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[目的]探讨北方食管癌高发区人群体质指数(BMI)与贲门高级别上皮内瘤变(HIN)关系。[方法]选择4078例内镜筛查的40～69岁的队列人群为样本,采用病例—队列研究。根据WHO2000年消化道肿瘤病理诊断标准,高级别上皮内瘤变包括贲门腺上皮重度不典型增生和黏膜内癌。中国成人BMI分类标准划分为4个切点:BMI18.5～23.9为正常组、<18.5为体重过低,24.0～27.9为超重,≥28.0为肥胖。以超重和肥胖为暴露组,体重过低和正常组为非暴露组。采用病例—队列研究方法,分析准拟然危险度,以准拟然危险度估计RR值和95%可信区间(CI)。[结果]暴露组高级别上皮内瘤变患病准拟然危险度为0.0125,非暴露组为0.0328,RR=0.39,95%CI:0.16～0.95,P=0.032。[结论]在中国北方食管癌高发区40～69岁人群中,肥胖和超重是贲门高级别上皮内瘤变患病的保护因素。
[Objective] To investigate the relationship between body mass index (BMI) and high-grade intraepithelial neoplasia (HIN) in patients with esophageal cancer in northern areas. [Methods] A total of 4078 cohorts from 40 to 69 years who were screened by endoscopy were enrolled in this study. Case-cohort studies were performed. According to the 2000 WHO diagnosis of neonatal mortality according to the standard, high-grade intraepithelial neoplasia, including cardia glandular epithelial dysplasia and intramucosal cancer. Chinese adult BMI classification criteria are divided into four points: BMI18.5 ~ 23.9 for the normal group, <18.5 for underweight, 24.0 ~ 27.9 for overweight, ≥28.0 for obesity. Overweight and obesity were exposed group, underweight and normal group were non-exposed group. A case-cohort study was used to analyze the likelihood of a hazard and to estimate RR and 95% confidence interval (CI) for the expected hazard ratio. [Results] The proposed risk of high grade intraepithelial neoplasia was 0.0125 in the exposed group, 0.0328 in the non-exposed group, RR = 0.39, 95% CI 0.16-0.95, P = 0.032. [Conclusion] Obesity and overweight are the protective factors in the diagnosis of high-grade intraepithelial neoplasia of the cardia in 40 ~ 69-year-old population with high incidence of esophageal cancer in northern China.