目的：探讨中老年人体质指数（BMI）、腰臀比（WHR）与食管癌的关系。方法采用以医院为基础的病例对照研究。选取2012年9月—2013年3月入住辽宁医学院附属第一医院、附属第三医院和锦州市中心医院肿瘤科和胸外科病房，经临床组织病理学诊断为食管癌，年龄≥40岁的282例食管癌患者为病例组；选取与病例同期入住相同医院，未患食管及其他消化系统癌症，罹患其他疾病的282例患者为对照组。采用标准调查表对患者进行面对面调查，同时对身高、体质量、腰围、臀围进行测量，并计算 BMI 及 WHR。结果两组患者的年龄、性别、职业、文化程度、居住地及高血压史间差异均无统计学意义（p >0.05）；家庭人均月收入、吸烟、饮酒及糖尿病史间差异均有统计学意义（p <0.05）。病例组的 BMI 为（24.43±3.40） kg/ m2，对照组为（22.79±3.30） kg/ m2；病例组男性的WHR 为（0.96±0.05），对照组男性为（0.91±0.05）；病例组女性的 WHR 为（0.95±0.05），对照组女性为（0.90±0.07），两组间差异均有统计学意义（p <0.05）。单因素 Logistic 回归分析结果显示，病例组 BMI 为24.00~27.99 kg/ m2、≥28.00 kg/ m2患者发生食管癌的危险性分别为对照组 BMI 为18.50~23.99 kg/ m2患者的1.526倍和1.817倍；WHR >0.95患者发生食管癌的危险性是对照组 WHR <0.83患者的1.854倍。在调整了性别、年龄等多种混杂因素后，多因素 Logistic 回归分析结果显示，与对照组 BMI 为18.50~23.99 kg/ m2患者比较，病例组 BMI 为24.00~27.99 kg/ m2、≥28.00 kg/ m2患者发生食管癌的危险性分别升高59.4%和78.2%；与 WHR <0.83的患者比较，WHR为0.83~0.89、0.90~0.94、>0.94患者发生食管癌的危险性分别升高4.8%、32.6%和36.5%。结论 BMI、WHR是发生食管癌的重要危险因素，超重和肥胖的人群发生食管癌的危险性明显增加，维持正常体质量可能是食管癌发病的保护因素。%[AbstraCt] ObjeCtive To explore the association between body mass index(BMI),waist to hip ratio(WHR)and esophageal cancer risk in middle aged and elderly people. Methods A hospital _ based case _ control study was conducted. Cases (n = 282)were esophageal cancer patients who were hospitalized in department of oncology and chest surgery,the First Affiliated Hospital and the Third Affiliated Hospital,Liaoning Medical University and Central Hospital,Jinzhou from September,2012 to March,2013 and confirmed by clinical histopathological examination,and controls(n = 282)were patients admitted to the same hospital for different diseases. All of them received face _ to _ face investigation with a standardized questionnaire. Their height and weight,waist circumference and hip circumference were measured and BMI and WHR were calculated. Results There was no statistically significant difference between two groups about age,gender,occupation,education background,and place of residence,as well as the history of hypertension( p > 0. 05 );but the differences in monthly family income per person, drinking,smoking and diabetic history were significant( p < 0. 05). BMI was(24. 43 ± 3. 40) kg/ m2 in case group and (22. 79 ± 3. 30)kg/ m2 in control group;WHR was(0. 96 ± 0. 05)in male cases,(0. 91 ± 0. 05)in male controls,(0. 95± 0. 05)in female cases,and(0. 90 ± 0. 07)in female controls and the differences between the two groups were significant(p< 0. 05). Univariate Logistic regression showed the danger of occurrence of esophageal cancer in case patients whose BMI was 24. 00 ~ 27. 99 kg/ m2 ,≥28. 00 kg/ m2 was 1. 526 times and 1. 817 times respectively that in control patients whose BMI was 18. 50 ~ 23. 99 kg/ m2;the danger in case groups whose WHR was > 0. 95 was 1. 854 times that in control group whose WHR was< 0. 83. After adjusting many confounding factors such as age and gender,etc. ,multiple logistic regression analysis showed that compared with that in the patients in control whose BMI was 18. 50 ~ 23. 99 kg/ m2 ,the danger of the occurrence in case group patients whose BMI was 24. 00 ~ 27. 99 kg/ m2 ,≥28. 00 kg/ m2 was increased by 59. 4% and 78. 2% respectively;compared with that in the patients in control whose WHR was < 0. 83,the danger of the occurrence in case group patients whose WHR was 0. 83 ~ 0. 89,0. 90 ~ 0. 94, > 0. 94 was increased by 4. 8% ,32. 6% and 36. 5% respectively. ConClusion BMI and WHR are important risk factors for esophageal cancer. Overweight or obesity is associated with a significantly increased risk of esophageal cancer. So keeping normal weight may be a protective factor.
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