Cancer: A Public Health Perspective. AEP, 1997, 7(2): 137-145.
[12] T. Watanabe, N. Nakaya, K. Kurashima, et al. Constipation, laxative use and risk of colorectal cancer: The Miyagi Cohort Study. European Journal of Cancer, 2004, 40(14) :2109-2115.
[13] K. A. Rosenblatt, D. Li. Gao, R. M. Ray, et al. Contraceptive methods??and induced abortions and their association with the risk of coloncancer in Shanghai, China. European Journal of Cancer,2004,40 (4):590-593.
[14] Kari Hemminki, Bowang Chen. Familial association of colorectaladenocarcinoma with cancers at other sites. European Journal ofCancer, 2004, 40(16):2480-2487.
[15] N. Andrieu, G. Launoy, R. Guillois, et al. Familial relative riskof colorectal cancer: a population-based study. European Journal ofCancer, 2003, 39(13):1904-1911.
[16] Temitope 0. Keku, Robert C. Millikan, Chris Martin, et al. Familyhistory of colon cancer what does it mean and how is it useful? AmJ Prev Med, 2003, 24(2):170-176.
[17]陈坤，裘炯良，张扬．大肠癌危险因素的Meta分析．浙江大学学报(医 学版)，2002，31(4)：254-258．
[18] Qinting Jiang, Kun Chen, Xinyuan Ma, et al. Diets, polymorphisms of Methylenetetrahydrofolate reductase, and the susceptibility of colon cancer and rectal cancer. Cancer Detection and Prevention, 2005,29(2):146-154.
[19]聂绍发，姚璇，朱桂宝，等．武汉市大肠癌危险因素的1：2配比病例对照 研究．中国公共卫生，2002，18(12)：1482-1484．
[20]刘爱忠，谭红专，王洁如，等．153对大肠癌危险因素的配对病例对照研究． 中国公共卫生，1997，13(4)：206-207．
[21]陈功，万德森，潘志忠，等．广州市结肠癌危险因素的病例对照研究．癌症， 2001，20(10)：1086-1088．
[22]岳正学，蔡元坤，刘俊钧，等．上海闵行区胆囊结石与大肠癌相关性流行病学 调查．中华普通外科杂志，2001，16(6)：336-337．
[23]李军，张吉翔，李孟英，等．胆结石、胆囊切除术与大肠癌关系的探讨．江西 医学院学报，2003，43(6)：100-101．
[24]赵立明，张钧书，俞泳．胆囊结石胆囊切除与大肠癌关系．肿瘤学杂 志，2006，12(2)：151-152．
[25]陈坤，舒国通，马新源，等．阑尾炎史与结直肠癌发病关系的研究．浙江预 防医学，2004，16(3)：6-8．
[26] Tetsuya Mizoue, Manami Inoue, Keitaro Tanaka,et al. Tobacco smoking and colorectal cancer risk: an evaluation based on a systematic??review of epidemiologic evidence among the japanese population. JpnJ Clin Oncol, 2006, 36(1):25-39.
[27] Barbara D Avanzo, Carlo La Vecchia, Silvia Franceschi, et al.Cigarette Smoking and Colorectal Cancer: A Study of 1, 584 Cases and2,879 Controls. Preventive Medicine, 1995, 24(6):571-579.
[28] Brinn C. -H. Chiu, Charles F. Lynch, James R. Cerhan, et al. CigaretteSmoking and Risk of Bladder, Pancreas, Kidney, and Colorectal Cancersin Iowa. AEP, 2001,11(1):28-37.
[29]朱丽萍，梅家模，赵军，等．江西省308例大肠癌危险因素的病例对照研 究．中国慢性病预防与控制，2001，9(3)：117-118．
[30]汪祥辉，雷通海，马新源，等．结肠癌危险因素的病例对照研究．癌症， 2001，20(9)：977-980．
[31]熊甲英，申道君，朱飞跃．娄底市大肠癌高危因素临床流行病学研究．中国 医师杂志，2002，4(4)：389-391．
[32]魏艳静，卞红磊．便秘的国内流行病学研究进展．疾病控制杂 志，2004，8(5)：449-451．
[33]李立明．流行病学．第五版．北京：人民卫生出版社，2004．92．
[34] Thompson WG, Longstreth GF,Drossman DA, et al. Functional bowel disorder and functional abdominal pain. Gut, 1999,45(s12): 1143-1147.
[35]姚璇，聂绍发，魏善波，等．武汉市大肠癌危险因素的病例对照研究． 疾病控制杂志，2001，5(2)：118-120．
[36] Alicia Navarro, Maria P. Diaz, Sonia E. Munoz, et al.Characterization of Meat Consumption and Risk of Colorectal Cancer in Cordoba, Argentina. Nutrition, 2003,19(1):7-10.
[37] D. W. Voskuil, E. Kampman, M. J. A. L. Grubben, et al. Meat consumption and meat preparation in relation to colorectal adenomas among sporadic and HNPCC family patients in the Netherlands. European Journal of Cancer, 2002, 38(17):2300-2308.
[38]王坚，施维锦，仇宗江，等．胆囊切除、胆囊结石与大肠癌．肝胆胰外科杂 志，1999，11(3)：114-115．
[39]黄杰安，沈志祥，于皆平．粪胆汁酸与大肠癌．国外医学内科学分册，1994， 21(5)：206-208．
[40] Johan Askling, Paul W Dickman, Per Karlen, et al. Colorectal cancer??rates among first-degree relatives of patients with inflammatory bowel disease:a population-based cohort study. Lancet,2001, 357 (9252): 262-266.
[41]汪祥辉，雷通海，马新源，等．大肠癌高发区居民结肠癌危险因素研究．中 华肿瘤杂志，2001，23(6)：480-482．
[1] WHO. Facts about cancer. Available t:http://www.who. int/mediacentre/factsheets/fs297. Accessed at: Sep 10,2007.
[2] American Cancer Society [Online]. Colorectal Cancer Facts and Figures- Special Edition 2005.
[3]郑树，蔡善荣．中国大肠癌的病因学及人群防治研究．中华肿瘤杂志， 2004，26(1)：1-3．
[4]戴颖秀，王建华，叶苗凉，等．上海市杨浦区1992年～2001年结肠癌流行特 征和趋势．中国肿瘤，2003，12(8)：452-454．
[5] Sheila A Bingham, Nicholas E Day, Robert Luben, et al. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. The Lancet,2003,361(9368):1496-1501.
[6] Ulrike Peters, Rashmi Sinha, Nilanjan Chatterjee,et al. Dietary fibre and colorectal adenoma in a colorectal cancer early detection programme. The Lancet, 2003, 361(9368):1491-1495.
[7] F. Levi, C. Pasche, F. Lucchinia, et al. Dietary fibre and the risk of colorectal cancer. European Journal of Cancer, 2001, 37(16): 2091-2096.
[8] Edward D. Gorham, Cedric F. Garland, Frank C. Garland, et al. Vitamin D and prevention of colorectal cancer. Journal of Steroid Biochemistry & Molecular Biology, 2005,97(1-2):179-194.
[9] L. Joseph SU, Lenore ARAB. Nutritional Status of Folate and Colon Cancer Risk: Evidence from NHANES I Epidemiologic Follow-up Study. Ann Epidemiol, 2001,11(1):65-72.
[10] Qinting Jiang, Kun Chen, Xinyuan Ma, et al. Diets, polymorphisms of methylenetetrahydrofolatereductase, and the susceptibility of colon cancer and rectal cancer. Cancer Detection and Prevention, 2005,29(2): 146-154.
[11] F. Levi, C. Pasche, F. Lucchini, et al. Selected micronutrients and colorectal cancer: a case-control study from the Canton of Vaud, Switzerland. European Journal of Cancer, 2000, 36(16):2115-2119.
[12]周伦，鱼达，余海，等．饮用水源中的微囊藻毒素与大肠癌发病的关系．中 华预防医学杂志，2000，34(4)：224-226．
[13]陈坤，俞维萍，马新源，等．饮水类型与结直肠癌发病率关系的前瞻性队 列研究．Chinese Journal of Cancer，2004，23(5)：550-554．
[14]陈坤，裘炯良，张扬．大肠癌危险因素的Meta分析．浙江大学学报(医 学版)，2002，31(4)：254-258．
[15]聂绍发，姚璇，朱桂宝，等．武汉市大肠癌危险因素的1：2配比病例对照 研究．中国公共卫生，2002，18(12)：1482-1484．
[16] Alicia Navarro, Maria P. Diaz, Sonia E. Munoz, et al.Characterization of Meat Consumption and Risk of Colorectal Cancerin Cordoba, Argentina. Nutrition,2003,19(1):7-10.
[17] D. W. Voskuil, E. Kampman, M. J. A. L. Grubben,et al. Meat consumptionand meat preparation in relation to colorectal adenomas amongsporadic and HNPCC family patients in The Netherlands. EuropeanJournal of Cancer, 2002,38(17):2300-2308.
[18] Martha L. Slattery, Sandra L. Edwards, KHE NI MA, et al.PhysicalActivity and Colon Cancer: A Public Health Perspective.AEP, 1997, 7(2): 137-145.
[19]马恒太，余佩武，葛海燕，等．体力活动对结直肠癌发病影响的重庆地区 大样本病例2对照研究．第三军医大学学报，2005，27(22)：2276-2279．
[20]温素莲，张晓慧．大肠肿瘤与体力活动关系的病例对照研究．海南医学，2006， 17(4)：21-22．
[21] Tetsuya Mizoue, Manami Inoue, Keitaro Tanaka,et al. Tobacco Smoking and Colorectal Cancer Risk: An Evaluation Based on a Systematic Review of Epidemiologic Evidence among the Japanese Population. Jpn J Clin Oncol, 2006, 36(1):25-39.
[22] Barbara D Avanzo, Carlo La Vecchia, Silvia Franceschi, et al.Cigarette Smoking and Colorectal Cancer: A Study of 1, 584 Cases and 2,879 Controls. Preventive Medicine, 1995,24(6):571-579.
[23] Brian C. -H. CHIU, Charles F. LYNCH, James R. CERHAN, et al. Cigarette Smoking and Risk of Bladder, Pancreas, Kidney, and Colorectal Cancers in Iowa. AEP, 2001,11(1):28-37.
[24]朱丽萍，梅家模，赵军，等．江西省308例大肠癌危险因素的病例对照研 究．中国慢性病预防与控制，2001，9(3)：117-118．
[25]汪祥辉，雷通海，马新源，等．结肠癌危险因素的病例对照研究．癌症，2001， 20(9)：977-980．
[26] T. Watanabe, N. Nakaya, K. Kurashima, et al. Constipation, laxativeuse and risk of colorectal cancer: The Miyagi Cohort Study. EuropeanJournal of Cancer, 2004,40(14):2109-2115.
[27] Kari Hemminki, Bowang Chen. Familial association of colorectaladenocarCInoma with cancers at other sites. European Journal ofCancer, 2004,40(16):2480-2487.
[28] N. Andrieu, G. Launoy, R. Guillois, et al. Familial relative riskof colorectal cancer: a population-based study. European Journal ofCancer, 2003, 39(13): 1904-1911.
[29] Temitope 0. Keku, Robert C. Millikan, Chris Martin, et al. FamilyHistory of Colon Cancer What Does It Mean and How Is It Useful? AmJ Prev Med, 2003, 24(2): 170-176.
[30] Johan Askling, Paul W Dickman, Per Karlen, et al. Colorectal cancerrates among first-degree relatives of patients with inflammatorybowel disease:a population-based cohort study. Lancet, 2001,357 (9252): 262-266.
[31] H. Nakama , B. Zhang, K. Fukazawa, et al. Family history of colorectaladenomatous polyps as a risk factor for colorectal cancer. EuropeanJournal of Cancer, 2000, 36(16):2111-2114.
[32]陈功，万德森，潘志忠，等．广州市结肠癌危险因素的病例对照研究．癌症， 2001，20(10)：1086-1088．
[33]汪祥辉，雷通海，马新源，等．大肠癌高发区居民结肠癌危险因素研究．中 华肿瘤杂志，2001，23(6)：480-482．
[34]高雪芹，孙素玲，孙方利，等．非甾体类抗炎药对肠息肉及结、直肠癌保护 作用的病例对照研究．中华预防医学杂志，2002，36(5)：332-335．
[35] Til Sturmer, Julie E. Buring, I-Min Lee, et al. Colorectal cancer after start of onsteroidal anti-inflammatory drug use. The American Journal of Medicine, 2006,119(6), 494-502.
[36]王坚，施维锦，仇宗江．等．胆囊切除、胆囊结石与大肠癌．肝胆胰外科杂 志，1999，11(3)：114-115．
[37]黄杰安，沈志祥，于皆平．粪胆汁酸与大肠癌．国外医学内科学分册，1994， 21(5)：206-208．
[38]岳正学，蔡元坤，刘俊钧，等．上海闵行区胆囊结石与大肠癌相关性流行病学 调查．中华普通外科杂志，2001，16(6)：336-337．
[39]李军，张吉翔，李孟英，等．胆结石、胆囊切除术与大肠癌关系的探讨．江西 医学院学报，2003，43(6)：100-101．
[40]赵立明，张钧书，俞泳．胆囊结石胆囊切除与大肠癌关系．肿瘤学杂 志，2006，12(2)：151-152．
[41]陈坤，舒国通，马新源，等．阑尾炎史与结直肠癌发病关系的研究．浙江预 防医学，2004，16(3)：6-8．
[42]陈坤，舒国通，马新源，等．肠息肉与结直肠癌发病关系队列研究．中国公共 卫生，2004，20(2)：168-170．
[43] Francine Grodstein, Polly A. Newcomb, Meir J. Stampfer.Postmenopausal Hormone Therapy and the Risk ofColorectal Cancer: A Review andMeta-analysis. The American Journal of Medicine, 1999, 106(5): 574-582.
[44] Pamela M. Marcus, Polly A. Newcomb, Terry Young, et al. The Association of Reproductive and Menstrual Characteristics and Colon and Rectal Cancer Risk in Wisconsin Women. AEP, 1995, 5(4):303-309.
[45] K. A. Rosenblatt, D. Li. Gao, R. M. Ray, et al. Contraceptive methods and induced abortions and their association with the risk of colon cancer in Shanghai, China. European Journal of Cancer, 2004, 40 (4): 590-593.
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