Relationship between soil selenium content and liver cancer mortality: a monitoring data analysis with generalized additive model
-
摘要:
目的 分析全国161个监测点(区县)土壤硒含量与肝癌死亡之间的关系,为应用微量元素硒防治肝癌提供依据。 方法 利用全国疾病监测系统161个死因监测点肝癌死亡监测数据、乙肝、丙肝报告发病数、行为危险因素调查数据及社会经济发展和医疗卫生资源相关指标,用因子分析的方法对社会经济发展、医疗卫生资源相关指标进行降维处理,用广义可加模型分析土壤硒含量与肝癌死亡之间的关系。使用SAS 9.4进行统计分析,显著性水准α = 0.05。 结果 土壤硒含量与肝癌死亡之间存在着非线性关系。对社会经济发展和医疗卫生资源相关指标降维,获得2个公因子,分别代表经济发展和卫生资源,2个公因子的累积贡献率为91.24 %。广义可加模型分析结果显示,肝癌的完整模型和没有土壤硒含量非参数部分模型相比,差异有统计学意义(P < 0.01)。非参数光滑成分效应图显示,土壤硒含量与肝癌非参数部分光滑成分之间呈现类似“N”型关系。 结论 土壤硒含量较高时,肝癌死亡危险性较高;土壤硒含量处于中等偏上水平时,肝癌死亡危险性较低,应关注土壤硒含量的地区差异,加强硒在肝癌防治方面的应用。 Abstract:Objective To analyze the relationship between soil selenium content and liver cancer mortality in 156 districts/counties covered by a vital registration system in China and to provide references for the application of trace selenium in the prevention and treatment of liver cancer. Methods We collected following data for the 156 districts/counties: population sampling survey in 2012, liver cancer mortality and hepatitis B/C incidence in 2012, disease behavioral risk factor survey in 2010, socio-economic development and healthcare resources in 2013, and interpolatedly estimated soil selenium content based on sampling survey data published in 1994. Dimension reduction process was performed for socio-economic development and healthcare resource indicators with factor analysis. Generalized additive model was adopted to analyze the relationship between soil selenium content and liver cancer mortality. SAS for Windows 9.4 was employed and the significant level was set to be 0.05 in data statistics. Results There was a nonlinear relationship between soil selenium content and liver cancer mortality. Two common factors were derived in dimension reduction for indicators of socio-economic development and healthcare resources, representing economic development and health resource, and the cumulative contribution rate of the two common factors was 91.24%. The results of generalized additive model analysis revealed a significant difference between the complete model of liver cancer mortality and the model without soil selenium content as a non-parametric variable (P < 0.001). The non-parametric smooth component effect graph demonstrated an analogous ‘N’ shape correlation between soil selenium content and the non-parametric smooth component of liver cancer mortality. Conclusion Higher soil selenium content may correlate with increased risk of liver cancer mortality but moderate to upper soil selenium content may associate with low liver cancer mortality. The results should be concerned when conducting selenium supplementation-related liver cancer prevention. -
表 1 社会经济发展和医疗卫生资源状况及正交旋转后的因子载荷
指标 最小值 最大值 四分位数 因子载荷 P25 P50 P75 公因子1 公因子2 人均GDP(元) 19 710.00 93 173.00 29 608.00 35 711.00 52 763.00 0.92 0.02 居民消费水平(元) 5 339.50 36 892.90 10 572.90 11 600.80 15 195.50 0.98 0.06 城镇居民消费水平(元) 12 958.40 39 095.20 16 131.30 17 296.10 21 472.80 0.96 0.13 农村居民消费水平(元) 3 098.20 18 512.30 5 647.80 6 445.30 8 212.20 0.96 0.06 在岗职工平均工资(元) 35 179.00 85 306.00 39 092.00 42 572.00 46 091.00 0.82 – 0.30 城镇居民家庭人均可支配收入(元) 17 156.89 40 188.34 20 232.78 20 839.59 23 222.67 0.95 0.14 农村居民家庭人均纯收入(元) 4 506.66 17 803.68 6 356.63 7 611.31 9 383.72 0.95 0.14 医院合计数 56.00 627.00 271.00 381.00 501.00 – 0.07 0.95 卫生技术人员数 9 336.00 530 082.00 152546.25 220761.00 329556.00 0.21 0.96 医疗卫生机构床位数(万张) 0.84 97.38 13.92 19.47 28.70 0.04 0.98 注:公因子1为社会经济;公因子2为卫生资源。 表 2 回归模型参数估计结果
参数 类别 参照组 参数估计 $S_{\bar x}$ t 值 P 值 截距 – 5.697 34 0.052 26 – 109.03 < 0.001 经济发展 yinzi1_1 yinzi1_3 0.038 43 0.029 60 1.30 0.195 yinzi1_2 – 0.072 05 0.034 69 – 2.08 0.038 卫生资源 yinzi2_1 yinzi2_3 – 0.411 15 0.024 11 – 17.05 < 0.001 yinzi2_2 – 0.132 64 0.020 27 – 6.54 < 0.001 孕产妇死亡率(/10万) Maternal_1 Maternal_3 0.312 27 0.031 08 10.05 < 0.001 Maternal_2 0.486 10 0.026 40 18.41 < 0.001 日均饮酒量(g/d) Alcohol_1 Alcohol_3 – 0.227 87 0.023 71 – 9.61 < 0.001 Alcohol_2 – 0.064 93 0.028 76 – 2.26 0.024 乙肝表面抗原阳性率(%) HbsAg_1 HbsAg_3 – 0.233 95 0.021 01 – 11.13 < 0.001 HbsAg_2 0.051 60 0.024 97 2.07 0.039 丙肝发病率(/10万) Hcv_1 Hcv_3 – 0.203 07 0.021 98 – 9.24 < 0.001 Hcv_2 – 0.101 64 0.018 28 – 5.56 < 0.001 乙肝发病率(/10万) Hbv_1 Hbv_3 – 0.379 36 0.023 64 – 16.05 < 0.001 Hbv_2 – 0.272 72 0.019 32 – 14.12 < 0.001 年龄(岁) Age_0 Age_3 – 3.543 17 0.028 25 – 125.41 < 0.001 Age_1 – 1.746 10 0.020 58 – 84.83 < 0.001 Age_2 – 0.598 79 0.020 06 – 29.85 < 0.001 性别 Gender_0 Gender_1 – 0.981 82 0.017 03 – 57.64 < 0.001 Linear(Se) – 0.231 18 0.165 05 – 1.40 0.162 -
[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA: A Cancer Journal for Clinicians, 2018, 68(6): 394 – 424. doi: 10.3322/caac.21492 [2] 张玥, 曲春枫, 任建松, 等. 中国肝癌发病与死亡数据集[J]. 中华肿瘤杂志, 2015(9): 705 – 720. doi: 10.3760/cma.j.issn.0253-3766.2015.09.017 [3] 贾丽军, 于石成, 胡跃华, 等. 多水平模型在肝癌死亡病例与关联因素生态学分析中应用[J]. 中国公共卫生, 2017, 33(7): 1033 – 1037. doi: 10.11847/zgggws2017-33-07-01 [4] 张典, 姜凤良, 胡志芳, 等. 原发性肝癌的预防措施[J]. 中国老年学杂志, 2018, 38(17): 4317 – 4319. doi: 10.3969/j.issn.1005-9202.2018.17.081 [5] 张勇胜, 李仁兰, 刘妍, 等. 硒对人体健康作用的研究进展[J]. 内科, 2018, 13(4): 623 – 625, 662. [6] 徐兵河. 微量元素硒的防癌抗癌作用[J]. 中国新药杂志, 1998, 7(3): 176 – 179. doi: 10.3321/j.issn:1003-3734.1998.03.006 [7] Schomburg L, Hughes DJ. The missing link? The potential role of selenium in the development of liver cancer and significance for the general population[J]. Expert Review of Gastroenterology and Hepatology, 2017, 11(8): 707 – 709. doi: 10.1080/17474124.2017.1320219 [8] 王义国. 微量元素硒与肝癌的预防[C]//第二届泰山微量元素高级论坛论文集, 济南: 山东省科学技术协会, 2008: 96 – 99. [9] 郄文娟, 许永红, 冯俊贤, 等. 微量元素硒及其生物学功能[J]. 微量元素与健康研究, 2009, 26(5): 67 – 68. [10] 师雪, 何琪杨. 硒预防肿瘤及机制研究进展[J]. 中国公共卫生, 2018, 34(6): 934 – 936. doi: 10.11847/zgggws1112597 [11] Rayman MP. Selenium and human health[J]. The Lancet, 2012, 379(9822): 1256 – 1268. doi: 10.1016/S0140-6736(11)61452-9 [12] 中国环境监测总站. 中华人民共和国土壤环境背景值图集[M]. 北京: 中国环境科学出版社, 1994. [13] 张东威, 刘杰, 李生智, 等. 土壤元素背景值与自然因素的相关性[J]. 上海环境科学, 1989, 8(5): 32 – 34. [14] 田庚善, 徐京杭, 于岩岩. 硒与肝癌的预防[J]. 中国综合临床, 2006, 22(10): 957 – 959. doi: 10.3760/cma.j.issn.1008-6315.2006.10.047 [15] Hughes DJ, Duarte-Salles T, Hybsier S, et al. Prediagnostic selenium status and hepatobiliary cancer risk in the European Prospective Investigation into Cancer and Nutrition cohort[J]. The American Journal of Clinical Nutrition, 2016, 104(2): 406 – 414. doi: 10.3945/ajcn.116.131672 [16] 方珏敏, 王理伟. 硒, 防治癌症的得力"助手"[J]. 中老年保健, 2010(6): 53. [17] Zhang ZW, Bi MY, Liu Q, et al. Meta-analysis of the correlation between selenium and incidence of hepatocellular carcinoma[J]. Oncotarget, 2016, 7(47): 77110 – 77116. doi: 10.18632/oncotarget.12804 [18] 顾公望, 周汉高. 硒与肝癌研究进展[J]. 世界肿瘤杂志, 2003, 2(2): 87 – 88. [19] 许凌凌, 许月明. 微量元素硒与人体健康研究[J]. 农技服务, 2016, 33(6): 85 – 86. doi: 10.3969/j.issn.1004-8421.2016.06.062