Prevalence and risk factors of pulmonary nodules among the occupational population in Anshun
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摘要:
目的 肺结节作为早期肺癌最常见的临床征象，早期检出对肺癌防治具有重要意义。本研究基于安顺地区呼吸疾病筛查队列，分析安顺地区职业人群中肺结节特征并逐一探讨危险因素，为推动该地区肺癌防治、加强肺结节人群的管理提供数据支持。 方法 以安顺市人民医院2022年6月—2023年12月经胸部低剂量螺旋CT(LDCT)筛查的2 730名职业人群为研究对象，以问卷形式收集研究对象的人口学特征及个人行为习惯等信息，综合问卷信息及结节影像学特征，探讨肺结节、阳性结节的危险因素。 结果 (1) 职业人群检出肺结节1 921例，总检出率为70.36%，其中阳性结节914例，占总人群的33.48%，矿工人群中肺结节检出率最高。(2)男性、已婚、初中学历、吸烟史、二手烟暴露史、厨房无油烟机排风、接触有害物质且接触时间≥1年、父母呼吸系统疾病史是肺结节的独立危险因素。(3)不同职业人群间，肺结节的数目、位置存在差异，质地、大小、是否阳性在不同职业人群间差异无统计学意义。(4)厨房无油烟机排风、年龄＞50岁、吸烟指数＞30包年是交警阳性结节的独立危险因素。年龄＞50岁、吸烟指数＞30包年是矿工阳性结节的独立危险因素。厨房无油烟机排风是环卫、司机阳性结节的独立危险因素。 结论 肺结节在职业人群中高发，男性、已婚、吸烟史、二手烟暴露史、有害物质接触史、家族呼吸系统病史等是肺结节的独立危险因素。不同职业人群间肺结节的数目、位置存在差异。厨房无油烟机排风是各职业人群阳性结节的独立危险因素。 Abstract:Objective As the most common clinical indicator of early lung cancer, the early detection of pulmonary nodules is crucial for lung cancer prevention and treatment. Based on the screening cohort of respiratory diseases in Anshun city, this study analyzed the characteristics of pulmonary nodules in the occupational population and explored associated risk factors. The findings aim to support efforts in the prevention and treatment of lung cancer, and to improve management of individuals with pulmonary nodules in this region. Methods A total of 2 730 occupational individuals who underwent low-dose spiral computed tomography (LDCT) chest screening from June 2022 to December 2023 at Anshun People ' s Hospital were selected as research subjects. Demographic data and personal habits of these research subjects were collected through questionnaires at the beginning of the study. The questionnaire data were combined with imaging characteristics of the pulmonary nodules to explore risk factors for pulmonary nodules and positive nodules. Results (1) A total of 1 921 occupational individuals (70.36%) were found to have pulmonary nodules. Of these, 914 had positive nodules (33.48%). Miners had the highest prevalence of pulmonary nodules. (2) Risk factors of pulmonary nodules included being male, married, having a junior high school education, smoking, exposure to second-hand smoking, cooking without a range hood, exposure to hazardous substances for more than one year, and having parents with respiratory disease. (3) The number and location of pulmonary nodules varied among occupational groups, through no significant differences were observed in texture, size, or positivity across groups. (4) Cooking without a range hood, age over 50 years old, and smoking index more than 30 pack-years were independent risk factors for positive nodules among traffic police. For miners, smoking index more than 30 pack years and age over 50 years old were independent risk factors. Cooking without a range hood was the sole independent risk factor for positive nodules among sanitation workers and drivers. Conclusion Pulmonary nodules are highly prevalent in occupational individuals. Being male, married, smoking, exposure to second-hand smoking, exposure to hazardous substances, and a family history of respiratory disease are independent risk factors of pulmonary nodules. The number and location of pulmonary nodules among different occupational groups. Cooking without a range hood is a universal independent risk factor of positive nodules across all occupational individuals. -
Key words:
- Pulmonary nodules /
- Low-dose spiral CT /
- Prevalence rate /
- Risk factors /
- Questionnaire survey
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图 1 不同职业肺结节检出率
Figure 1. Detection rate of pulmonary nodules across different occupational group
表 1 肺结节检出情况
Table 1. Detection of pulmonary nodules
LUNG-RADS分级 例(%) 结节性质 例(%) 1 824(30.18) 阳性 914(33.48) 2 1 262(46.23) 阴性 1 007(36.89) 3 528(19.34) 无 809(29.63) 4A 96(3.52) 4B 15(0.55) 4X 1(0.04) S 0 C 2(0.07) 
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表 2 变量赋值情况
Table 2. Variable assignment
变量 赋值 变量 赋值 变量 赋值 性别 学历 吸烟指数(包年) 女性 0 文盲 0 ＜30 0 男性 1 小学 1 ≥30 1 婚姻 初中 2 厨房有无油烟机排风 未婚 0 高中及中专 3 有 0 已婚 1 本科及大专 4 无 1 有害物质接触史 研究生及以上 5 同事吸烟情况 未接触 0 个人吸烟 不吸烟 0 接触时间＜1年 1 从不吸烟 0 吸烟 1 接触时间≥1年 2 吸烟 1 同事是否戒烟 父亲患呼吸系统疾病 母亲患呼吸系统疾病 已戒烟 0 否 0 否 0 是 1 是 1
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表 3 肺结节影响因素的二元logistic回归分析
Table 3. Binary logistic regression analysis of factors influencing pulmonary nodules
变量 B SE Waldχ2 P值 OR值 95% CI 性别(男性) 0.237 0.092 6.640 0.010 1.267 1.058~1.517 婚姻状况(已婚) 0.621 0.260 5.717 0.017 1.861 1.118~3.095 学历 小学 0.309 0.164 3.556 0.059 1.163 0.988~1.879 初中 0.040 0.151 8.459 0.004 1.552 1.154~2.087 高中/中专 0.238 0.171 1.937 0.614 1.269 0.907~1.774 本科/大专 0.093 0.179 0.270 0.603 1.098 0.773~1.519 研究生及以上 0.215 1.232 0.010 0.919 1.133 0.101~12.684 有害物质接触史 接触时间＜1年 0.257 0.166 2.383 0.123 1.293 0.933~1.790 接触时间≥1年 0.301 0.123 6.048 0.014 1.352 1.063~1.719 厨房有无油烟机排风(无) 0.400 0.112 12.763 ＜0.001 1.492 1.198~1.859 个人吸烟(吸烟) 0.973 0.508 10.173 0.013 3.765 1.068~ 5.412 吸烟指数(＞30包年) 0.414 0.140 8.708 0.003 1.513 1.149~1.991 同事吸烟情况(吸烟) 0.274 0.088 9.749 0.002 1.315 1.107~1.562 同事是否戒烟(未戒烟) 0.741 0.295 6.299 0.012 2.098 1.176~3.742 母亲患病(是) 0.375 0.142 7.009 0.008 1.454 1.102~1.919 父亲患病(是) 0.236 0.132 4.838 0.047 1.364 1.056~ 1.684
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表 4 不同职业人群的肺结节影像学特征[例(%)]
Table 4. Imaging characteristics of pulmonary nodules in different occupational populations[cases(%)]
项目 交警
(n=148)矿工
(n=657)环卫
(n=743)城管
(n=41)司机
(n=332)总计
(n=1 921)χ2值 P值 数目 15.135 ＜0.001 单发 69(46.62) 223(33.94) 304(40.92) 20(48.78) 138(41.57) 754(39.30) 多发 79(53.38) 434(66.06) 439(59.08) 21(51.22) 194(58.43) 1 167(60.70) 位置 10.212 ＜0.001 左肺上叶 59(39.86) 207(31.51) 233(31.36) 13(31.71) 119(35.84) 631(32.85) 左肺下叶 27(18.25) 121(18.42) 140(18.84) 10(24.39) 75(22.59) 373(19.42) 右肺上叶 20(13.51) 152(23.14) 153(20.59) 4(9.76) 63(18.98) 392(20.41) 右肺中叶 18(12.16) 61(9.28) 79(10.63) 6(14.63) 33(9.94) 197(10.26) 右肺下叶 24(16.22) 116(17.65) 138(18.58) 8(19.51) 42(12.65) 328(17.06) 质地 19.725 0.511 实性 89(60.14) 438(66.67) 514(69.18) 28(68.29) 242(72.89) 1 311(68.25) 纯磨玻璃 53(35.81) 204(31.05) 220(29.61) 11(26.83) 88(26.51) 576(29.98) 部分实性 6(4.05) 15(2.28) 9(1.21) 2(4.88) 2(0.60) 34(1.77) 直径 7.709 0.122 ＜5 mm 75(50.68) 263(40.03) 422(56.80) 22(53.66) 219(65.96) 1 001(52.10) 5~15 mm 72(48.65) 387(58.90) 315(42.40) 18(43.90) 113(34.04) 905(47.10) ＞15 mm 1(0.67) 7(1.07) 6(0.80) 1(2.44) 0 15(0.80) 性质 7.890 0.051 阳性 74(50.00) 386(58.75) 319(42.93) 20(48.78) 115(34.64) 914(47.58) 阴性 74(50.00) 271(41.25) 424(57.07) 21(51.22) 217(65.36) 1 007(52.42)
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表 5 不同职业人群肺结节影响因素变量赋值情况
Table 5. Variable assignment of factors influencing pulmonary nodules in different occupational populations
变量 赋值 变量 赋值 变量 赋值 性别 从业年限(年) 吸烟指数(包年) 女性 0 ＜3 0 0~14 0 男性 1 3~5 1 15~30 1 婚姻 6~10 2 ＞30 2 未婚 0 11~20 3 是否做饭 已婚 1 ＞20 4 否 0 年龄 个人吸烟 是 1 ＜50岁 0 从不吸烟 0 厨房有无油烟机排风 ≥50岁 1 吸烟 1 有 0 无 1
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表 6 交警人群不同性质结节影响因素的二元logistic回归分析
Table 6. Binary logistic regression analysis of factors influencing nodule characteristics in the traffic police population
变量 B SE Waldχ2 P值 OR值 95% CI 性别(男性) 1.247 0.475 6.884 0.009 1.287 1.113~2.729 个人吸烟(吸烟) 1.675 0.768 5.661 0.026 1.998 1.201~ 3.475 厨房有无油烟机排风(无) 0.879 0.344 6.531 0.011 2.409 1.227~4.728 年龄(≥50岁) 1.064 0.484 4.837 0.028 0.345 0.134~0.891 吸烟指数(>30包年) -0.268 0.388 0.478 0.489 0.765 0.357~1.636 注：以性别为女性、从不吸烟、有厨房油烟机排风、年龄 < 50岁、吸烟指数0~14包年为参照。
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表 7 矿工人群不同性质结节影响因素的二元logistic回归分析
Table 7. Binary logistic regression analysis of factors influencing nodule types in the miner population
变量 B SE Waldχ2 P值 OR值 95% CI 年龄(≥50岁) 0.483 0.202 5.749 0.017 1.617 0.416~1.916 吸烟指数(包年) 15~30 -0.223 0.195 1.315 0.251 0.800 0.546~1.171 ＞30 1.567 0.342 1.480 0.047 1.268 1.216~ 1.998 注：以年龄 < 50岁、吸烟指数0~14包年为参照。
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