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目的:探讨北方食管癌高发区人群体质指数(BMI)与早期贲门腺癌和上皮内瘤变的关系。方法:2004年3月和2006年7月,选择磁县两个乡25个自然村40～65岁为内镜筛查队列样本,应筛查5331例,实际内镜筛查4078例。筛查率76.5%,其中男性2012例,女性2066例,性别比0.97,中位年龄47.0岁。以WHO2000年消化道肿瘤病理诊断标准,贲门腺上皮轻度不典型增生划为低级别上皮内瘤变(LIN),高级别上皮内瘤变(HIN)包括重度不典型增生、粘膜内癌。本队列共检出贲门LIN55例、HIN31例和早期浸润腺癌17例。根据中国成人BMI分类标准,<18.5体重过低、18.5～23.9正常、24.0～27.9超重、≥28.0肥胖共计4个切点,与病理诊断正常人群、贲门腺上皮内瘤变(LIN、HIN)和早期浸润癌,建立R×C列联表,分析BMI与贲门腺上皮内瘤变和贲门腺癌关联性。结果:男性在BMI正常切点,病理诊断正常、LIN、HIN和浸润癌分别占62.3%、64.1%、81.0%和83.0%;在BMI>24.0以上分别占34.5%、33.3%、19.0%和16.7%,χ2=6.675,P>0.05;女性分别为51.7%、56.3%、70.0%和40.0%;45.4%、43.8%、30.0%和60.0%,χ2=5.387,P>0.05。结论:中国北方食管癌高发区贲门LIN、HIN及早期浸润癌在BMI不同切点的变化无关联性,BMI可能不是贲门癌主要危险因素。
Objective: To investigate the relationship between body mass index (BMI) and early gastric cardia adenocarcinoma and intraepithelial neoplasia in high incidence areas of northern esophageal cancer. Methods: In March 2004 and July 2006, 25-40 villages in 25 villages of two counties of Cixian County were chosen as endoscopic screening cohort samples. 5331 cases should be screened and 4078 cases should be screened by endoscopy. Screening rate of 76.5%, of which 2012 male and female 2066 cases, sex ratio 0.97, the median age of 47.0 years. According to WHO2000 diagnostic criteria for cullomyelitis, mild dysplasia of cardiac glandular epithelium was classified as low grade intraepithelial neoplasia (LIN). High grade intraepithelial neoplasia (HIN) included severe dysplasia and intramucosal carcinoma. The cohort were detected cardia LIN55 cases, HIN31 cases and early invasive adenocarcinoma in 17 cases. According to the Chinese adult BMI classification criteria, <18.5 total body weight loss, 18.5 to 23.9 normal, 24.0 to 27.9 overweight, ≥ 28.0 obesity, a total of 4 points, with pathological diagnosis of normal population, cardiac gland intraepithelial neoplasia (LIN, HIN) and Early invasive cancer, the establishment of R × C contingency table, analysis of gastric cardia gland intraepithelial neoplasia and gastric cardia adenocarcinoma associated. Results: The normal pathological diagnosis of BMI was normal in men, with 62.3%, 64.1%, 81.0% and 83.0% for LIN, HIN and invasive carcinoma respectively, 34.5%, 33.3%, 19.0% and 16.7% for BMI> 24.0 %, χ2 = 6.675, P> 0.05 respectively; women were 51.7%, 56.3%, 70.0% and 40.0%, 45.4%, 43.8%, 30.0% and 60.0%, respectively. CONCLUSION: There is no correlation between changes of cardia LIN, HIN and early invasive carcinoma in different sites of BMI in the high incidence area of esophageal cancer in northern China. BMI may not be the main risk factor of cardia cancer.