大腸直腸癌與壓力及其相關因子之病例對照研究

A case-control study of colorectal cancer, stress and its related risk factors.

陳長暉(Chang-Hui Chen)

指導教授 ： 王理

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2010年)

https://doi.org/10.6834/CSMU.2010.00080

摘要

研究目的：探討生活壓力及其相關因子在大腸直腸癌患者與非大腸直腸癌患者是否有所不同，以瞭解影響台灣民眾罹患大腸直腸癌是否與生活壓力及其相關因素相關。
研究背景：台灣大腸直腸癌的發生率與死亡率均不斷提高，目前為國內發生人數最多的癌症；大腸直腸癌的發生是複雜的機制，包括生活方式、飲食等因子；而壓力可能直接或間接引起大腸直腸癌的發生。
材料方法：本研究是一項以醫院為基礎的病例對照研究，收集病例組168人，對照組與病例組以年齡與性別進行1：1的配對，以結構式問卷作為資料收集工具；以條件式邏輯斯迴歸及邏輯斯迴歸等統計方法進行分析，以探討危險因子與大腸直腸癌的關係。
研究結果：結果顯示職業類別會影響大腸直腸癌的發生，吸菸、排便狀況不規律、高度炸烤類食物攝取與有大腸直腸癌家族史是大腸直腸癌發生的危險因子，增加飲水量、兩到三日飲用綠茶的習慣與較多的蔬果類食物攝取均可降低罹患大腸直腸癌的危險。多變項調整後，高度壓力對於大腸直腸癌的發生是危險因子(AOR=4.52，95%CI=1.62-12.59)，並且具有顯著的劑量效應關係(P-trend=0.010)。在雙變項分層後壓力與大腸直腸癌危險性的分析，在無吸菸組別(AOR=4.23，95%CI=1.63-11.05)、低身體活動量(AOR=8.70，95%CI=2.13-35.54)、低飲水量(AOR=15.39，95%CI=2.82-84.18)、無綠茶飲用習慣(AOR=4.77，95%CI=1.73-13.18)、排便狀況規律(AOR=6.40，95%CI=2.31-17.75)、炸烤類食物攝取程度低(AOR=13.97，95%CI=2.62-74.63)與蔬果類攝取程度低(AOR=5.32，95%CI=1.02-27.87)發現高度壓力對於大腸直腸癌的發生有顯著較高的危險。
結論：大腸直腸癌的發生受到生活型態、遺傳、壓力等多因子的影響，壓力高會提高大腸直腸癌發生的危險，也會與其他因子相互影響大腸直腸癌的發生。

關鍵字

大腸直腸癌 ； 壓力 ； 生活型態

並列摘要

Objective: This study is to examine the difference between life stress and related risk factors of colorectal cancer patients and non-cancer patients in order to realize the role of life stress and its related risk factors in colorectal cancer in Taiwan.
Background: Colorectal Cancer incidence and mortality has gradually increased in Taiwan and is the most commonly occurred cancer. It is a multistep carcinogenesis with many associated factors, which include life factors and diet. Stress may also directly or indirectly induce colorectal cancer.
Method: This study was based on a hospital-based case-control study of 168 patients with colorectal cancer and 168 controls who did not have cancer. They were matched through age and sex by a 1:1 ratio. Subjects information was collected through face-to-face interviews using structured questionnaires. Conditional logistic regression and binary logistic regression analyses were used to analyze the association between the factors and colorectal cancer.
Results: Our results show that occupation was associated with the occurrence of colorectal cancer. Smoking, chewing betel quid, unusual bowel movements, heavy consumption of fried food, as well as a family history of colorectal cancer will increase the occurrence of colorectal cancer. Increased water intake, drinking green tea every two to three days, and an increased diet of vegetables will reduce the risk of colorectal cancer. After multivariate adjustments, high levels of stress was concluded to be a risk factor of colorectal cancer (AOR=4.52, 95%:1.62-12.59) with a significant trend (P=0.010). Bivariate stratified analyses showed that there is a significant positive association between stress and colorectal cancer in patients who were non-smokers (AOR=4.23, 95%:1.63-11.05), had low levels of physical activity (AOR=8.70, 95%:2.13-35.54), insufficient levels of water consumption (AOR=15.39, 95%:2.82-84.18), did not consume green ten (AOR=4.77, 95%:1.73-13.18), casual bowel habits (AOR=6.40, 95%CI:2.31-17.75), low levels of fried food consumption (AOR=13.97, 95%CI=2.62-74.63) and low levels of vegetable consumption (AOR=5.32, 95%CI=1.02-27.87).
Conclusion: Lifestyle, genetic factors, and stress are all associated with colorectal cancer. High levels of stress will increase the risk of colorectal cancer in conjunction with the other risk factors.

並列關鍵字

Colorectal cancer ； stress ； life style

參考文獻

Yeh, C. C., Hsieh, L. L., Tang, R., Chang-Chieh, C. R. & Sung, F. C. (2003). Risk factors for colorectal cancer in Taiwan: a hospital-based case-control study. Journal of the Formosan Medical Association, 102(5), 305-312.

初麗娟和高尚仁（民95）。壓力知覺對負面心理健康影響：靜坐經驗、情緒智能調節效果之探討。中華心理學刊，47（2），147-149。

國民健康局 (民89)。中華民國八十六年癌症登記報告。行政院衛生署國民健康局。

國民健康局 (民98)。中華民國九十七年癌症登記報告。行政院衛生署國民健康局。

Adams, K. F., Leitzmann, M. F., Albanes, D., Kipnis, V., Mouw, T., Hollenbeck, A. & Schatzkin, A. (2007). Body mass and colorectal cancer risk in the NIH-AARP cohort. Am J Epidemiol, 166(1), 36-45.