胰岛素和胰岛素样生长因子及其结合蛋白与结直肠癌发生的关系

目的探讨血清胰岛素、胰岛素样生长因子（IGF-1）、IGF结合蛋白（IGFBPs）体质量指数（BMI）、腰臀围比（WHR）的变化及与结直肠癌发生、发展的关系。方法检测对象为2006年6月至2007年10月间住院收治和门诊复查的结直肠癌患者615例（术前检测244例，术后371例）和健康对照者150例。采用酶联免疫吸附法检测血清胰岛素、IGF-1和IGFBPS水平。结果结直肠癌患者术前血清胰岛素、IGF-1水平和IGF-I／IGFBP-3比值与健康对照组、术后患者比较，均明显升高，IGFBP-3水平明显降低，差异均有统计学意义（P〈0.05，P〈0.01）。结直肠癌术后未发生转移者与有肝或腹腔远处转移者胰岛素、IGF-1、IGFBP-1、IGFBP-3、IGF-1／IGFBP-3比较，差异均无统计学意义（P〉0.05）。结直肠癌患者WHR明显高于健康对照组（P〈0.01和P〈0.05）；而BMI与健康对照组比较，差异无统计学意义（P〉0.05）。结肠癌患者WHR、BMI与胰岛素水平、IGF-1／IGFBP-3比值呈正相关（P〈0.01，P〈0.05），与IGFBP-3呈负相关（P〈0.01，P〈0.05）；直肠癌患者WHR与血清瘦素、胰岛素水平及BMI与血清IGFBP-1水平均呈正相关（P〈0.05），与其他无相关性（P〉0.05）。结论胰岛素、IGF-1水平和IGF-I／IGFBP-3比值升高及IGFBP-3水平降低，可能与结直肠癌的发生有关，但与肿瘤转移与否无关，中心性肥胖是结肠癌发生的危险因素之一。

Association of insulin, insulin-like growth factor and insulin-like growth factor binding proteins with the risk of colorectal cancer

Objective To study the association of the changes of serum insulin, insulin-like growth factor (IGF-1), insulin-like growth factor binding proteins(IGFBPs), body mass index (BMI), waist and hip circumference ratio (WHR) with the genesis of colorectal cancer. Methods Sere from 244 colorectal cancer patients before operation, 371 patients after operation and 150 healthy subjects were assayed for insulin, ieptin, IGF-1, IGFBP-1 and IGFBP-3 by the enzyme-linked immunosorbent assay. SPSS 13.0 statistics software was applied to analyze the data. Results The serum levels of insulin, IGF-1 and the ratio of IGF-1/ IGFBP-3 in colorectal cancer patients before and after surgical treatment were significantly higher than those in controls. The serum levels of IGFBP-3 in patients before and after operation were significantly lower than those in controls, and the differences were significant (P=0.015,P=0.001, respectively). The BMI in colorectal carcinoma patients was not significantly different to the healthy controls (P>0.05). The WHR in colorectal carcinoma patients was higher than that in healthy subjects, and the difference was significant (P=0.003, P=0.035 respectively). The WHR in colon cancer patients was different to that in rectal cancer patients (P=0.046). The WHR and BMI in colon carcinoma patients were positively correlated with the serum insulin level and the value of IGF/IGFBP3. The WHR and BMI were negatively correlated with IGFBP3. The WHR and BMI were not correlated with IGF-1 and IGFBP1. Conclusions The serum insulin, IGF-1 levels and the value of IGF-I/IGFBP-3 are significantlyincreased in colorectal cancer patients, and serum IGFBP-3 level is markedly decreased, which may be related to the genesis of colorectal cancer, but are not correlated with the progress and improvement of colorectal cancer. Central adipositas may be a risk factor for the genesis of colon cancer.