新诊断2型糖尿病合并恶性肿瘤的危险因素分析

目的分析新诊断2型糖尿病(T2DM)合并恶性肿瘤的临床特点以及影响因素,为临床防治提供依据。方法选择病程小于1年的新诊断T2DM患者合并恶性肿瘤40例(肿瘤均在诊断糖尿病后检出)为病例组,同时选择年龄、性别、糖尿病病程、体重指数(BMI)及居住环境匹配的T2DM无恶性肿瘤患者40例作为对照组。两组糖尿病患者均未应用降糖调脂药物治疗。问卷调查糖尿病家族史、饮酒、吸烟、饮茶等生活习惯,并测定血糖、血脂水平,分析肿瘤的临床特点以及危险因素。结果 (1)病例组中,男性以消化系统恶性肿瘤构成比最高,为47.5%(19/40);女性则以雌激素依赖肿瘤(乳腺癌,子宫内膜癌)构成比最高,为40.0%(16/40)。(2)Spearman相关分析显示恶性肿瘤与饮茶、胆固醇水平呈负相关(r值分别为-0.22,-0.24,均P<0.05),与HbA1C、糖尿病家族史呈正相关(r值分别为0.25,0.24,均P<0.05)。(3)多因素非条件Logistic回归分析发现,糖尿病家族史、HbA1C为恶性肿瘤的危险因素(OR分别为1.52,3.85,均P<0.05),饮茶、高胆固醇则是保护性因素(OR值分别为0.79,0.86,均P<0.05)。结论高血糖与恶性肿瘤密切相关,新诊断T2DM特别是伴有糖尿病家族史患者,应加强消化道肿瘤(男性)、乳腺癌及子宫内膜癌(女性)的筛查。

Risk factors of newly diagnosed type 2 diabetic patients with cancer

Objective To analyze clinical characteristics and risk factors of newly diagnosed type 2 diabetes with cancer,and to provide evidence for clinical prevention and treatment.Methods This study was conducted among 40 diabetic patients newly diagnosed with cancer as the case group and 40 newly diagnosed diabetic patients without cancer as the control group.The above two groups were matched in age,sex,diabetes duration and body mass index.Blood glucose,blood lipid profiles were measured.The questionnaires included family history of diabetes,drinking,smoking,drinking tea,and so on.The clinical characteristics and risk factors of cancer were analyzed.Results The highest constitution ratio of the tumor of men was the digestive tract tumor,and the constitution ratio of estrogen-dependent tumor including breast cancer,endometrial cancer was highest in women.Spearman correlation analysis showed that cancer was negatively correlated with frequent tea drinking and higher cholesterol （r=-0.22,-0.24,respectively,all P〈0.05）,and positively correlated with glycated hemoglobin,family history of diabetes （r=0.25,0.24,respectively,all P〈0.05）.The multi-factor logistic regression analysis showed that glycated hemoglobin,familial diabetes were independent risk factors for cancer.Frequent tea drinking and higher cholesterol were protective factors for cancer.Conclusions Hyperglycemia is closely related to malignant tumors. The digestive tract tumor （male）,breast cancer and endometrial cancer screening （female）should be strengthened among newly diagnosed type 2 diabetes,especially those with family history of diabetes.