28.hwp

Size: px

Start display at page:

Download "28.hwp"

상미 예
5 years ago
Views:

1 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology Vol.6, No.11, November (2016), pp 국내일부지역의식도암발생위험요인과관련된요인 이성란 요약 본연구는국내일부지역의식도암발생위험요인과관련된요인을규명하기위해수행하였다자료는년월일부터년월일까지서울지역에소재한종합병원내과에내원한환자군명대조군명을대상으로시행하였다연구대상자의일반적인특성과의료행태와관련된요인은를시행하였다식도암위험요인간의교치비를구하기위해를사용하였다연구결과는다음과같다첫째가족력을보면가족력이있는경우환자군이로대조군의보다유의하게높게나타났다둘째고혈압여부는고혈압이있는경우환자군은대조군은로환자군이대조군보다유의하게높은분포를보였다셋째성별은여성에비해남성에서식도암의위험요인이배유의하게높게나타났다넷째남성현재흡연을할수록당뇨병과복부비만이있는경우식도암위험요인이유의하게나타났다이러한결과를토대로식도암의효과적인예방은교육및검진이요구된다고본다핵심어식도암흡연복부비만가족력검진 Abstract This study was attempted to identify the factors influencing on esophageal cancer incidence of local area in Korea. A total of 76 incident cases of esophageal cancer admitted to the department of internal medicine in a general hospital form December 1, 2015 to January 31, 2016 were compared with 76 matched controls admitted to same hospital in same period. Factors associated with general characteristics and medical behaviors were performed using Chi-square test. Odds ratio between risk factors of esophageal cancer were analyzed using multiple logistic regression analysis, Major findings are as follows. Firstly, for family history, case groups who have family history were significantly higher than control group(x 2 =1.67, p<.05). Secondly, case group who have hypertension were significantly higher than control group(x 2 =2.96, p<.05). Thirdly, for gender, men were significantly higher 3.12 times than women in risk factor of esophageal cancer(or=3.12, 95% Cl= ). Fourthly, through the logistic regression, it were statistically associated factors with esophageal cancer in subjects who were abdominal Received (September 3, 2016), Review Result (September 21, 2016) Accepted (September 28, 2016), Published (November 30, 2016) ISSN: AJMAHS Copyright 2016 HSST 319

2 obesity, diabetes mellitus, current smoking(p<.05). Based on this study, for effective prevention of the esophageal cancer, it is required to education and screening examination. Keywords : Esophageal cancer, Smoking, Abdominal obesity, Family history, Screening examination 서론 식도암은식도에서발생하는악성종양이다국내전체암사망률의를차지하고있다주로대사이의남성에게서자주발생하는질환이다주로세이상의연령층에서발생하고남성이여성보다배가량많다식도암은아직정확하게밝혀져있지않다식도암의원인중가장위험한것은음주흡연등으로음주와흡연을동시에하는경우식도암발생률이훨씬높다양잿물이나다른화학약품을마신경우에도식도암의위험이증가하며기타식도의선천성이상이나다른질병이있으며식도에만성염증이오래지속되는경우식도암의발생률이증가하게된다그러나뚜렷한위험인자가없어도식도암이생기는경우가많다식도암은식도에서발생되는것으로서연하곤란이주증상으로나타나는암이다식도암은상당히진행될때까지증상이없으며증상이나타났을때에는이미다른곳으로전이된경우가많다대표적인증상은음식물을삼키기힘든연하곤란이며이상의식도암에서나타난다처음에는고형음식을삼킬때에만불편감을느끼지만점차부드러운유동식을넘길때에도어려움을겪게되고나중에는물조차삼킬수없게된다식도암의연하곤란은만성적으로계속진행되며호전되지않는다체중감소도흔히발생한다연하통은연하곤란보다드물지만또하나의주요한증상이다전형적인연하통은지속적이고둔한통증이며등으로뻗치는듯한증상이흔하다심한지속성통증이있으면전이를의심해야한다그외에도구토출혈쉰목소리만성기침이나타날수있고소화액음식물이물질등이기도로잘못흡인되어야기되는흡인성폐렴이발생할수있다식도암은초기에는별다른증상이없어조기진단이어렵다식도암수술은암이처음진단되었을때이미주변조직으로퍼져있거나원격전이가발생한경우가많으므로최근에는식도암의치료를수술에만의존하지않고식도절제와항암화학요법및방사선치료를함께적용하는병합요법을시행하기도한다식도암은국가혹은지역에따라발생빈도의차이가커발생원인으로는식생활과토양그리고수질에따른영향으로알려져있다국내에발생되는식도암은대부분편평상피세포암으로환경적인인자들이외에흡연과음주가주된발병원인으로보도되고있다식도암의병리적증상이식도에국한되어있을경우에는외과적절제가가장중요한치료법이다외과적절제방법은국소재발방지와근본적치료를위한절제를목적으로시행하며식도와주변의림프절과종격동지방조직을함께광범위하게절제하는방법을주로사용한다그러나이런광범위절제가쉽지않고암이처음진단되었을때이미주변조직으로퍼져있거나원격전이가발생한경우가많으므로최근에는식도암의치료를수술에만의존하지않고식도절제와항암화학요법및방사선치료를함께적용하는병합요법을 320 Copyright 2016 HSST

3 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology Vol.6, No.11, November (2016) 시행하기도한다아직까지식도암치료에적용되는일관된원칙은수립되지않은상태이며환자의전신상태및여러다른요건들을고려하여치료방침을적절하게선택해야한다질병의예후는병의단계에따라다르지만전체적으로볼때예후가좋지않으며년생존율은정도이다따라서본연구는국내일부지역식도암발생위험요인들과관련된요인들을규명하기위해시행하였다이를통해식도암의사망률과유병률을감소시키는데있다 연구대상 연구대상및방법 본연구대상은식도암진단을받은서울지역에소재한종합병원의내과에내원한환자들을조사하였다환자군은명대조군도명으로식도암환자중중환자실의환자들은조사대상자에서제외하였다자료수집은설문조사로년월일부터년월일까지실시하였다훈련된조사원을통해설문및면접조사를하였다총표본크기는임의로할당한부중자료가부실하거나누락된설문지를제외하고최종부로분석하였다 연구방법 연구대상자의일반적인특성은를시행하였다연구대상자의의료행태와관련된요인은를시행하였다식도암위험요인의교차비는를사용하였다 연구대상자의일반적특성 연구결과 연구대상자의일반적인특성은표과같다연령별로보면세가환자군이대조군이로대조군이환자군보다높은분포를보였다성별로보면남성은환자군이대조군은로환자군이대조군보다유의하게높은분포를보였다가족력을보면가족력이있는경우환자군이로대조군의보다유의하게높게나타났다 ISSN: AJMAHS Copyright 2016 HSST 321

4 표 연구대상자의일반적특성 변수연령 N(%) 환자군 대조군 X (41.7) 7(58.3) (43.2) 21(56.8) (45.3) 29(54.7) (62.0) 19(38.0) 성별 남성 99 59(59.6) 40(40.4) 2.48* 여성 53 17(32.1) 36(67.9) 결혼기혼 (54.4) 47(45.6) 7.15 미혼 49 20(40.8) 29(59.2) 교육수준중졸이하 42 17(40.5) 25(59.5) 11.3 고졸 71 36(50.7) 35(49.3) 대졸이상 39 23(59.0) 16(41.0) 소득 (51.7) 28(48.3) (55.8) 19(44.2) 미만 (43.1) 29(56.9) 가족력유 94 57(60.6) 37(39.4) 1.67* 무 58 19(32.8) 39(67.2) 연구대상자의의료행태와관련된요인 연구대상자의의료행태와관련된요인은표과같다고혈압여부는고혈압이있는경우환자군은대조군은로환자군이대조군보다유의하게높은분포를보였다당뇨병이있는경우환자군이대조군이로환자군이대조군보다유의하게높은분포를보였다음주여부를보면음주를하는경우환자군이로대조군의보다유의하게높게나타났다 322 Copyright 2016 HSST

5 표 연구대상자의의료행태와관련된요인 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology onvergence Research Letter Vol.6, No.11, November (2016) Vol., No., (2016), pp. 변수 N(%) 환자군대조군 X 2 BMI 유 (57.9) 45(42.1) 5.18* 무 45 14(31.1) 31((68.9) 고혈압유 98 66(67.3) 32(32.7) 2.96* 무 54 10(18.5) 44(81.5) 흡연여부 금연 42 18(42.9) 24(57.1) 10.41* 과거흡연 89 51(57.3) 38(42.7) 현재흡연 21 7(33.3) 14(66.7) 당뇨병유 54 37(68.5) 17(31.5) 5.72* 무 98 39(39.8) 59(60.2) 음주음주 92 57(62.0) 35(38.0) 3.04* 금주 60 19(31.7) 41(68.3) 규칙적운동시행 59 32(54.2) 27(45.8) 6.59 비시행 93 44(47.3) 49(52.7) 식도암위험인자간의교차비 식도암위험요인간의교차비의유의성은표과같다성별에있어여성에비해남성에서식도암의위험요인이배유의하게높게나타났다당뇨병의유무에있어당뇨병이있는경우가당뇨병이없는경우보다배유의하게높은분포를보였다 표 식도암위험요인간의교차비 변수 OR 95% Cl 가족력유 1.00 무 성별여성 1.00 남성 ISSN: AJMAHS Copyright 2016 HSST 323

6 고혈압무 1.00 유 당뇨병무 1.00 유 흡연비흡연 1.00 현재흡연 음주금주 1.00 음주 복부비만무 1.00 유 식도암위험인자에영향을미치는요인 식도암위험인자에독립적인관련요인을파악하기위해개별관련요인들을독립변수로하여다변량로지스틱회귀분석을시행하였다표남성현재흡연을할수록당뇨병과복부비만이있는경우식도암의위험요인이유의하게나타났다 표 식도암위험인자에영향을미치는요인 변수 β OR 95% Cl 성별 흡연 당뇨병 복부비만 고찰 본연구는국내일부지역중년의식도암발생위험요인과관련된요인을규명하기위해수행하였다본연구결과성별에따른식도암의위험인자를보면식도암환자로진단받은환자중남성이약배높게나타났다선행연구에서남성은여성에비해위암으로인한사망할확률이약배많다고보고한연구와유사하다이는성별에따라치료에대한접근도에차이가있을수있겠지만성별에따른식도암의위험요인이다름을인식하고조기선별및개별화된관리가필요하다고여겨진다 324 Copyright 2016 HSST

7 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology Vol.6, No.11, November (2016) 본연구결과흡연은현재흡연이비흡연보다식도암교차비가배높게나타나흡연이식도암의주요위험인자로보았던선행연구들과일치하였다본연구에서는여성의흡연률이미비해서남녀를총괄해서분석하였다추후성별로구분한연구방법을시도해보는것이고려되며조절할수있는위험인자인흡연을막기위한구체적이고전략적인방안이필요하다고사료된다복부비만의경우본연구에서환자군에서정상군에비해복부비만이유의하게많은것으로나타났다이는복부둘레가유의하지않았던선행연구와일치된견해를보인다이는복부둘레측정당시남성은이상여성은이상의기준으로적용할때중년이상의연령층이복부비만에해당하는경우가상대적으로많았기때문에식도암환자결과에영향을미쳤을것으로본다본연구의제한점은단편적인환자대조군연구로고혈압당뇨병등의관련요인이식도암에미치는직접적인영향을파악하기위해서는연구대상자를확대한장기적이고포괄적인코호트연구가필요하다그러나본연구에서는대부분의선행연구들이단편적인개별요인을고찰했음에반해본연구는최근새롭게부각되고있는복부비만을포함하여현병력의유무를고려하여분석하였다는데연구의의의가있다 결론 본연구는국내일부지역식도암발생위험요인과관련된요인을규명하기위해수행하였다본연구대상은식도암진단을받은서울지역에소재한종합병원의내과에내원한환자들을대상으로하였다환자군명과대조군명인총명을조사하였다자료수집은설문조사로년월일부터년월일까지실시하였다연구결과는다음과같다연구결과첫째가족력을보면가족력이있는경우환자군이로대조군의보다유의하게높게나타났다둘째고혈압여부는고혈압이있는경우환자군은대조군은로환자군이대조군보다유의하게높은분포를보였다셋째성별은여성에비해남성에서식도암의위험요인이배유의하게높게나타났다넷째남성현재흡연을할수록당뇨병과복부비만이있는경우식도암위험요인이유의하게나타났다이러한결과를토대로식도암의효과적인예방은교육및검진이요구된다고본다 ISSN: AJMAHS Copyright 2016 HSST 325

8 References [1] Statistics Korea (2016), Annual Report on the Cause of Death Statistics. pp [2] X. Zhang, D. I, Watson, G. G. Jamieson, J. R. Bessell, P. G. Devitt, Neoadjuvant Chemoradiotherapy for Esophageal Carcinoma, Dis Esophagus, (2005), Vol. 18, pp [3] J. D. Urschel, S. Ashiku, R. Thurer, F. W, Sellke, Salvage or Planned Esophagectomy After Chemoradiation Therapy for Locally Advanced Esophageal Cancer, Dis Esophagus, (2003), Vol. 16, No. 1, pp [4] W. Wei, L. Lam, P, Yuen, J. Wong, Current Status of Pharyngolaryngo-esophagectomy and pharyngogastric anastomosis, Head Neck (2008), No. 20, pp [5] D, Vallbohmer, H. J. Lenz, Predictive and Prognostic Molecular Markers in Outcome of Esophageal Cancer, Dis Esophagus, (2006), Vol. 19, pp [6] J. B. Dimick, S. M. Cattaneo, P. A. Lipsett, P. J. Pronovost, R. F. Heitmiller, Hospital Volume is Related to Clinical and Economic Outcomes of Esophageal Resection in Maryland, Ann Thorac Surg. (2001), Vol. 72, pp [7] J. M. Blazeby, J. R. Farndon, J. Donovan, D. Alderson, A Prospective Longitudinal Study Examing the Quality of Life in Patients with Esophageal Carcinoma, Cancer, (2000), Vol. 88, No. 8, pp [8] A. S. Bloch, Nutrition Management of the Cancer Patient, Maryland, Aspen Publishers, (2000), pp [9] K. C. Calman, Quality of Life in Cancer Patients An Hypothesis, J Med Ethics, (2004), Vol. 10, No 3, pp [10] H. C. Fernando, I. D. Luketich Quality of Life After Esophageal Surgery, Thorac Surg Clinics, (2004), Vol. 14, No. 3, pp [11] B. R. Ferrell, K. H. Dow, M. Grant, Measurement of the Quality of Life in Cancer Survivors, Quality of Life Research, (2005), Vol. 4, No. 5, pp [12] P. A. Ganz, J. J. Lee, J. Siau, Quality of Life Assessment : An Independent Prognostic Variable for Survival in Lung Cancer, Cancer, (2001), Vol. 67, pp [13] M. Keane, Encyclopedia and Dictionary of Medicine, Nursing and Allied Health 6th Philadelphia, Saunders, (2007) [14] C. E. Kight, Nutrition Considerations in Esophagectomy Patients, Nutrition in Clinical Practice, (2008), Vol. 23, No. 5, pp Copyright 2016 HSST

서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of