摘要
目的探讨不同体质量指数(BMI)与消化系统肿瘤发病的关系。方法采用回顾性队列研究方法。收集2006年7月至2015年12月由华北理工大学附属开滦总医院、开滦林西医院、开滦赵各庄医院、开滦唐家庄医院、开滦范各庄医院、开滦荆各庄医院、开滦吕家坨医院、开滦林南仓医院、开滦钱家营医院、开滦马家沟医院、开滦医院分院行健康体检的95177例受试者的体检资料;男75909例,女19268例;年龄为(51±12)岁,年龄范围为18~98岁。依据《中国成人超重和肥胖症预防与控制指南(节录)》对BMI范围的定义将受试者分为3组:37660例受试者BMI<24kg/m^2设为正常体质量组,39793例受试者24kg/m2≤BMI<28kg/m^2设为超重组,17724例受试者BMI≥28kg/m^2设为肥胖组。由固定医师团队于2006、2008、2010、2012、2014年在相同地点按相同健康体检顺序对受试者进行5次健康体检。收集流行病学调查内容、人体测量学指标、生化指标。观察指标:(1)3组受试者的临床特征比较。(2)受试者消化系统肿瘤的发病情况。(3)影响受试者新发消化系统肿瘤的危险因素分析。(4)BMI对新发消化系统肿瘤模型拟合优度的比较。(5)影响受试者不同部位消化系统肿瘤的危险因素分层分析。正态分布的计量资料以Mean±SD表示,多组间比较采用单因素方差分析。偏态分布的计量资料采用M(范围)表示,多组间比较采用秩和检验(Kruskal-Wallis)。计数资料用例数和百分比表示,组间比较采用χ^2检验。采用Kaplan-Meier法计算累积发病率并绘制发病曲线,累积发病率的组间比较采用Log-rank检验。采用人年发病率(发病密度)计算不同BMI受试者消化系统肿瘤的发病情况。采用COX比例风险模型分析不同BMI水平(连续变量和分类变量)对新发消化系统肿瘤的风险比(HR)和95%可信区间。使用限制性立方样条曲线(RCS)计算连续变化的BMI和消化系统肿瘤发病风险的计量反应关系。使用似然比检验和赤池信息量准则(AIC)计算BMI对新发消化系统肿瘤模型拟合情况的影响。结果(1)3组受试者的临床特征比较:正常体质量组受试者年龄、男性、收缩压、舒张压、腰围、总胆固醇、甘油三酯、空腹血糖、C反应蛋白、吸烟、饮酒、体育锻炼、乙型肝炎病毒表面抗原阳性、高食盐摄入、直系亲属恶性肿瘤病史例数分别为(51±13)岁、28607例、(125±20)mmHg(1mmHg=0.133kPa)、(80±11)mmHg、(81±9)cm、(4.9±1.1)mmol/L、1.05mmol/L(0.75~1.49mmol/L)、(5.3±1.6)mmol/L、0.58mmol/L(0.20~1.60mmol/L)、11962例、6845例、5676例、711例、3640例、1298例;超重组分别为(52±12)岁、32928例、(133±21)mmHg、(85±11)mmHg、(89±8)cm、(5.0±1.2)mmol/L、1.39mmol/L(0.99~2.08mmol/L)、(5.6±1.7)mmol/L、0.84mmol/L(0.33~2.07mmol/L)、12364例、7413例、6322例、839例、4401例、1463例;肥胖组分别为(51±12)岁、14374例、(139±21)mmHg、(88±12)mmHg、(96±9)cm、(5.1±1.2)mmol/L、1.67mmol/L(1.18~2.51mmol/L)、(5.7±1.8)mmol/L、1.22mmol/L(0.53~2.82mmol/L)、5092例、2818例、2847例、355例、2235例、704例;3组上述指标比较,差异均有统计学意义(F=90.60,χ^2=576.34,F=2768.38,3570.80,22319.30,256.99,χ^2=9108.21,F=507.11,χ^2=3219.47,52.78,64.38,13.36,0.76,130.39,9.74,P<0.05)。(2)受试者消化系统肿瘤的发病情况:95177例受试者总随访时间为845085人年,共有新发消化系统肿瘤1215例,消化系统肿瘤总人年发病率为1.44千人/年。1215例患者中,结直肠肛管癌413例、肝癌306例、胃癌234例、食管癌113例、胰腺癌91例、胆囊癌和胆管癌36例、小肠癌25例。3例患者同时合并小肠癌和结直肠肛管癌。正常体质量组、超重组、肥胖组受试者消化系统肿瘤的人年发病率分别为1.46千人/年、1.37千人/年和1.53千人/年;累积发病率分别为11.8‰、10.1‰和12.1‰,3组累积发病率比较,差异有统计学意义(χ^2=6.13,P<0.05)。正常体质量组与肥胖组受试者的累积发病率比较,差异无统计学意义(χ^2=1.07,P>0.05);超重组分别与正常体质量组和肥胖组受试者的累积发病率比较,差异均有统计学意义(χ^2=3.90,4.10,P<0.05)。(3)影响受试者新发消化系统肿瘤的危险因素分析,COX比例风险模型分析结果显示:校正受试者年龄、性别、收缩压、总胆固醇、甘油三酯、空腹血糖、吸烟、饮酒、体育锻炼、乙型肝炎病毒表面抗原阳性、高食盐摄入、直系亲属恶性肿瘤病史及兄弟姐妹恶性肿瘤病史后,连续变化的BMI不是影响新发消化系统肿瘤的因素(HR=0.99,95%可信区间为0.98~1.01,P>0.05);当BMI以分类变量带入COX模型中,与正常体质量组比较,超重组受试者患消化系统肿瘤的风险降低(HR=0.88,0.88,95%可信区间为0.78~1.01,0.77~0.98,P<0.05),肥胖组受试者患消化系统肿瘤的风险不受影响(HR=1.03,1.04,95%可信区间为0.88~1.20,0.89~1.22,P>0.05)。限制性立方样条曲线结果显示:BMI与消化系统肿瘤的发病风险呈“U”型曲线关系,BMI为25~27kg/m^2时消化系统肿瘤发病风险最低。(4)BMI对新发消化系统肿瘤模型拟合优度的比较:建立多因素模型,将年龄、性别、收缩压、总胆固醇、甘油三酯、空腹血糖、吸烟、饮酒、体育锻炼、乙型肝炎病毒表面抗原阳性、高食盐摄入、直系亲属恶性肿瘤病史及兄弟姐妹恶性肿瘤病史因素带入模型中,计算此模型的-2LogL值和AIC值,分别为27175.05和27203.05。再将BMI变量带入多因素模型中,以正常体质量组为对照组,计算多因素模型+BMI模型的-2LogL值和AIC值,分别为27169.53和27201.53,差异有统计学意义(χ^2=5.52,P<0.05)。(5)影响受试者不同部位消化系统肿瘤的危险因素分层分析,COX比例风险模型分层分析结果显示:食管癌模型中,与正常体质量组比较,超重组和肥胖组受试者食管癌发病风险均降低(HR=0.57,0.42,95%可信区间为0.38~0.84,0.23~0.79,P<0.05)。肝癌模型中,与正常体质量组比较,超重组受试者肝癌发病风险降低(HR=0.72,95%可信区间为0.55~0.93,P<0.05);肥胖组受试者肝癌发病风险不受影响(HR=1.10,95%可信区间为0.82~1.47,P>0.05)。结论超重组受试者消化系统肿瘤发病率最低,尤其是食管癌和肝癌;当BMI为25~27kg/m^2时消化系统肿瘤发病风险最低。
ObjectiveTo explore the correlation between different body mass indexes and incidence of digestive carcinoma. MethodsThe retrospective cohort study was conducted. The data of 95 177 participants (75 909 males and 19 268 females) aged (51±12)years with the range of 18-98 years who participated health examination at the Kailuan General Hospital, Kailuan Linxi Hospital, Kailuan Zhaogezhuang Hospital, Kailuan Tangjiazhuang Hospital, Kailuan Fan′gezhuang Hospital,Kailuan Jinggezhuang Hospital, Kailuan Lyujiatuo Hospital, Kailuan Linnancang Hospital, Kailuan Qianjiaying Hospital, Kailuan Majiagou Hospital and Kailuan Branch Hospital from July 2006 to December 2015 were collected. According to definition of body mass indexes from Chinese guideline for prevention and control of adult overweight and obesity, all the 95 177 participants were allocated into the 3 groups, including 37 660 with BMI<24 kg/m^2 in the normal BMI group, 39 793 with with 24 kg/m^2≤BMI<28 kg/m^2 in the overweight group and 17 724 with BMI≥28 kg/m^2 in the obesity group. All participants received the same-order health examinations by the fixed team of doctors in 2006, 2008, 2010, 2012 and 2014 at the same place. Epidemiological investigation, anthropometric parameters and biochemical indicators were collected. Observation indicators: (1) comparisons of clinical characteristics among the 3 groups;(2) incidence of digestive carcinoma in the participants;(3) risk factors analysis affecting new-onset digestive carcinoma;(4) comparisons of the fitting degree of BMI on new-onset digestive carcinoma model;(5) stratified analysis of risk factors affecting new-onset digestive carcinoma at different locations. Measurement data with normal distribution were represented as Mean±SD, and comparisons among groups were analyzed using the one-way ANOVA. Measurement data with skewed distribution were described as M (range), and comparisons among groups were analyzed using the Kruskal-Wallis test. Count data were described as case number and percentage, and comparisons among groups were analyzed using the chi-square test. The cumulative incidence was calculated by the Kaplan-Meier method, and comparisons of incidences among groups were done by the Log-rank test. The incidences of digestive carcinoma in patients with different BMI were calculated by person-year incidence (incidence density). The hazard ratio (HR) and 95% confidence interval (CI) of different BMI (continuous variable and classification variable) on new-onset digestive carcinoma were estimated by the COX proportional hazards regression models. Restrictive cubic spline regression was used to calculate the dose-response relation between the continuous variable and the risks of digestive carcinoma. The fitting degree of BMI on new-onset digestive carcinoma model was calculated by the likelihood ratio test and akaike information criterion (AIC). Results(1) Comparisons of clinical characteristics among the 3 groups: age, sex (male), systolic pressure, diastolic pressure, waistline, total cholesterol (TC), triglyceride (TG), fasting plasma glucose (FPG), C reactive protein, cases with smoking, drinking, physical exercise, positive HBsAg, high salt intake, malignant tumor in immediate family were (51±13)yeas, 28 607, (125±20)mmHg (1 mmHg=0.133 kPa), (80±11)mmHg, (81±9)cm, (4.9±1.1)mmol/L, 1.05 mmol/L (range, 0.75-1.49 mmol/L), (5.3±1.6) mmol/L, 0.58 mmol/L (range, 0.20-1.60 mmol/L), 11 962, 6 845, 5 676, 711, 3 640, 1 298 in the normal BMI group and (52±12)years, 32 928, (133±21) mmHg, (85±11) mmHg, (89±8)cm, (5.0±1.2)mmol/L, 1.39 mmol/L (range, 0.99-2.08 mmol/L), (5.6±1.7)mmol/L, 0.84 mmol/L (range, 0.33-2.07 mmol/L), 12 364, 7 413, 6 322, 839, 4 401, 1 463 in the overweight group and (51±12)years, 14 374, (139±21)mmHg, (88±12)mmHg, (96±9)cm, (5.1±1.2)mmol/L, 1.67 mmol/L (range, 1.18-2.51 mmol/L), (5.7±1.8)mmol/L, 1.22 mmol/L (range, 0.53-2.82 mmol/L), 5 092, 2 818, 2 847, 355, 2 235, 704 in the obesity group, showing statistically significant differences among groups (F=90.60, χ^2=576.34, F=2 768.38, 3 570.80, 22 319.30, 256.99, χ^2=9 108.21, F=507.11, χ^2=3 219.47, 52.78, 64.38, 13.36, 0.76, 130.39, 9.74, P<0.05). (2) Incidence of digestive carcinoma in the participants: all the 95 177 participants were followed up for 845 085 person-year, 1 215 were diagnosed as new-onset digestive carcinoma, with a total person-year incidence of 1.44 thousand person / year. Of 1 215 patients, 413 had colorectal-anal cancer, 306 had liver cancer, 234 had gastric cancer, 113 had esophageal cancer, 91 had the pancreatic cancer,36 had gallbladder carcinoma or cholangiocarcinoma, 25 had intestinal cancer. Three patients had intestinal cancer complicated with colorectal-anal cancer. The person-year incidence of digestive carcinoma was 1.46 thousand person / year, 1.37 thousand person / year and 1.53 thousand person / year in the normal BMI group, overweight group and obesity group, respectively. The cumulative incidences of digestive carcinoma in the normal BMI, overweight, obesity group were respectively 11.8‰, 10.1‰ and 12.1‰, showing a statistically significant difference among 3 groups (χ^2=6.13, P<0.05). There was no statistically significant difference between the normal BMI group and obesity group (χ^2=1.07, P>0.05), and statistically significant differences between the overweight group and normal BMI group and obesity group, respectively (χ^2=3.90, 4.10, P<0.05). (3) Risk factors analysis affecting new-onset digestive carcinoma. Results of COX proportional hazards regression models showed that continuous BMI was not related factor affecting new-onset digestive carcinoma after adjustment of age, gender, systolic pressure, TC, TG, FPG, smoking, drinking, physical exercise, positive HBsAg, high salt intake, malignant tumor in immediate family (HR=0.99, 95%CI: 0.98-1.01, P>0.05). After adding BMI as classification variable in the COX model, risk of new-onset digestive carcinoma in the overweight group was reduced compared with normal BMI group (HR=0.88, 0.88, 95%CI: 0.78-1.01, 0.77-0.98, P<0.05) and risk of new-onset digestive carcinoma in the obesity group was not affected (HR=1.03, 1.04, 95%CI: 0.88-1.20, 0.89-1.22, P>0.05). Results of restrictive cubic spline regression showed a “U”shaped relationship between BMI and incidence risk of digestive carcinoma and the lowest incidence of digestive carcinoma in patients with BMI as 25-27 kg/m^2. (4) Comparisons of the fitting degree of BMI on new-onset digestive carcinoma model: multivariate model was constructed after adding risk factors of age,gender, systolic pressure, TC, TG, FPG, smoking, drinking, physical exercise, positive HBsAg, high salt intake, malignant tumor in immediate family, and-2Log L and AIC were 27 175.05 and 27 203.05 for the multivariate model. Then BMI variable was added into the multivariate model, and the-2Log L and AIC of the multivariate model+BMI model were 27 169.53 and 27 201.53, respectively, with a statistically significant difference compared with normal BMI group (χ^2=5.52, P<0.05). (5) Stratified analysis of risk factors affecting new-onset digestive carcinoma at different locations. Results of COX proportional hazards regression models showed risks of new-onset digestive carcinoma in the overweight and obesity groups were reduced compared with normal BMI group (HR=0.57, 0.42, 95%CI: 0.38-0.84, 0.23-0.79, P<0.05) in the esophageal cancer model. Risks of new-onset digestive carcinoma in the overweight group were reduced compared with normal BMI group (HR=0.72, 95%CI: 0.55-0.93, P<0.05) and risk of new-onset digestive carcinoma in the obesity group was not affected (HR=1.10, 95%CI: 0.82-1.47, P>0.05) in the liver cancer model. ConclusionsParticipants in the overweight group have the lowest incidence of digestive carcinoma, especially in the esophageal cancer and liver cancer model. Incidence of digestive carcinoma is the lowest with BMI as 25-27 kg/m^2.
作者
刘通
魏垚臣
梁明杨
王万超
王一鸣
曹立瀛
刘四清
刘希宁
计艳楠
Liu Tong;Wei Yaochen;Liang Mingyang;Wang Wanchao;Wang Yiming;Cao Liying;Liu Siqing;Liu Xining;Ji Yannan(Departrnent of Hepatobiliary Surgery,Kailuan General Hospital,North China University of Science and Technology, Tangshan 063000,Hebei Province,China;Graduate School,North China University of Science and Technology, Tangshan 063000,Hebei Province,China;Chengde Medical University,Chengde 067000,Hebei Province,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第1期74-82,共9页
Chinese Journal of Digestive Surgery
基金
河北省卫生和计划生育委员会重点科技研究计划(20171435).
