ABO血型与胰腺癌的病因学评价

1、ABO血型与胰腺癌的病因学评价某男，52岁，某工厂职工，B型血。因陪同同厂一B型血胰腺癌患者就医，并被告知B型血有较高患胰腺癌风险，且病死率为99%，故惶惶不可终日，前来咨询。患者询问：血型是否与胰腺癌有关？病例检索问题词根： ABO blood group疾病： Pancreatic Cancer检索结果 Wolpin BM, Chan AT, Hartge P, Chanock SJ, Kraft P, Hunter DJ, Giovannucci EL, Fuchs CS. ABO blood group and the risk of pancreatic cancer. J Natl

2、 Cancer Inst 2009; 101: 424-431主要内容A total of 107 503 subjects were included in this analysis. During 10 years of following-up between 1996 and 2005, 316 participants (199 female nurses and 117 male health professionals) developed pancreatic cancer. ABO blood type was associated with the risk of dev

3、eloping pancreatic cancer. Compared with participants with blood group O, those with blood groups A, AB, or B were more likely to develop pancreatic cancer (adjusted hazard ratios for incident pancreatic cancer were 1.32, 1.51 and 1.72, respectively).17% of the pancreatic cancer cases were attributa

4、ble to inheriting a non-O blood group (blood group A, B, or AB).Figure 1 . Cumulative pure incidence curves for pancreatic cancer by ABO blood group. Number of participants at risk is shown for selected times.分析评价真实性重要性适用性真实性1、测量结果是否具有真实性 blood group in this study was self-reported, making it suscep

5、tible to measurement error due to inaccurate reporting. However, because all participants were health care professionals, the accuracy of the reports is likely to be high.2、研究对象是否能代表所研究的目标人群 不能完全代表。研究对象为白种人，且是医务工作者。3、研究方法论证强度 采用prospective cohort studies，可行性较好，论证强度+4、随访时间是否足够？随访是否完整？ 本文提及了队列的开始时间及终止

6、时间，随访时间足够。问卷调查的应答率 为100%（调查方式决定）。真实性5、是否对影响结局的重要因素进行了统计学的校正 是。采用COX比例风险模型进行多因素分析，可以矫正多个混杂因素（年 龄、性别、体重、吸烟、糖尿病、遗传）的影响。6、病因学研究因果效应的先后顺序是否合理 当然。先有血型，再有癌症。7、病因学研究的结果是否符合流行病学的规律 不存在这种关系。 真实性8、病因致病的因果关系是否在不同的研究中反映出一致性 是。已有多个队列研究、病例对照研究涉及血型与胰腺癌之间的关系， 结果都是肯定的。9、病因致病的生物学依据是否充分研究发现，与周围正常导管细胞相比，胰腺癌细胞表面的A、B、H抗原丢

7、失或者异常。这些糖蛋白在免疫监视中有重要作用；慢性炎症状态：ABO基因位点的SNPs与TNF-和IAM-1与的密切关系；HP与ABO抗原糖蛋白之间的相互作用。重要性和适用性hazard ratios (HR)：ABO blood type was associated with the risk of developing ancreatic cancer ( P = .004; log-rank test). Compared with participants with blood group O, those with blood groups A, AB, or B were more likely to develop pancreatic cancer (adjusted HR for incident pancreatic cancer were 1.32 95% confidence interval CI = 1.02 to 1.72, 1.51 95% CI = 1.02 to 2.23, and 1.72 95% CI = 1.25 to 2.38, respectively). 用于指导防治政策。有血型的危险因素时，就要更加注意其他已知危险因