居住环境及室内空气污染与肺癌发病关系病例对照研究

刘志强; 何斐; 林勇; 俞婷婷; 张鑫; 熊为旻; 徐秋萍; 蔡琳

doi:10.11847/zgggws2017-33-09-12

摘要: 目的了解居住环境及室内空气污染与肺癌发病的关系。方法采用病例对照研究方法对2006年1月—2014年12月在福建医科大学附属第一医院、附属协和医院、南京军区福州总医院经病理确诊的1 374例新发肺癌患者和同期到医院非肿瘤科室访视的按性别、年龄（±2岁）频数匹配的1 374名健康对照人群进行问卷调查。结果病例组肺癌患者居住地附近企业污染类型为废气污染、废水污染、粉尘污染、多种污染、其他污染、家庭被动吸烟、10年前烹调燃料为煤烟型、近10年烹调燃料为煤烟型、室内烹调油烟量很少、有些、很多、厨房与卧室不分开、居室通风情况一般、差的比例分别为10.2%、3.2%、2.2%、2.6%、1.5%、46.5%、40.2%、11.6%、54.7%、23.8%、4.5%、2.9%、18.5%、3.3%，均高于对照组健康人群的4.2%、0.9%、0.5%、0.7%、0.6%、25.7%、22.9%、5.2%、48.3%、18.7%、1.7%、1.5%、9.0%、1.2%（均P<0.05）；病例组肺癌患者使用排风扇或抽油烟机、炒菜时油温中等热、住宅类型为楼房的比例分别为58.8%、63.3%、67.6%，均低于对照组健康人群的75.3%、70.2%、86.8%（均P<0.05）；在调整性别、年龄、民族、文化程度、婚姻状况、体质指数、吸烟情况、职业危险因素暴露史、肿瘤家族史、肺部疾病史等混杂因素后，多因素非条件logistic回归分析结果显示，居住地附近企业污染类型为废气、废水、粉尘和多种污染、家庭被动吸烟、10年前烹调燃料为煤烟型、室内烹调有油烟和居室通风不良是肺癌发病的危险因素，炒菜时油温中等热和住宅类型为楼房是肺癌发病的保护因素。结论居住环境及室内空气污染可增加肺癌的发病风险。

Abstract: Objective To investigate the relationship between residential environment,indoor air pollution and the incidence of lung cancer.Methods A case-control study was conducted among 1 374 first pathologically confirmed lung cancer patients in three general hospitals in Fuzhou city of Fujian province (the First Affiliated Hospital of Fujian Medical University,Fujian Medical University Union Hospital,and Fuzhou General Hospital of Nanjing Military Command) and 1374 gender and age (±2 years) frequency-matched healthy permanent residents (living in Fuzhou city more than 10 years) who visited departments other than oncology department at the same hospital as the cases during the same period from January 2006 to December 2014.Epidemiological data were collected with an in-person interview using a standard questionnaire.Results Compared to those in the controls,significantly higher ratios were reported in the cases for exposures to exhausted gas (10.2% vs.4.2%),waste water (3.2% vs.0.9%),dust (2.2% vs.0.5%),mixed pollution (2.6% vs.0.7%),other pollution (1.5% vs.0.6%),passive smoking at home (46.5% vs.25.7%),using coal as cooking fuel 10 years ago (40.2% vs.22.9%),using coal as cooking fuel during recent 10 years (11.6% vs.5.2%),light smokiness during cooking (54.7% vs.48.3%),medium smokiness during cooking (23.8% vs.18.7%),heavy smokiness during cooking (4.5% vs.1.7%),with a kitchen not separated from bedroom (2.9% vs.1.5%),normal residential ventilation (18.5% vs.9.0%),and insufficient residential ventilation (3.3% vs.1.2%)(P<0.05 for all);whereas significantly lower proportions were reported in the cases for using a ventilator in kitchen (58.8% vs.75.3%),keeping proper oil temperature during cooking (63.3% vs.70.2%),and living in a storied building (67.6% vs.86.8%)(P<0.05 for all).After adjusting for confounding factors including gender,age,nationality,education,marital status,body mass index,smoking status,exposure history of occupational risk factors,family history of cancer,and history of lung diseases,the results of multivariate unconditional logistic regression analyses indicated that exposure to exhaust gas,waste water,dust,mixed pollution,passive smoking at home,using coal as cooking fuel 10 years ago,smokiness during cooking,and insufficient residential ventilation were risk factors of lung cancer;while keeping proper oil temperature during cooking and living in a storied building were protective factors of lung cancer incidence.Conclusion Residential environment and indoor air pollution could increase the risk of lung cancer.

居住环境及室内空气污染与肺癌发病关系病例对照研究

Residential environment,indoor air pollution and risk of lung cancer:a case-control study