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Article(id=1241342456822820867, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241342451043061769, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202304217, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1681228800000, receivedDateStr=2023-04-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773888704733, onlineDateStr=2026-03-19, pubDate=1708790400000, pubDateStr=2024-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773888704733, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773888704733, creator=13701087609, updateTime=1773888704733, updator=13701087609, issue=Issue{id=1241342451043061769, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773888703356, creator=13701087609, updateTime=1773893026321, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241360582939562716, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241342451043061769, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241360582939562717, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241342451043061769, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=619, endPage=624, ext={EN=ArticleExt(id=1241342457607155735, articleId=1241342456822820867, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Associations between dietary vitamin andglioma: a case-control study based on Chinese, columnId=1240375107953161116, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Foold Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the relationship between dietary vitamins A, vitamin C and vitamin E and glioma in Chinese population.

Methods

Based on the case-control study of 1:1 individual matched, a questionnaire survey was carried out on 343 patients with glioma and 343 healthy controls. The intake of three dietary vitamins was evaluated through the food frequency questionnaire, and the intake of dietary vitamins and gloima was analyzed by logistic regression, and explored the dose-response relationship between the two.

Results

Compared with the lowest quantile, the highest quantile of dietary vitamin A intake was associated with a decrease in overall glioma risk (OR=0.10, 95% CI: 0.04-0.30), astrocytoma risk (OR=0.71, 95% CI: 0.59-0.86), glioblastoma risk (OR=0.86, 95% CI: 0.78-0.96), low-grade glioma risk (OR=0.65, 95% CI: 0.47-0.91), and high-grade glioma risk(OR=0.87, 95% CI: 0.80-0.94).The highest quantile of dietary vitamin C intake was associated with a decrease in overall glioma risk (OR=0.02, 95% CI: 0.01-0.08), astrocytoma risk (OR=0.69, 95% CI: 0.54-0.87), glioblastoma risk (OR=0.82, 95% CI: 0.74-0.91), low-grade glioma risk (OR=0.75, 95% CI: 0.62-0.91) and high-grade glioma risk (OR=0.79,95% CI: 0.72-0.86). However, dietary vitamin E intake was only associated with an increased risk of astrocytoma (OR=2.99, 95% CI: 1.23-7.30).There was a significant linear dose-reaction relationship between the two, but the results of vitamin E were inconsistent and should be treated with caution.

Conclusion

High intake of dietary vitamin A and vitamin C may be associated with a reduced risk of glioma, but the impact of vitamin E on different clinical subtypes of glioma is not consistent. In the future, prospective studies should be conducted to further verify the association between these dietary vitamins and glioma.

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目的

了解中国人群中膳食维生素A、维生素C和维生素E与胶质瘤的关系。

方法

基于1：1个体匹配的病例对照研究，对343例胶质瘤患者和343例健康对照进行问卷调查和体格测量，通过食物频率问卷评估三种膳食维生素的摄入量，采用 logistic 回归分析膳食维生素摄入量与胶质瘤风险的关联性，并探索二者之间的剂量-反应关系。

结果

与最低分位数相比，最高分位数的膳食维生素A摄入量与胶质瘤总体风险（OR=0.10，95% CI：0.04~0.30）、星形细胞瘤风险（OR=0.71，95% CI：0.59~0.86）、胶质母细胞瘤风险（OR=0.86，95% CI：0.78~0.96）、低级别胶质瘤风险（OR=0.65，95% CI：0.47~0.91）和高级别胶质瘤风险（OR=0.87，95% CI：0.80~0.94）降低有关，最高分位数的膳食维生素C摄入量与胶质瘤总体风险（OR=0.02，95% CI：0.01~0.08）、星形细胞瘤风险（OR=0.69，95% CI：0.54~0.87）、胶质母细胞瘤风险（OR=0.82，95% CI：0.74~0.91）、低级别胶质瘤风险（OR=0.75，95% CI：0.62~0.91）和高级别胶质瘤风险（OR=0.79，95% CI：0.72~0.86）降低有关.但膳食维生素E摄入量仅与星形细胞瘤风险升高有关（OR=2.99，95% CI：1.23~7.30）。膳食维生素A和维生素C摄入量与胶质瘤风险之间存在显著的剂量-反应关系。

结论

摄入较多的膳食维生素A和维生素C可能与胶质瘤风险降低相关，但维生素E对不同临床亚型的胶质瘤的影响并不一致。在未来，应通过前瞻性研究进一步验证这些膳食维生素与胶质瘤的关联性。

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韩丽军，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=0h14I+XsJz4Dy3BVxlXn3A==, magXml=48MaroZxivWt1PJi+7F7WQ==, pdfUrl=null, pdf=jVrIQsLOIxqT+q/EFUAJLg==, pdfFileSize=983287, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=G5Dn88fN8IzK4QIl/l976w==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=qrFC/VcLFwtRiG2s1Ne+tQ==, mapNumber=null, authorCompany=null, fund=null, authors=

王磊（1980—），女，本科，主管护师，研究方向：神经肿瘤护理

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Oncotarget, 2017, 8(41): 70366-70377., articleTitle=A prospective study of serum metabolites and glioma risk, refAbstract=null), Reference(id=1241359976720035962, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, doi=null, pmid=null, pmcid=null, year=2010, volume=10, issue=null, pageStart=215, pageEnd=null, url=null, language=null, rfNumber=[25], rfOrder=29, authorNames=Delorenze GN, Mccoy L, Tsai AL, journalName=BMC Cancer, refType=null, unstructuredReference=Delorenze GN, Mccoy L, Tsai AL, et al. Daily intake of antioxidants in relation to survival among adult patients diagnosed with malignant glioma[J]. BMC Cancer, 2010, 10: 215., articleTitle=Daily intake of antioxidants in relation to survival among adult patients diagnosed with malignant glioma, refAbstract=null)], funds=[Fund(id=1241359974102790194, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, awardId=RCYJ-2020-LWB, language=CN, fundingSource=北京天坛医院人才引进(RCYJ-2020-LWB), fundOrder=null, country=null), Fund(id=1241359974157316149, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, awardId=null, language=CN, fundingSource=2020年国家和省级临床重点专科能力建设项目, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241359967207355294, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, xref=null, ext=[AuthorCompanyExt(id=1241359967215743903, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, companyId=1241359967207355294, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Departent of Comprehensive Neuro-Oncology Treatment, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China), AuthorCompanyExt(id=1241359967228326816, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, companyId=1241359967207355294, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=首都医科大学附属北京天坛医院神经肿瘤综合治疗，北京 100070)])], figs=[ArticleFig(id=1241359971653316629, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=EN, label=Fig.1, caption=Dose-response relationship between dietary vitamins and glioma (A: Vitamin A, B: Vitamin C), figureFileSmall=5Tg3w0frMnu+UbNf5WBwPQ==, figureFileBig=j9//jS+mWLMl5jUWO9Girg==, tableContent=null), ArticleFig(id=1241359971733008408, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=CN, label=图1, caption=膳食维生素与胶质瘤的剂量-反应关系(A:维生素A，B：维生素C), figureFileSmall=5Tg3w0frMnu+UbNf5WBwPQ==, figureFileBig=j9//jS+mWLMl5jUWO9Girg==, tableContent=null), ArticleFig(id=1241359971854643228, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=EN, label=Table 1, caption=

Basic characteristics of the study population

, figureFileSmall=null, figureFileBig=null, tableContent=
变量病例组对照组t/χ2P值
年龄（岁）42.56±13.1640.97±12.951.6000.110
性别1.0001.000
男196(57.1)196(57.1)
女147(42.9)147(42.9)
BMI情况4.9040.027
正常156（45.5）185（53.9）
异常187（54.5）158（46.1）
文化程度34.247<0.001
小学及以下19（5.5）10（2.9）
中学145（42.3）80（23.3）
大学及以上179(52.2)253(73.8)
月收入（元/月）14.335<0.001
<3 00027(7.9)60(17.5)
≥3 000316(92.1)283(82.5)
吸烟情况2.6030.107
吸烟237(69.1)256(74.6)
不吸烟106(30.9)87(25.4)
饮酒情况0.7260.394
饮酒206(60.1)195(56.9)
不饮酒137(39.9)148(43.1)
肿瘤家族史6.1830.013
有108(31.5)79(23.0)
无235(68.5)264(77.0)
体力活动水平88.846<0.001
低47(13.7)150(43.7)
中144(42.0)127(37.0)
高152(44.3)66(19.3)
), ArticleFig(id=1241359971946917919, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=CN, label=表1, caption=

研究人群基本情况[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量病例组对照组t/χ2P值
年龄（岁）42.56±13.1640.97±12.951.6000.110
性别1.0001.000
男196(57.1)196(57.1)
女147(42.9)147(42.9)
BMI情况4.9040.027
正常156（45.5）185（53.9）
异常187（54.5）158（46.1）
文化程度34.247<0.001
小学及以下19（5.5）10（2.9）
中学145（42.3）80（23.3）
大学及以上179(52.2)253(73.8)
月收入（元/月）14.335<0.001
<3 00027(7.9)60(17.5)
≥3 000316(92.1)283(82.5)
吸烟情况2.6030.107
吸烟237(69.1)256(74.6)
不吸烟106(30.9)87(25.4)
饮酒情况0.7260.394
饮酒206(60.1)195(56.9)
不饮酒137(39.9)148(43.1)
肿瘤家族史6.1830.013
有108(31.5)79(23.0)
无235(68.5)264(77.0)
体力活动水平88.846<0.001
低47(13.7)150(43.7)
中144(42.0)127(37.0)
高152(44.3)66(19.3)
), ArticleFig(id=1241359972043386914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=EN, label=Table 2, caption=

Intake of three dietary Vitamins

, figureFileSmall=null, figureFileBig=null, tableContent=
膳食维生素病例组对照组P值
维生素A（μgRAE/d）449.95±346.18721.98±705.22<0.001
维生素C（mg/d）73.00±47.24137.79±81.81<0.001
维生素E（mg/d）23.95±9.6222.13±14.140.048
), ArticleFig(id=1241359972114690084, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=CN, label=表2, caption=

三种膳食维生素摄入情况

, figureFileSmall=null, figureFileBig=null, tableContent=
膳食维生素病例组对照组P值
维生素A（μgRAE/d）449.95±346.18721.98±705.22<0.001
维生素C（mg/d）73.00±47.24137.79±81.81<0.001
维生素E（mg/d）23.95±9.6222.13±14.140.048
), ArticleFig(id=1241359972190187558, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=EN, label=Table 3, caption=

Association between intake of three dietary vitamins and glioma

, figureFileSmall=null, figureFileBig=null, tableContent=
膳食维生素Q1Q2Q3Q4连续c
维生素A（μgRAE/天）<306.41306.41-448.94448.94-652.52>652.52
病例/对照109/63106/6583/8945/126
模型1a10.79(0.49~1.26)0.48(0.30~0.78)0.19(0.11~0.31)0.88(0.84~0.92)
模型2b10.96(0.39~2.40)0.29(0.11~0.74)0.10(0.04~0.30)0.84(0.78~0.90)
维生素C（mg/天）<49.2849.28~83.7383.73~143.18>143.18
病例/对照128/44107/6479/9329/142
模型1a10.51(0.31~0.84)0.29(0.17~0.48)0.07(0.04~0.12)0.85(0.82~0.88)
模型2b10.28(0.11~0.73)0.34(0.14~0.81)0.02(0.01~0.08)0.80(0.75~0.86)
维生素E（mg/天）<13.4513.45~22.3422.34~29.75>29.75
病例/对照66/10667/104115/5795/76
模型1a11.05(0.69~1.60)3.02(1.94~4.70)1.99(1.27~3.11)1.14(1.01~1.30)
模型2b11.56(0.75~3.267.55(2.97~19.212.68(1.03~6.95)1.25(0.92~1.70)
), ArticleFig(id=1241359972353765416, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=CN, label=表3, caption=

三种膳食维生素摄入量与胶质瘤的关联性[OR（95% CI）]

, figureFileSmall=null, figureFileBig=null, tableContent=
膳食维生素Q1Q2Q3Q4连续c
维生素A（μgRAE/天）<306.41306.41-448.94448.94-652.52>652.52
病例/对照109/63106/6583/8945/126
模型1a10.79(0.49~1.26)0.48(0.30~0.78)0.19(0.11~0.31)0.88(0.84~0.92)
模型2b10.96(0.39~2.40)0.29(0.11~0.74)0.10(0.04~0.30)0.84(0.78~0.90)
维生素C（mg/天）<49.2849.28~83.7383.73~143.18>143.18
病例/对照128/44107/6479/9329/142
模型1a10.51(0.31~0.84)0.29(0.17~0.48)0.07(0.04~0.12)0.85(0.82~0.88)
模型2b10.28(0.11~0.73)0.34(0.14~0.81)0.02(0.01~0.08)0.80(0.75~0.86)
维生素E（mg/天）<13.4513.45~22.3422.34~29.75>29.75
病例/对照66/10667/104115/5795/76
模型1a11.05(0.69~1.60)3.02(1.94~4.70)1.99(1.27~3.11)1.14(1.01~1.30)
模型2b11.56(0.75~3.267.55(2.97~19.212.68(1.03~6.95)1.25(0.92~1.70)
), ArticleFig(id=1241359972450234411, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=EN, label=Table 4, caption=

Association between intake of three dietary vitamins and clinical subtypes of glioma

, figureFileSmall=null, figureFileBig=null, tableContent=
临床亚型c模型1aP值模型2bP值
星形细胞瘤
维生素A0.85(0.76~0.95)0.0030.71(0.59~0.86)<0.001
维生素C0.83(0.76~0.90)<0.0010.69(0.54~0.87)0.002
维生素E1.09(0.85~1.40)0.5162.99 (1.23~7.30)0.016
胶质母细胞瘤
维生素A0.87(0.82~0.93)<0.0010.86(0.78~0.96)0.005
维生素C0.85(0.81~0.89)<0.0010.82(0.74~0.91)<0.001
维生素E1.14(0.96~1.35)0.1361.24(0.77~2.00)0.370
低级别胶质瘤
维生素A0.81(0.71~0.93)0.0020.65(0.47~0.91)0.011
维生素C0.84(0.78~0.91)<0.0010.75(0.62~0.91)0.004
维生素E1.11(0.86~1.45)0.4311.64(0.80~3.35)0.177
高级别胶质瘤
维生素A0.89(0.85~0.94)<0.0010.87(0.80~0.94)0.001
维生素C0.86(0.82~0.89)<0.0010.79(0.72~0.86)<0.001
维生素E1.15(0.99~1.33)0.0651.30(0.87~1.94)0.197
), ArticleFig(id=1241359972538314797, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342456822820867, language=CN, label=表4, caption=

三种膳食维生素摄入量与胶质瘤临床亚型的关联性[OR（95%CI）]

, figureFileSmall=null, figureFileBig=null, tableContent=
临床亚型c模型1aP值模型2bP值
星形细胞瘤
维生素A0.85(0.76~0.95)0.0030.71(0.59~0.86)<0.001
维生素C0.83(0.76~0.90)<0.0010.69(0.54~0.87)0.002
维生素E1.09(0.85~1.40)0.5162.99 (1.23~7.30)0.016
胶质母细胞瘤
维生素A0.87(0.82~0.93)<0.0010.86(0.78~0.96)0.005
维生素C0.85(0.81~0.89)<0.0010.82(0.74~0.91)<0.001
维生素E1.14(0.96~1.35)0.1361.24(0.77~2.00)0.370
低级别胶质瘤
维生素A0.81(0.71~0.93)0.0020.65(0.47~0.91)0.011
维生素C0.84(0.78~0.91)<0.0010.75(0.62~0.91)0.004
维生素E1.11(0.86~1.45)0.4311.64(0.80~3.35)0.177
高级别胶质瘤
维生素A0.89(0.85~0.94)<0.0010.87(0.80~0.94)0.001
维生素C0.86(0.82~0.89)<0.0010.79(0.72~0.86)<0.001
维生素E1.15(0.99~1.33)0.0651.30(0.87~1.94)0.197
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膳食维生素摄入与胶质瘤关联性的病例对照研究
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王磊 , 张维春柏 , 庄维维 , 王婵媛 , 郭伟 , 易晓平 , 韩丽军
现代预防医学 | 营养与食品卫生 2024,51(4): 619-624
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现代预防医学 | 营养与食品卫生 2024, 51(4): 619-624
膳食维生素摄入与胶质瘤关联性的病例对照研究
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王磊, 张维春柏, 庄维维, 王婵媛, 郭伟, 易晓平, 韩丽军
作者信息
  • 首都医科大学附属北京天坛医院神经肿瘤综合治疗，北京 100070

    • 王磊（1980—），女，本科，主管护师，研究方向：神经肿瘤护理

通讯作者:

韩丽军，E-mail：
Associations between dietary vitamin andglioma: a case-control study based on Chinese
Lei WANG, ZHANG Wei-chun-bai, Wei-wei ZHUANG, Chan-yuan WANG, Wei GUO, Xiao-ping YI, Li-jun HAN
Affiliations
  • Departent of Comprehensive Neuro-Oncology Treatment, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
出版时间: 2024-02-25 doi: 10.20043/j.cnki.MPM.202304217
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摘要
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目的

了解中国人群中膳食维生素A、维生素C和维生素E与胶质瘤的关系。

方法

基于1：1个体匹配的病例对照研究，对343例胶质瘤患者和343例健康对照进行问卷调查和体格测量，通过食物频率问卷评估三种膳食维生素的摄入量，采用 logistic 回归分析膳食维生素摄入量与胶质瘤风险的关联性，并探索二者之间的剂量-反应关系。

结果

与最低分位数相比，最高分位数的膳食维生素A摄入量与胶质瘤总体风险（OR=0.10，95% CI：0.04~0.30）、星形细胞瘤风险（OR=0.71，95% CI：0.59~0.86）、胶质母细胞瘤风险（OR=0.86，95% CI：0.78~0.96）、低级别胶质瘤风险（OR=0.65，95% CI：0.47~0.91）和高级别胶质瘤风险（OR=0.87，95% CI：0.80~0.94）降低有关，最高分位数的膳食维生素C摄入量与胶质瘤总体风险（OR=0.02，95% CI：0.01~0.08）、星形细胞瘤风险（OR=0.69，95% CI：0.54~0.87）、胶质母细胞瘤风险（OR=0.82，95% CI：0.74~0.91）、低级别胶质瘤风险（OR=0.75，95% CI：0.62~0.91）和高级别胶质瘤风险（OR=0.79，95% CI：0.72~0.86）降低有关.但膳食维生素E摄入量仅与星形细胞瘤风险升高有关（OR=2.99，95% CI：1.23~7.30）。膳食维生素A和维生素C摄入量与胶质瘤风险之间存在显著的剂量-反应关系。

结论

摄入较多的膳食维生素A和维生素C可能与胶质瘤风险降低相关，但维生素E对不同临床亚型的胶质瘤的影响并不一致。在未来，应通过前瞻性研究进一步验证这些膳食维生素与胶质瘤的关联性。

胶质瘤  /  膳食调查  /  维生素  /  神经肿瘤护理
Objective

To understand the relationship between dietary vitamins A, vitamin C and vitamin E and glioma in Chinese population.

Methods

Based on the case-control study of 1:1 individual matched, a questionnaire survey was carried out on 343 patients with glioma and 343 healthy controls. The intake of three dietary vitamins was evaluated through the food frequency questionnaire, and the intake of dietary vitamins and gloima was analyzed by logistic regression, and explored the dose-response relationship between the two.

Results

Compared with the lowest quantile, the highest quantile of dietary vitamin A intake was associated with a decrease in overall glioma risk (OR=0.10, 95% CI: 0.04-0.30), astrocytoma risk (OR=0.71, 95% CI: 0.59-0.86), glioblastoma risk (OR=0.86, 95% CI: 0.78-0.96), low-grade glioma risk (OR=0.65, 95% CI: 0.47-0.91), and high-grade glioma risk(OR=0.87, 95% CI: 0.80-0.94).The highest quantile of dietary vitamin C intake was associated with a decrease in overall glioma risk (OR=0.02, 95% CI: 0.01-0.08), astrocytoma risk (OR=0.69, 95% CI: 0.54-0.87), glioblastoma risk (OR=0.82, 95% CI: 0.74-0.91), low-grade glioma risk (OR=0.75, 95% CI: 0.62-0.91) and high-grade glioma risk (OR=0.79,95% CI: 0.72-0.86). However, dietary vitamin E intake was only associated with an increased risk of astrocytoma (OR=2.99, 95% CI: 1.23-7.30).There was a significant linear dose-reaction relationship between the two, but the results of vitamin E were inconsistent and should be treated with caution.

Conclusion

High intake of dietary vitamin A and vitamin C may be associated with a reduced risk of glioma, but the impact of vitamin E on different clinical subtypes of glioma is not consistent. In the future, prospective studies should be conducted to further verify the association between these dietary vitamins and glioma.

Glioma  /  Diet  /  Vitamins  /  Nutritional care
王磊, 张维春柏, 庄维维, 王婵媛, 郭伟, 易晓平, 韩丽军. 膳食维生素摄入与胶质瘤关联性的病例对照研究. 现代预防医学, 2024 , 51 (4) : 619 -624 . DOI: 10.20043/j.cnki.MPM.202304217
Lei WANG, ZHANG Wei-chun-bai, Wei-wei ZHUANG, Chan-yuan WANG, Wei GUO, Xiao-ping YI, Li-jun HAN. Associations between dietary vitamin andglioma: a case-control study based on Chinese[J]. Modern Preventive Medicine, 2024 , 51 (4) : 619 -624 . DOI: 10.20043/j.cnki.MPM.202304217
正文
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胶质瘤是起源于神经胶质细胞的原发性颅内肿瘤，与其他类型的肿瘤相比，其发病率较低，年发病率仅为5.7/10万，是最常见的恶性中枢神经系统肿瘤[1]。由于胶质瘤的预后较差，即使经过包含手术切除、放射治疗以及化学治疗的标准治疗后，其生存时间仍不理想，远低于其他恶性肿瘤。由于中国人口基数大，即使发病率较低，也导致了相对较多的胶质瘤患病人数，已造成了严重的疾病负担[2]。因此，早期预防胶质瘤是降低其死亡率的关键。尽管对胶质瘤病因学的研究已进行了数十年，但目前胶质瘤仍有许多潜在的影响因素尚不明确[3]。饮食被认为与肿瘤的关系紧密，它与胶质瘤可能也不例外。在诸多饮食因素中，膳食抗氧化剂，如维生素A、维生素C和维生素E等，一直备受关注。由于这些膳食维生素是自由基清除剂，其潜在的抗氧化能力提示它们可能在预防胶质瘤中发挥重要作用[4]，但迄今为止，大部分研究集中在西方人群[5]，尚无亚洲人群的研究被报道。考虑中国饮食与西方饮食的差异性，本研究通过病例对照研究，采用食物频率问卷，收集研究对象相关膳食的摄入量，探索三种常见膳食维生素与胶质瘤的关联性。
1　材料与方法
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1.1　对象来源
选取了2022年12月至2023年5月在首都医科大学附属北京天坛医院肿瘤中心就诊的胶质瘤患者作为病例组。所有病例均由神经肿瘤医生和病理科医生根据2021年世界卫生组织中枢神经系统肿瘤诊断标准进行确诊[6]。对照组来自社区招募的健康人群，并按照性别相同和年龄相差5岁以内进行1:1匹配。纳入标准：①所有研究对象的年龄≥18岁；②病例组为神经肿瘤医生和病理科医生共同诊断为胶质瘤的患者。排除标准：①孕产妇；②病理信息缺失；③除胶质瘤外，患有其他恶性肿瘤；④接受调查前5年内饮食行为存在重大改变；⑤能量摄入异常（大于5 000 kcal/d或小于400 kcal/d)；⑥因语言障碍等原因无法完成调查。最终分别纳入343例胶质瘤患者和健康对照。本研究经首都医科大学附属北京天坛医院伦理委员会批准（KY2022-203-02），所有受试者均知情并同意参与研究。
1.2　资料收集
1.2.1　问卷调查
本研究中涉及的数据资料主要通过问卷调查完成的。所有参与问卷调查的研究人员均具有医学背景，且经过统一培训考核合格后方可进行调查。资料收集过程中，研究人员采用一对一、面对面的形式对研究对象进行调查。调查内容包括人口学资料（出生日期、性别、文化程度、家庭收入）、生活行为习惯（吸烟和饮酒行为）、恶性肿瘤家族史和膳食信息等。
1.2.2　膳食维生素摄入量评估
膳食调查通过食物频率问卷完成。这份食物频率问卷共涉及114项食物条目，接受调查的研究对象需要填写在过去一年内食物频率问卷中涉及的每种食物的摄入情况，包括是否食用了食物，摄入频率（每天/周/月的摄入量），以及每次的平均摄入量。本次问卷的有效性和重复性在先前的研究中已得到验证，食物组消费量和营养素摄入量的相关系数均在0.380~0.847之间[7]。
食物每日摄入量根据食物摄入的频率和每次平均摄入量计算。根据《中国食物成分表》[8]提供了各类食物中维生素A、维生素C和维生素E的单位含量，通过对各类食物每日摄入量和维生素的单位含量乘积后求和计算为相应维生素的总摄入量。能量摄入情况也按照此方法进行计算。
1.2.3　体格测量
体格测量数据主要包括身高和体重，由经过培训的工作人员使用标准测量方法以及经过校准的设备在研究对象接受调查前测量，并计算体质指数（Body mass index, BMI）=体重（kg）/身高2（m2），结果精确到小数点后两位，并根据BMI的正常范围（18.5 kg/m2≤BMI<24 kg/m2）划分为正常和异常两类[9]。
1.2.4　协变量
文化程度根据研究对象所接受的最高教育水平划分为小学及以下、中学和大学及以上。经济收入情况划分为3 000元/月以下和3 000元/月及以上。吸烟情况划分为吸烟（至今总计吸烟超过100支）和不吸烟（至今总计吸烟未超过100支）。饮酒情况划分为饮酒（过去一年内每周饮酒至少一次）和不饮酒（过去一年内不曾每周饮酒）。恶性肿瘤家族史被定义为研究对象三代以内的直系亲属曾患有恶性肿瘤。体力活动水平根据国际体力活动问卷进行调查后，计算相应的代谢当量，并划分为低、中和高三个水平。
1.3　统计分析
采用SPSS 26.0和R 4.1.1进行统计分析。计量资料以均数±标准差表示，t检验比较组间差异；计数资料以百分比表示，卡方检验比较组间差异。采用logistic回归分别计算维生素A、维生素C和维生素E与胶质瘤的关联性，并计算比值比（Odds ratio，OR）和95%置信区间（Confidence interval，CI）。单因素模型为未调整任何混杂变量的粗模型，多因素模型调整了年龄、文化程度、经济收入情况、吸烟情况、饮酒情况、恶性肿瘤家族史、体力活动水平和能量。为进一步探索维生素摄入量与胶质瘤的关系，基于多因素模型，采用限制性立方样条函数描述二者的剂量-反应关系，其节点设置在维生素摄入量的第20、40、60和80的百分位数，参考值（OR=1）设为第10的百分位数。检验标准为α=0.05.
2　结果
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2.1　研究对象的基本情况
本研究共纳入了343例胶质瘤患者和343例健康对照，其中，病例组平均年龄（42.56±13.16）岁，对照组平均年龄（40.97±12.95）岁，两组在年龄的差异没有统计学意义（P=0.110），性别构成高度一致（P=1.000）。与病例组相比，对照组人群具有较低的BMI（P<0.001），较高的文化程度（P<0.001），较低比例的恶性肿瘤家族史（P=0.013）以及较低比例的高体力活动水平（P<0.001），在经济收入方面也有显著差异（P<0.001）。但二者在吸烟（P=0.107）和饮酒（P=0.394）方面无显著差异（见表1）。
病例组与对照组三种维生素摄入情况如表2所示，对照组维生素A（P<0.001）和维生素C（P<0.001）的摄入量显著高于病例组，但维生素E摄入量显著低于病例组（P=0.048）.
2.2　三种维生素与胶质瘤的关联性
三种维生素摄入情况与胶质瘤的关联性如表3所示，对于维生素摄入量的分类变量，与第一分位数相比，最高分位数维生素A摄入量与胶质瘤风险降低有关（OR=0.10，95% CI：0.04~0.30），最高分位数维生素C摄入量与胶质瘤风险降低有关（OR=0.02，95% CI：0.01~0.08），最高分位数维生素E摄入量与胶质瘤风险升高有关（OR=2.68，95% CI：1.03~6.95）。对于维生素摄入量的连续变量，维生素A和维生素C的结果与分类变量一致，但维生素E则不具有统计学意义（OR=1.25，95% CI:0.92~1.70）。
2.3　三种维生素与胶质瘤临床亚型的关联性
胶质瘤的病理亚型如表3所示，对于星形细胞瘤，维生素A（OR=0.71，95% CI：0.59~0.86）和维生素C（OR=0.69，95% CI：0.54~0.87）与其风险降低有关，维生素E与其风险升高有关（OR=2.99，95% CI：1.23~7.30）。对于胶质母细胞瘤，维生素A（OR=0.86，95% CI：0.78~0.96）和维生素C（OR=0.82，95% CI：0.74~0.91）与其风险降低有关，维生素E则不具有统计学意义（OR=1.24，95% CI：0.77~2.00）。
胶质瘤的病理分级如表4所示。对于低级别胶质瘤，维生素A（OR=0.65，95% CI：0.47~0.91）和维生素C（OR=0.75，95% CI：0.62~0.91）与其风险降低有关，维生素E则不具有统计学意义（OR=1.64，95% CI：0.80~3.35）。对于高级别胶质瘤，维生素A（OR=0.87，95% CI：0.80~0.94）和维生素C（OR=0.79，95% CI：0.72~0.86）与其风险降低有关，维生素E与其风险升高无关（OR=1.30，95% CI：0.87~1.94）。
2.4　维生素与胶质瘤的剂量-反应关系
基于限制性立方样条函数，我们探索了多因素回归模型中具有显著意义的维生素与胶质瘤的剂量-反应关系。维生素A与胶质瘤风险之间存在显著的非线性剂量-反应关系（P-非线性=0.0457），其摄入量超过473.96μgRAE/天时，胶质瘤风险显著下降，在636.71 μgRAE/天之后，趋势近于平稳。维生素C与胶质瘤之间存在显著的线性剂量-反应关系（P-非线性=0.416 7）其摄入量超过82.88 mg/天时，胶质瘤风险显著下降，在216.05 mg/天之后，趋势近于平稳（见图1）。
3　讨论
收起
目前在本研究中发现，增加来源于膳食的维生素A和维生素C的摄入量与胶质瘤风险降低关系密切，且呈显著的剂量-反应关系。对于维生素E，虽然在总人群中也观察到显著的结果——较高的摄入量可能与胶质瘤风险升高有关，但在连续变量的结果中并未观察到具有统计意义，并且在临床亚型中的结果并不一致，因此应谨慎对待这一结果。
维生素A是维持视觉健康、预防感染和细胞生长和分化所必需的微量营养素[10]。由于β-胡萝卜素在体内也可以转化为维生素A[10]，因此人类摄取维生素A主要依赖于富含维生素A或胡萝卜素的食物，如深绿色蔬菜和橘黄色蔬菜。早期有关维生素A和胶质瘤的研究，也是围绕评估这些食物摄入量进行的，发现摄入深绿色蔬菜（OR=0.80，95% CI：0.66~0.98)和橘黄色蔬菜（OR=0.79，95% CI：0.66~0.96)均对胶质瘤具有保护作用[11]。并且关于维生素A摄入量与胶质瘤的Meta分析仍表明膳食维生素A摄入量与胶质瘤风险降低显著相关(Relative risk，RR=0.80, 95% CI：0.62~0.98)[12]，与我们的结果一致。但目前极少有相关机制的研究被报道。早期细胞研究发现，维生素A类似物对胶质瘤细胞具有抗增殖作用，也可以与鸟氨酸脱羧酶抑制剂在此基础上发挥协同作用[13]。Liang等人的研究则通过不同浓度的维生素A衍生物处理胶质瘤细胞系发现，与空白对照组相比，处理组胶质瘤细胞的迁移、侵袭和增殖受到显著抑制，细胞凋亡率显著升高，且存在剂量依赖性，并认为这一现象与金属蛋白酶-2表达能力下调有关[14]。
维生素C是膳食中最广为人知的抗氧化剂。在既往研究中也得到了与本研究一致的结果，Tedeschi-Blok等人进行的膳食抗氧化剂与胶质瘤的病例对照研究发现，较高的维生素C摄入量与胶质瘤风险降低相关(OR=0.70, 95% CI: 0.51~0.94)[15]。Heydari 等基于伊朗人群建立的胶质瘤病例对照研究也发现了相似的结果（OR=0.14，95% CI：0.05~0.36），并与我们的结果接近[5]。此外，Preston-martin等发现产前补充维生素C可显著降低儿童患有包括胶质瘤在内的脑肿瘤的风险(RR=0.50, 95% CI: 0.30~0.90)，并且摄入量与脑瘤风险之间存在剂量-反应关系[16]。但针对成人的维生素C补充剂研究却并没有发现显著结果[17]。目前相关机制并不清晰。一方面，维生素C可以以剂量依赖的方式抑制和减少大鼠C6胶质瘤细胞中N-乙酰转移酶活性和2-氨基芴- DNA加合物的形成[18]。另一方面，大鼠实验发现，在维生素C等抗氧化剂喂养的大鼠中，发现了两种与脑肿瘤增殖相关的标记物——血小板衍生生长因子受体和Ki-67显著减少，提示在大鼠模型中，维生素C等抗氧化剂对限制胶质瘤的侵袭性具有一定的积极作用[19]。此外，维生素C似乎可以作为胶质瘤治疗药物的佐剂。维生素C能够协同二氯乙酸盐促进 BCL2A1和CDC25A这两种蛋白的降解，进而抑制胶质瘤细胞的迁移侵袭等行为[20]。类似地还有替莫唑胺等[21]。
尽管维生素E也具有一定的抗氧化作用，但其结果却与其他两种维生素相反。虽然Gile等人在澳大利亚男性人群中也发现维生素E摄入量与胶质瘤的正向关联（OR=1.68，95% CI：1.07~2.63）[22]，但在队列研究中并未观察到相似的结果[7]。一项纳入10项研究的Meta分析也得出了维生素E摄入与胶质瘤风险无关的结论（RR=0.88, 95% CI:0.69~1.12）[23]。但前瞻性胶质瘤血清代谢组学的结果显示，血清α-生育酚(维生素E最具生物活性的形式)浓度与胶质瘤风险显著负相关[24]。考虑这可能与不同临床亚型的胶质瘤有关，根据我们的研究发现，膳食维生素E对不同病理亚型和病理级别的胶质瘤影响存在差异。相关的预后分析中也发现，仅高维生素E摄入量的III级恶性胶质瘤患者生存率更高[25]。因此，针对维生素E与胶质瘤的关联性仍需谨慎看待。
本研究采用1：1匹配的病例对照研究设计，无法确定膳食维生素与胶质瘤的因果关系，因此在以后的研究中需要更大样本的队列研究去验证。但考虑胶质瘤发病率极低，病例对照研究仍是目前研究胶质瘤的最常见研究方法之一。此外，也无法避免病例对照研究固有的偏倚，如回忆偏倚。针对此，我们也采用验证食物频率问卷的有效性和重复性，以及在调查过程中通过膳食图谱辅助调查等方式尽量减少相关偏倚的影响。但本研究仍有几个优点，首先这是目前为止基于中国人群样本量最大的膳食维生素与胶质瘤的研究，其结果具有一定的代表性。其次，首次针对不同临床亚型进行分析，并发现维生素E对不同类型胶质瘤的影响存在差异。并且，这也是第一次描述了膳食维生素摄入量与胶质瘤的剂量-反应关系。这些均为胶质瘤的一级预防提供一定的科学依据。
综上，摄入较多的膳食维生素A和维生素C可能与胶质瘤风险降低相关，它们之间存在剂量-反应关系，建议在日常饮食中应注意这些维生素的补充，在一定程度上可能降低胶质瘤的风险。
基金
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  • 北京天坛医院人才引进(RCYJ-2020-LWB)
  • 2020年国家和省级临床重点专科能力建设项目
文献
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2024年第51卷第4期
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doi: 10.20043/j.cnki.MPM.202304217
  • 接收时间：2023-04-12
  • 首发时间：2026-03-19
  • 出版时间：2024-02-25
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  • 收稿日期：2023-04-12
基金
北京天坛医院人才引进(RCYJ-2020-LWB)
2020年国家和省级临床重点专科能力建设项目
作者信息
    首都医科大学附属北京天坛医院神经肿瘤综合治疗，北京 100070

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2种不同金属材料的力学参数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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