中华预防医学杂志
中華預防醫學雜誌
중화예방의학잡지
CHINESE JOURNAL OF
2015年
8期
677-682
,共6页
王孟%郝长青%赵德利%李变云%王进武%雷复华%周瑞雪%马山蕊%马箐%李琰琰%冯昊%李新庆%魏文强
王孟%郝長青%趙德利%李變雲%王進武%雷複華%週瑞雪%馬山蕊%馬箐%李琰琰%馮昊%李新慶%魏文彊
왕맹%학장청%조덕리%리변운%왕진무%뢰복화%주서설%마산예%마정%리염염%풍호%리신경%위문강
食管肿瘤%癌前状态%患病率
食管腫瘤%癌前狀態%患病率
식관종류%암전상태%환병솔
Esophageal neoplasms%Precancerous conditions%Prevalence
目的：了解我国食管癌高发区食管癌及其癌前病变人群分布特征，为制定高发区食管癌及其癌前病变检出率参考值范围提供依据。方法利用食管癌高发区建立的自然人群队列，回顾性整理2005—2009年中国食管癌高发区河南省林州市和山东省肥城市40~69岁参加内镜下碘染色筛查人群病理诊断数据，共15709名，排除筛查前患有重要器官疾患者11例及病理诊断不明确者35例，进入分析的目标人群共15663名。计算内镜筛查依从性，比较食管癌及其癌前病变性别、地区、年龄分布差异，采用95%CI值分析食管癌及各级别癌前病变检出率范围。结果内镜筛查依从性为49.36%（15709/31826），女性(54.05%，8447/15628)依从性高于男性（44.83%，7262/16198）（χ2=88.14，P<0.001）。食管病变检出率为21.88%（3427/15663）。男性食管基底细胞增生、低级别上皮内瘤变、高级别上皮内瘤变、食管癌检出率分别为4.17%（302/7246）、17.22%（1248/7246）、1.67%（121/7246）、0.83%（60/7246），均高于女性[分别为3.45%（290/8417）、14.82%（1247/8417）、1.41%（119/8417）、0.48%（40/8417）]，且除高级别上皮内瘤变外，差异均有统计学意义（P值分别为0.018、<0.001、0.960、0.006）。食管癌及各级癌前病变检出率均随年龄增加而增加（P值均<0.001），其中40~44岁调查对象食管基底细胞增生、低级别上皮内瘤变、高级别上皮内瘤变、食管癌检出率分别为2.69%(94/3500)、8.11%（284/3500）、0.40%(14/3500)和0.14%(5/3500)；65~69岁调查对象分别为5.46%(46/843)、23.25%(196/843)、3.68%(31/843)和2.14%(18/843)。林州市食管基底细胞增生、低级别上皮内瘤变、高级别上皮内瘤变、食管癌检出率分别为4.90%（504/10287）、17.37%（1787/10287）、1.79%（184/10287）、0.60%（62/10287），除食管癌外，均高于肥城市[分别为1.64%（88/5376）、13.17%（708/5376）、1.04%（56/5376）、0.71%（38/5376）]（P值分别为<0.001、<0.001、<0.001、0.437）。食管癌及各级癌前病变检出率（95%CI值）分别为：基底细胞增生：3.78%（3.48%~4.08%）；低级别上皮内瘤变：15.93%（15.37%~16.50%），其中轻度异型增生：12.31%（11.79%~12.82%），中度异型增生3.62%（3.33%~3.91%）；高级别上皮内瘤变：1.53%（1.34%~1.72%）；食管癌：0.64%（0.51%~0.76%）。结论中国食管癌高发区自然人群中无症状癌前病变及癌症患者比例高达21.88%；年龄、性别与检出率密切相关；高发区食管癌内镜筛查应重视癌前病变的检出率，尤其要关注男性筛查对象内镜筛查依从性。
目的：瞭解我國食管癌高髮區食管癌及其癌前病變人群分佈特徵，為製定高髮區食管癌及其癌前病變檢齣率參攷值範圍提供依據。方法利用食管癌高髮區建立的自然人群隊列，迴顧性整理2005—2009年中國食管癌高髮區河南省林州市和山東省肥城市40~69歲參加內鏡下碘染色篩查人群病理診斷數據，共15709名，排除篩查前患有重要器官疾患者11例及病理診斷不明確者35例，進入分析的目標人群共15663名。計算內鏡篩查依從性，比較食管癌及其癌前病變性彆、地區、年齡分佈差異，採用95%CI值分析食管癌及各級彆癌前病變檢齣率範圍。結果內鏡篩查依從性為49.36%（15709/31826），女性(54.05%，8447/15628)依從性高于男性（44.83%，7262/16198）（χ2=88.14，P<0.001）。食管病變檢齣率為21.88%（3427/15663）。男性食管基底細胞增生、低級彆上皮內瘤變、高級彆上皮內瘤變、食管癌檢齣率分彆為4.17%（302/7246）、17.22%（1248/7246）、1.67%（121/7246）、0.83%（60/7246），均高于女性[分彆為3.45%（290/8417）、14.82%（1247/8417）、1.41%（119/8417）、0.48%（40/8417）]，且除高級彆上皮內瘤變外，差異均有統計學意義（P值分彆為0.018、<0.001、0.960、0.006）。食管癌及各級癌前病變檢齣率均隨年齡增加而增加（P值均<0.001），其中40~44歲調查對象食管基底細胞增生、低級彆上皮內瘤變、高級彆上皮內瘤變、食管癌檢齣率分彆為2.69%(94/3500)、8.11%（284/3500）、0.40%(14/3500)和0.14%(5/3500)；65~69歲調查對象分彆為5.46%(46/843)、23.25%(196/843)、3.68%(31/843)和2.14%(18/843)。林州市食管基底細胞增生、低級彆上皮內瘤變、高級彆上皮內瘤變、食管癌檢齣率分彆為4.90%（504/10287）、17.37%（1787/10287）、1.79%（184/10287）、0.60%（62/10287），除食管癌外，均高于肥城市[分彆為1.64%（88/5376）、13.17%（708/5376）、1.04%（56/5376）、0.71%（38/5376）]（P值分彆為<0.001、<0.001、<0.001、0.437）。食管癌及各級癌前病變檢齣率（95%CI值）分彆為：基底細胞增生：3.78%（3.48%~4.08%）；低級彆上皮內瘤變：15.93%（15.37%~16.50%），其中輕度異型增生：12.31%（11.79%~12.82%），中度異型增生3.62%（3.33%~3.91%）；高級彆上皮內瘤變：1.53%（1.34%~1.72%）；食管癌：0.64%（0.51%~0.76%）。結論中國食管癌高髮區自然人群中無癥狀癌前病變及癌癥患者比例高達21.88%；年齡、性彆與檢齣率密切相關；高髮區食管癌內鏡篩查應重視癌前病變的檢齣率，尤其要關註男性篩查對象內鏡篩查依從性。
목적：료해아국식관암고발구식관암급기암전병변인군분포특정，위제정고발구식관암급기암전병변검출솔삼고치범위제공의거。방법이용식관암고발구건립적자연인군대렬，회고성정리2005—2009년중국식관암고발구하남성림주시화산동성비성시40~69세삼가내경하전염색사사인군병리진단수거，공15709명，배제사사전환유중요기관질환자11례급병리진단불명학자35례，진입분석적목표인군공15663명。계산내경사사의종성，비교식관암급기암전병변성별、지구、년령분포차이，채용95%CI치분석식관암급각급별암전병변검출솔범위。결과내경사사의종성위49.36%（15709/31826），녀성(54.05%，8447/15628)의종성고우남성（44.83%，7262/16198）（χ2=88.14，P<0.001）。식관병변검출솔위21.88%（3427/15663）。남성식관기저세포증생、저급별상피내류변、고급별상피내류변、식관암검출솔분별위4.17%（302/7246）、17.22%（1248/7246）、1.67%（121/7246）、0.83%（60/7246），균고우녀성[분별위3.45%（290/8417）、14.82%（1247/8417）、1.41%（119/8417）、0.48%（40/8417）]，차제고급별상피내류변외，차이균유통계학의의（P치분별위0.018、<0.001、0.960、0.006）。식관암급각급암전병변검출솔균수년령증가이증가（P치균<0.001），기중40~44세조사대상식관기저세포증생、저급별상피내류변、고급별상피내류변、식관암검출솔분별위2.69%(94/3500)、8.11%（284/3500）、0.40%(14/3500)화0.14%(5/3500)；65~69세조사대상분별위5.46%(46/843)、23.25%(196/843)、3.68%(31/843)화2.14%(18/843)。림주시식관기저세포증생、저급별상피내류변、고급별상피내류변、식관암검출솔분별위4.90%（504/10287）、17.37%（1787/10287）、1.79%（184/10287）、0.60%（62/10287），제식관암외，균고우비성시[분별위1.64%（88/5376）、13.17%（708/5376）、1.04%（56/5376）、0.71%（38/5376）]（P치분별위<0.001、<0.001、<0.001、0.437）。식관암급각급암전병변검출솔（95%CI치）분별위：기저세포증생：3.78%（3.48%~4.08%）；저급별상피내류변：15.93%（15.37%~16.50%），기중경도이형증생：12.31%（11.79%~12.82%），중도이형증생3.62%（3.33%~3.91%）；고급별상피내류변：1.53%（1.34%~1.72%）；식관암：0.64%（0.51%~0.76%）。결론중국식관암고발구자연인군중무증상암전병변급암증환자비례고체21.88%；년령、성별여검출솔밀절상관；고발구식관암내경사사응중시암전병변적검출솔，우기요관주남성사사대상내경사사의종성。
Objective To understand the distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates in high-risk areas. Methods Endoscopy with Lugol's iodine staining was performed on 15 709 local residents aged 40 to 69 years old in Linzhou of Henan province and Feicheng of Shandong province from 2005-2009. 35 cases without accurate pathology diagnosis and 11 cases with vital disease before screening were excluded.15 663 subjects were enrolled in this study. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi-square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer.95%CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions. Results The compliance rate of screening endoscopy of this study was 49.36%(15 709/31 826) of all, and female's compliance (54.05%,8 447/15 628) was much higher than that of male(44.83%,7 262/16 198)(χ2=88.14, P<0.001). The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males were 4.17%(302/7 246),17.22%(1 248/7 246),1.67%(121/7 246),0.83%(60/7 246),and were higher than that of females(3.45%(290/8 417),14.82%(1 247/8 417),1.41%(119/8 417),0.48%(40/8 417), respectively). Except for high-grade intraepithelial neoplasia, the detection rates of male were higher than that of female (P values were 0.018,<0.001,0.960,0.006) . The detection rates of all grades of precursor lesions increased with age rising(all P values <0.001), among which the detection rates of the mentioned four lesions for 40-44 years old were 2.69%(94/3 500),8.11%(284/3 500),0.40%(14/3 500), 0.14%(5/3 500), and that of 65-69 years old were 5.46% (46/843), 23.25% (196/843), 3.68% (31/843), 2.14% (18/843). The proportion of esophageal precursor lesion of Linzhou were higher than that of Feicheng observably except for esophageal squamous cell cancer (P values were<0.001,<0.001,<0.001,0.437). The detection rates of the four lesions of Linzhou and Feicheng were 4.90%(504/10 287),17.37%(1 787/10 287),1.79%(184/1 0287),0.60%(62/10 287) and 1.64%(88/5 376),13.17%(708/5 376),1.04%(56/5 376),0.71%(38/5 376).The 95%CI of detection rates of various lesions were, 3.78%(3.48%-4.08%) for basal cell hyperplasia, 15.93%(15.37%-16.50%) for low-grade intraepithelial neoplasia,12.31% (11.79%-12.82%)for mild dysplasia and 3.62% (3.33%-3.91%) for moderate hyperplasia, 1.53%(1.34%-1.72%) for high-grade intraepithelial neoplasia and 0.64%(0.51%-0.76%) for esophageal squamous cell cancer, respectively. Conclusion Up to 21.88%residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high-risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age, which suggested that males were supposed to be paid more attention to.
