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[目的]探讨新鲜水果摄入是否可以降低吸烟人群食管癌的长期死亡风险。[方法]选取年龄为40~69岁8862名男性吸烟人群为研究对象,开展基线人口学特征、生活习惯、疾病史及饮食习惯的调查,随后对该人群进行随访至今约30年。以食管癌死亡病例作为研究终点。利用Log-rank检验比较不同新鲜水果摄入频率受试人群中食管癌累积死亡率间的差异。风险比(HR)和95%可信区间(CI)则通过Cox等比例风险模型进行估计,用来表示受试者死于食管癌的相对风险。[结果]截至2015年12月31日,共计发生食管癌死亡病例891例。经过30年随访后,男性吸烟人群中,不同新鲜水果摄入频率受试人群中食管癌的30年累积死亡率分别为21.91%、16.48%、14.08%、11.03%和12.09%,且随着新鲜水果摄入频次的增加,食管癌30年累积死亡率呈下降趋势。与不食用新鲜水果受试人群相比,每月吃、1~3次/周、4~6次/周和每天吃的受试者食管癌的死亡风险分别降低27%(HR=0.73,95%CI:0.61~0.87)、39%(HR=0.61,95%CI:0.50~0.75)、49%(HR=0.51,95%CI:0.35~0.73)和49%(HR=0.51,95%CI:0.35~0.75)。在调整年龄、性别、地区、体重指数、教育水平、饮酒史和家族史、干预因素后,每周摄入新鲜水果1次以上仍可以降低食管癌的死亡风险(HR=0.87,95%CI:0.76~1.00),这种保护性效应在平原地区(HR=0.78,95%CI:0.63~0.96)和无饮酒史(HR=0.82,95%CI:0.68~1.00)的受试人群中尤为明显。[结论]新鲜水果的摄入可能降低男性吸烟人群中食管癌的长期死亡风险。
[Objective] To investigate whether fresh fruit intake can reduce the long-term mortality risk of esophageal cancer in smokers. [Methods] A total of 8,862 male smokers aged 40-69 years were enrolled in this study. The baseline demographic characteristics, lifestyle, disease history and dietary habits were investigated. The follow-up of the population was about 30 years. Esophageal cancer deaths as the study end point. Log-rank tests were used to compare differences in cumulative esophageal cancer mortality among subjects with different fresh fruit intake frequencies. Risk ratios (HRs) and 95% confidence intervals (CIs) were estimated by proportional hazard models such as Cox to represent the relative risk of death from esophageal cancer in subjects. [Results] As of December 31, 2015, a total of 891 cases of esophageal cancer deaths occurred. After 30 years of follow-up, the 30-year cumulative mortality rates of esophageal cancer among the male smokers were 21.91%, 16.48%, 14.08%, 11.03% and 12.09%, respectively, in the test subjects with different frequency of fresh fruit intake. Increasing the frequency of fruit intake, 30-year cumulative esophageal cancer mortality showed a downward trend. The risk of death from esophageal cancer was reduced by 27% in subjects who ate three times a week, four to six times per week, and ate each day, compared with those who did not eat fresh fruits (HR = 0.73, 95 39% (HR = 0.61, 95% CI: 0.50-0.75), 49% (HR = 0.51, 95% CI: 0.35-0.73) and 49% (HR = 0.51, 95% CI : 0.35 ~ 0.75). After adjusting for age, gender, area, body mass index, educational level, drinking history, family history and intervention factors, weekly intake of fresh fruit could still reduce the risk of esophageal cancer death (HR = 0.87, 95% CI: 0.76 to 1.00). This protective effect was particularly evident in subjects in the plain (HR = 0.78, 95% CI: 0.63 to 0.96) and without alcohol consumption (HR = 0.82, 95% CI: 0.68 to 1.00) . [Conclusion] The intake of fresh fruits may reduce the long-term risk of esophageal cancer in male smokers.