女性生殖生育因素与乳头状甲状腺癌发病风险的病例对照研究
Case-control study on association of female reproductive factors with risk of papillary thyroid cancer
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摘要:
背景 乳头状甲状腺癌是多种致病因素共同作用的结果，不同地区人群乳头状甲状腺癌的患病率存在较大差异，且对女性人群危害更大。
目的 探讨女性生殖生育因素与乳头状甲状腺癌的关系，为乳头状甲状腺癌的预防和控制提供基础数据。
方法 采用以医院为基础的1∶1配对病例对照研究，选择2012年11月至2013年12月在上海市两家医院首次确诊的331例女性乳头状甲状腺癌患者为病例组，年龄相差±3岁的体检无甲状腺结节人群作为对照配对，比较两组人群月经史、孕产史、妇科和乳腺病史的差异。
结果 单因素分析结果表明，病例组中本科以下文化程度、已（在）婚、体力劳动为主者所占的比例明显高于对照组（
P <0.05）；病例组中有甲状腺疾病家族史者所占的比例明显高于对照组（P <0.05）；病例组月经不规律（77.34%）、服用过避孕药或激素类药物（24.77%）、有妇科良性疾病史者（31.72%）、做过妇科手术者（9.67%）所占的比例明显高于对照组（P <0.05）。在调整了可能的混杂因素包括CT检查史、年龄、食用盐种类、每日总碘摄入量、文化程度、职业、婚姻状况、体重指数（BMI）及甲状腺疾病家族史后，多因素分析结果提示月经不规律（OR =1.767，95%CI :1.122~2.782；P =0.014）、手术停经（OR =12.787，95%CI :3.202~51.057；P <0.001）、怀孕次数>1次（OR =2.490，95%CI :1.196~5.184；P =0.015）、服用过避孕药或激素类药物（OR =2.389，95%CI :1.338~4.268；P =0.003）可能是乳头状甲状腺癌的危险因素。结论 女性月经不规律、手术停经、怀孕次数>1次、有避孕药或激素类药物服用史可能是乳头状甲状腺癌的危险因素，应加强健康教育，防止避孕药物滥用，以降低该肿瘤的发生率。
Abstract:Background Papillary thyroid cancer is the result of a variety of pathogenic factors. The prevalence of papillary thyroid cancer varies greatly in different regions, and the disease is more harmful to women.
Objective This study aims to explore the relationship between reproductive factors and papillary thyroid cancer, and to provide basic data for prevention and control of the disease.
Methods A 1∶1 age (±3 years) matched case-control study was conducted in 331 pairs of newly confirmed papillary thyroid cancer cases and controls from two hospitals in Shanghai from November 2012 to December 2013. Comparisons were made in the history of menstruation, pregnancy, gynecological and breast diseases, and other variables between the two groups.
Results The results of univariate analysis indicated that the proportions of education below bachelor degree, married, and mainly manual workers in the case group were significantly higher than those in the control group (
P <0.05); the proportion of those with a family history of thyroid diseases in the case group was significantly higher than that in the control group (P <0.05); the proportions of the cases with irregular menstruation (77.34%), a history of using oral contraceptive or hormone drugs (24.77%), a history of benign gynecological diseases (31.72%), and a history of gynecological surgery (9.67%) were significantly higher than the proportions in the control group (P <0.05). After adjusting potential confounding factors such as history of CT examination, age, kinds of family salt, total iodine intake every day, education level, occupation, marital status, body mass index, and family history of thyroid diseases, the results of multiple logistic regression analysis showed that irregular menstruation (OR =1.767, 95%CI : 1.122-2.782;P =0.014), surgical menopause (OR =12.787, 95%CI : 3.202-51.057;P <0.001), pregnancy >1 time (OR =2.490, 95%CI : 1.196-5.184;P =0.015), and the history of using oral contraceptive or hormone drugs (OR =2.389, 95%CI : 1.338-4.268;P =0.003) were the risk factors of papillary thyroid cancer.Conclusion Irregular menstruation, surgical menopause, history of pregnancy, and history of using oral contraceptive or hormone drugs might be the risk factors of papillary thyroid cancer. To reduce the incidence of papillary thyroid cancer, strengthened health education and rational use of contraceptives are recommended.
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