吸煙與肺癌關系的Meta分析_《中國呼吸與危重監護雜志》

作者：

王冬梅 ¹ ,  李為民 ^1,2 , 李靜 ³ , 陳文彬 ¹

1 四川大學華西醫院呼吸內科（四川成都 610041）;;
2四川大學生物治療國家重點實驗室（四川成都 610041）;;
3 四川大學華西醫院循證醫學與流行病學研究中心（四川成都 610041）;

關鍵詞：

肺癌 Meta 分析吸煙危險因素

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目的從循證醫學的角度評價吸煙與肺癌之間的相互關系。方法采用Meta 分析專用軟件ReviewManager 4. 2 對近10 年國內外29 篇關于吸煙與肺癌關系文獻的病例對照研究進行 Meta 分析。結果吸煙與肺癌之間關聯明顯( Z = 12. 16, P lt; 0. 000 01) , 合并OR 值為5. 75( 4. 34,7. 62) 。吸煙的人群歸因危險度百分比( PARP) 為69. 16% 。每日吸煙量1 ～10 支/d、10 ～20 支/d、20 ～40 支/d 和40 支/d 以上的合并OR 值分別為1. 97( 1. 69, 2. 30) 、5. 20( 3. 54, 7. 62) 、7. 46( 5. 22,10. 67) 和15. 14( 5. 27, 43. 44) ; 吸煙持續時間20 年以下、20 ～40 年和40 年以上的合并OR值分別為1. 25( 1. 01, 1. 53) 、5. 10( 3. 03, 8. 57) 和10. 77( 7. 30, 15. 89) ; 吸煙總量10 包年以下、10 ～20 包年、20 ～40 包年和40 包年以上的合并OR 值分別為1. 73( 1. 01, 2. 96) 、3. 73( 3. 02, 4. 61) 、5. 69( 3. 79,8. 54) 和8. 41( 4. 56, 15. 51) ; 吸煙初始年齡15 歲以下、15 ～20 歲和20 歲以上的合并OR 值分別為 13. 31( 7. 09, 24. 97) 、7. 21( 4. 51,11. 52) 和4. 74( 3. 47, 6. 47) ; 戒煙1 ～10 年、10 ～20 年和20 年以上的合并OR值分別為7. 16( 4. 70, 10. 91) 、2. 12( 1. 16, 3. 86) 和1. 47( 0. 67, 3. 20) , 其中戒煙20 年以上無統計學意義, 尚需要增大樣本量進一步研究; 淺吸煙( 口腔吸煙) 和深吸煙( 肺吸煙) 的合并OR值分別為3. 26( 1. 24, 8. 58) 和8. 07( 4. 67, 13. 94) 。結論吸煙是肺癌發生的一個重要危險因素。每日吸煙量越大, 吸煙持續時間越長, 吸煙總量越大, 吸煙初始年齡越小, 戒煙時間越短, 吸煙深度越深, 患肺癌的危險性就越大。

引用本文： 王冬梅,李為民,李靜,陳文彬. 吸煙與肺癌關系的Meta分析. 中國呼吸與危重監護雜志, 2009, 09(3): 229-233. doi: 復制

1.	Pirozynski M.
2.	Lichtenstein MJ, Mulrow CD, Elwood PC. Guidelines for reading case-control studies. J Chronic Dis, 1987, 40: 893-903.
3.	Light RJ, Pillemer DB. Quantitative procedures. In Summing up: The Science of Reviewing Research: Harvard University Press, 1984.
4.	Rachtan J, Sokolowski A. Risk factors for lung cancer among women in Poland. Lung Cancer, 1997, 18: 137-145.
5.	劉雙, 劉澤英, 胡尚基. 吸煙與肺癌發生的回顧性分析. 心肺血管病雜志, 1999, 18: 222-223.
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9.	Droste JH, Weyler JJ, Van Meerbeeck JP, et al. Occupational risk factors of lung cancer: a hospital based case-control study. Occup Environ Med, 1999, 56: 322-327.
10.	Agudo A, Ahrens W, Benhamou E, et al. Lung cancer and cigarette smoking in women: a multicenter case-control study in Europe. Int J Cancer, 2000, 88: 820-827.
11.	Osann KE, Lowery JT, Schell MJ. Small cell lung cancer in women:risk associated with smoking, prior respiratory disease, and occupation. Lung Cancer, 2000, 28: 1-10.
12.	Simonato L, Zambon P, Ardit S, et al. Lung cancer risk in Venice: a population-based case-control study. Eur J Cancer Prev, 2000 , 9: 35 -39.
13.	Seow A, Poh WT, Teh M, et al. Fumes from meat cooking and lung cancer risk in Chinese women. Cancer Epidemiol Biomarkers Prev,2000, 9: 1215-1221.
14.	顧雪松. 吸煙與肺癌危險性的病例對照研究. 江蘇預防醫學,2000, 11: 18-19.
15.	Stellman SD, Takezaki T, Wang L, et al. Smoking and Lung Cancer Risk in American and Japanese Men: An International Case-Control Study. Cancer Epidemiol Biomarkers Prev, 2001, 10: 1193-1199.
16.	Pisa FE, Barbone F, Betta A, et al. Residential radon and risk of lung cancer in an Italian alpine area. Arch Environ Health, 2001 ,56: 208-215.
17.	Kreienbrock L, Kreuzer M, Gerken M, et al. Case-control study on lung cancer and residential radon in western Germany. Am J Epidemiol, 2001, 153: 42-52.
18.	Rachtan J. Smoking, passive smoking and lung cancer cell types among women in Poland. Lung Cancer, 2002, 35: 129-136.
19.	Kubík AK,Zatloukal P, Tomásek L, et al. Lung cancer risk among Czech women: a case-control study. Prev Med, 2002, 34: 436 -444.
20.	Sasco AJ, Merrill RM, Dari I, et al. A case-control study of lung cancer in Casablanca, Morocco. Cancer Causes Control, 2002, 13 :609-616.
21.	Ruano-Ravina A, Figueiras A, Montes-Martínez A, et al. Doseresponse relationship between tobacco and lung cancer: new findings. Eur J Cancer Prev, 2003, 12: 257-263.
22.	Chan-Yeung M, Koo LC, Ho JC, et al. Risk factors associated with lung cancer in Hong Kong. Lung Cancer, 2003, 40: 131-140.
23.	張亞旭, 吳樹嶺, 韓惠麗. 哈爾濱市南崗區103 例肺癌患者相關危險因素對照分析. 中國初級衛生保健, 2003, 17: 32-33.
24.	De Stefani E, Deneo-Pellegrini H, Boffetta P, et al. Cigarette smoking and risk of large cell carcinoma of the lung: a case-control study in Uruguay. Lung Cancer, 2004, 43: 267-274.
25.	盧家強, 陳亞利, 霍敏琴. 順德容奇地區肺癌危險因素的病例對照研究. 中國自然醫學雜志, 2004, 6: 13-15.
26.	Fano V, Michelozzi P, Ancona C, et al. Occupational and environmental exposures and lung cancer in an industrialised area in Italy. Occup Environ Med, 2004, 61: 757-763.
27.	Marugame T, Sobue T, Nakayama T, et al. Filter cigarette smoking and lung cancer risk; a hospital-based case--control study in Japan.Br J Cancer, 2004, 90: 646-651.
28.	De Stefani E, Boffetta P, Brennan P, et al. Occupational exposures and risk of adenocarcinoma of the lung in Uruguay. Cancer Causes Control, 2005, 16: 851-856.
29.	韓勇, 王云杰, 朱江, 等. 西安地區肺癌危險因素的病例對照分析. 現代腫瘤醫學, 2005, 13: 267-269.
30.	Franco-Marina F, Villalba-Caloca J, Corcho-Berdugo A, et al. Role of active and passive smoking on lung cancer etiology in Mexico City. Salud Publica Mex, 2006, 48( suppl 1) : S75-S82.
31.	Neuberger JS, Mahnken JD, Mayo MS, et al. Risk factors for lung cancer in Iowa women: implications for prevention. Cancer Detect Prev, 2006, 30: 158-167.
32.	靳光付, 胡志斌, 馬紅霞, 等. 腫瘤家族史和吸煙在肺癌發生中的交互作用研究. 中華流行病學雜志, 2006, 27: 1095-1096.
33.	Wakai K, Inoue M, Mizoue T, et al. Tobacco Smoking and Lung Cancer Risk: An Evaluation Based on a Systematic Review of Epidemiological Evidence Among the Japanese Population. Jpn J Clin Oncol, 2006, 36: 309-324.
34.	years of lung cancer. Respir Med, 2006 , 100 :2073-2084.

1. Pirozynski M.
2. Lichtenstein MJ, Mulrow CD, Elwood PC. Guidelines for reading case-control studies. J Chronic Dis, 1987, 40: 893-903.
3. Light RJ, Pillemer DB. Quantitative procedures. In Summing up: The Science of Reviewing Research: Harvard University Press, 1984.
4. Rachtan J, Sokolowski A. Risk factors for lung cancer among women in Poland. Lung Cancer, 1997, 18: 137-145.
5. 劉雙, 劉澤英, 胡尚基. 吸煙與肺癌發生的回顧性分析. 心肺血管病雜志, 1999, 18: 222-223.
6. Pohlabeln H, J　ckel KH, Müller KM. The relation between various histological types of lung cancer and the number of years since cessation of smoking. Lung Cancer, 1997, 18: 223-229.
7. Matos E, Vilensky M, Boffetta P, et al. Lung cancer and smoking: a case-control study in Buenos Aires, Argentina. Lung Cancer, 1998 ,21: 155-163.
8. J　ckel KH, Ahrens W, Jahn I, et al. Occupational risk factors for lung cancer: a case-control study in West Germany. Int J Epidemiol,1998, 27: 549-560.
9. Droste JH, Weyler JJ, Van Meerbeeck JP, et al. Occupational risk factors of lung cancer: a hospital based case-control study. Occup Environ Med, 1999, 56: 322-327.
10. Agudo A, Ahrens W, Benhamou E, et al. Lung cancer and cigarette smoking in women: a multicenter case-control study in Europe. Int J Cancer, 2000, 88: 820-827.
11. Osann KE, Lowery JT, Schell MJ. Small cell lung cancer in women:risk associated with smoking, prior respiratory disease, and occupation. Lung Cancer, 2000, 28: 1-10.
12. Simonato L, Zambon P, Ardit S, et al. Lung cancer risk in Venice: a population-based case-control study. Eur J Cancer Prev, 2000 , 9: 35 -39.
13. Seow A, Poh WT, Teh M, et al. Fumes from meat cooking and lung cancer risk in Chinese women. Cancer Epidemiol Biomarkers Prev,2000, 9: 1215-1221.
14. 顧雪松. 吸煙與肺癌危險性的病例對照研究. 江蘇預防醫學,2000, 11: 18-19.
15. Stellman SD, Takezaki T, Wang L, et al. Smoking and Lung Cancer Risk in American and Japanese Men: An International Case-Control Study. Cancer Epidemiol Biomarkers Prev, 2001, 10: 1193-1199.
16. Pisa FE, Barbone F, Betta A, et al. Residential radon and risk of lung cancer in an Italian alpine area. Arch Environ Health, 2001 ,56: 208-215.
17. Kreienbrock L, Kreuzer M, Gerken M, et al. Case-control study on lung cancer and residential radon in western Germany. Am J Epidemiol, 2001, 153: 42-52.
18. Rachtan J. Smoking, passive smoking and lung cancer cell types among women in Poland. Lung Cancer, 2002, 35: 129-136.
19. Kubík AK,Zatloukal P, Tomásek L, et al. Lung cancer risk among Czech women: a case-control study. Prev Med, 2002, 34: 436 -444.
20. Sasco AJ, Merrill RM, Dari I, et al. A case-control study of lung cancer in Casablanca, Morocco. Cancer Causes Control, 2002, 13 :609-616.
21. Ruano-Ravina A, Figueiras A, Montes-Martínez A, et al. Doseresponse relationship between tobacco and lung cancer: new findings. Eur J Cancer Prev, 2003, 12: 257-263.
22. Chan-Yeung M, Koo LC, Ho JC, et al. Risk factors associated with lung cancer in Hong Kong. Lung Cancer, 2003, 40: 131-140.
23. 張亞旭, 吳樹嶺, 韓惠麗. 哈爾濱市南崗區103 例肺癌患者相關危險因素對照分析. 中國初級衛生保健, 2003, 17: 32-33.
24. De Stefani E, Deneo-Pellegrini H, Boffetta P, et al. Cigarette smoking and risk of large cell carcinoma of the lung: a case-control study in Uruguay. Lung Cancer, 2004, 43: 267-274.
25. 盧家強, 陳亞利, 霍敏琴. 順德容奇地區肺癌危險因素的病例對照研究. 中國自然醫學雜志, 2004, 6: 13-15.
26. Fano V, Michelozzi P, Ancona C, et al. Occupational and environmental exposures and lung cancer in an industrialised area in Italy. Occup Environ Med, 2004, 61: 757-763.
27. Marugame T, Sobue T, Nakayama T, et al. Filter cigarette smoking and lung cancer risk; a hospital-based case--control study in Japan.Br J Cancer, 2004, 90: 646-651.
28. De Stefani E, Boffetta P, Brennan P, et al. Occupational exposures and risk of adenocarcinoma of the lung in Uruguay. Cancer Causes Control, 2005, 16: 851-856.
29. 韓勇, 王云杰, 朱江, 等. 西安地區肺癌危險因素的病例對照分析. 現代腫瘤醫學, 2005, 13: 267-269.
30. Franco-Marina F, Villalba-Caloca J, Corcho-Berdugo A, et al. Role of active and passive smoking on lung cancer etiology in Mexico City. Salud Publica Mex, 2006, 48( suppl 1) : S75-S82.
31. Neuberger JS, Mahnken JD, Mayo MS, et al. Risk factors for lung cancer in Iowa women: implications for prevention. Cancer Detect Prev, 2006, 30: 158-167.
32. 靳光付, 胡志斌, 馬紅霞, 等. 腫瘤家族史和吸煙在肺癌發生中的交互作用研究. 中華流行病學雜志, 2006, 27: 1095-1096.
33. Wakai K, Inoue M, Mizoue T, et al. Tobacco Smoking and Lung Cancer Risk: An Evaluation Based on a Systematic Review of Epidemiological Evidence Among the Japanese Population. Jpn J Clin Oncol, 2006, 36: 309-324.
34. years of lung cancer. Respir Med, 2006 , 100 :2073-2084.

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