膀胱癌之描述性流行病學、危險因子及遺傳易感受性

Descriptive Epidemiology, Risk Factors and Genetic Susceptibility of Urinary Bladder Cancer

許鈴宜(Ling-I Hsu) ； 陳建仁(Chien-Jen Chen)

《中華公共衛生雜誌》 18卷6期 (1999/12) Pp. 387-412

https://doi.org/10.6288/CJPH1999-18-06-03

摘要

本文綜述近年來膀胱癌的描述性流行病學特徵、危險因子、個人易感受性之文獻，並回顧台灣往年的研究成果。比較全世界各國之膀胱癌發生率，發現歐洲及北美洲為膀胱癌的高發生地區。膀胱癌好發於男性，發病年齡多在65歲以上。根據歐美的研究，膀胱癌的主要危險因子為抽菸及職業暴露，其可歸因百分比在男性分別可達50%及35%。進一步分析香菸成分及職業暴露資料，成認芳香胺類是膀胱癌的主要致癌物。此外，游離輻射、服用止痛藥、無機砷及有機氣暴露、住血吸蟲感染、膀胱發炎既往史、飲食因素等，也是重要的致病因子。個人遺傳易感受性的研究中，最常被探討的氮－乙醯轉移酵素(N-acetyltransferase, NAT)與麩胺硫轉移酵素(glutathione S-transferase, GST)之遺傳多形性與膀胱癌的相關性，前者並未有一致的結果，而後者則多數的証據支持有顯著正相關。台灣雖屬膀胱癌低發生地區，但高發生鄉鎮市區明顯集中於西南沿海，尤其以烏腳病盛行區的北門、學甲、布袋、義竹最高。一系到流行病學調查顯示，當地高砷飲用井水與膀胱癌的發生率有顯著相關。戴至目前，砷引起膀胱癌的致病機轉、分子遺傳模式、以及個人易感受性與環境暴露間的交互作用等，仍有待闡明。未來需要進行更多分子及遺傳流行病學研究，來闡明台灣－特別是烏腳病盛行地區膀胱癌發生的機轉。

關鍵字

膀胱癌 ； 描述性流行病學 ； 危險因子 ； 遺傳易感受性

並列摘要

This review focuses on the descriptive epidemiology, risk factors, and genetic susceptibility of urinary bladder cancer, including the recent studies in Taiwan. International comparison has shown Europe and North American are the high-incidence areas of bladder cancer. In these countries, the major risk factors of bladder cancer are cigarette smoking and occupational exposure with attributable risk percentages in males of 50% and 35% respectively. It has been well recognized that aromatic amines are the main urinary bladder carcinogens from tobacco smoke and occupational exposure. Ionic radiation, analgesics, arsenic exposure, drinking water containing chlorinated byproducts, S haematobium infection, urinary infection, and dietary factors are also attributable to an increased risk of urinary bladder cancer. Recent studies on individual susceptibility showed inconsistent association with urinary bladder cancer for N-acetyl transferase (NAT), but positive association was observed between glutathione S-transferase(GST) and bladder cancer. The incidence of bladder cancer is comparatively low in Taiwan, but areas with unexpected high incidence are clustered in southwestern Taiwan, especially in the endemic area of blackfoot disease(BFD) in Paimen, Hsuechia, Putai and Ichu. Several epidemiological investigations showed an increased incidence of bladder cancer associated with the long-term consumption of high- arsenic drinking water. However, the mechanism of arsenic-induced urinary bladder carcinogenesis, as well as the interaction between individual susceptibility and environmental exposure remain unclear. Further genetic and molecular epidemiological studies are essential for the elucidation of the carcinogenesis of urinary bladder cancer in the BFD area.

並列關鍵字

Bladder cancer ； descriptive epidemiology ； risk factors ； genetic susceptibility