肥胖相关指标与女性乳腺癌危险性的关系

阐述了肥胖相关指标、肥胖女性乳房与乳腺癌的关系，分析了影响其关系的因素，指出控制体重可作为乳腺癌预防的量化指标。     

瘦素及其受体与乳腺癌研究进展

瘦素是肥胖基因(Ob基因)表达的多肽产物,对肥胖起到调节作用,近年来研究发现瘦素受体广泛存在于体内各组织器官,瘦素作为一种内分泌激素,具有广泛的生物学效应,特别是与肿瘤发生发展的关系已被人们广泛而深入地研究。瘦素及其受体的表达在70%～80%的乳腺癌病例中都存在,其中包括激素受体及HER阳性或者阴性的癌症患者。瘦素对肿瘤细胞具有刺激生长、转移、侵袭及促血管生成作用,在乳腺癌中尤其是晚期乳腺癌瘦素及其受体过度表达。很多学者研究了瘦素及其受体与乳腺癌的发生机制,本文将对瘦素及其受体与乳腺癌的最新研究进展进行综述。一、瘦素及其受体     

绝经期乳腺癌与肥胖、高脂血症等相关因素分析

乳腺癌的高危因素如雌激素水平增高，一级直亲家族乳腺癌史等均已被证实，为论证乳腺癌的发病与肥胖及高脂血症的关系，笔者对本院2002年1月至2005年6月住院的52例50岁以上的女性乳腺癌患者，进行相关数据收集和统计，并与正常组对照分析，现报告如下。     

肥胖儿童维生素D缺乏与心血管及代谢紊乱危险因素的关系

目的 探讨肥胖儿童维生素D缺乏与心血管及代谢紊乱危险因素的关系.方法 选择50例肥胖儿童为肥胖组,另选健康儿童50例为对照组.比较肥胖组和对照组儿童、肥胖组维生素D缺乏和非维生素D缺乏儿童、对照组维生素D缺乏和非维生素D缺乏儿童心血管及代谢紊乱危险因素指标差异.分析25-羟基维生素D水平与其他指标的相关性.结果 肥胖组...     

乳腺癌超声表现与分子免疫组化指标关系研究新进展

癌基因表达从不同角度反映了乳腺癌的恶性生物学行为,并引起组织病理学改变,进而形成多种影像学表现。因此,越来越多的学者发现乳腺癌超声表现与分子免疫组化指标之间存在一定相关性,通过乳腺癌的超声征象可以预测某些分子免疫组化指标的表达及其预后。本文主要对乳腺癌超声表现与雌激素受体、孕激素受体、人表皮生长因子受体2及Ki67抗原表达的关系研究进行综述。     

能量代谢指标与肥胖评价方法关系分析

目的:根据肥胖的定义,建立肥胖评价标准应该参照体内多余能量堆积程度能否破坏健康和引发相关疾病这一依据.实验试图找出能量代谢指标与不同肥胖评价方法测试结果之问的相关关系,探索以能量指标为参照依据不同方法评价肥胖的合理性.方法:于2002-11采用多阶段随机抽样方法,随机选取西安市3个城区,每个城区再随机选取2个社区,每个社区中再随机抽取居住5年或以上的常住女性居民120名,剔除有明显严重急、慢性疾患和肥胖遗传史者70名及无效问卷者93人,共557名纳入分析,年龄50～60岁,平均年龄(54.1±2.6)岁.按国民体质监测工作手册的测试要求,采用3种测量方法测试能量指标与形态指标.分别为ZW法,即采用张薇体密度推算公式来计算体脂率;BIA法,采用日本TANITA公司提供的人体组成分析仪用生物电阻抗技术来测定体脂率;体质量指数法,是按<中国成人体质监测标准>进行测量身高和体质量,计算体质量指数.ZW法和BIA法评价成年女子肥胖的标准为体脂率/>30%.体质量指数法为体质量指数≥28 kg/m2为肥胖.结果:①不同肥胖评价方法测试结果与能量摄入和能量消耗均呈中度相关关系,与剩余能量呈显著相关,相关系数均在0.77以上.②不同肥胖评价方法测试结果与剩余能量的关系曲线图大致趋势一致,随剩余能量的增加,各方法测试结果也不断增加,尤其是BIA法体脂率与剩余能量指标的一致程度最好.结论:不同肥胖评价方法与能量代谢指标密切相关,可以以能量指标为参照依据评价方法的合理性.     

体质量指数与三阴性乳腺癌预后的相关性研究

目的观察三阴性乳腺癌(TNBC)患者的体重指数(BMI)与临床结局的关系。方法收集2005年12月至2015年12月在延庆区和大兴区医院肿瘤科就诊的1 680例乳腺癌患者相关资料,筛选三阴性乳腺癌患者纳入本研究,共计105例。通过患者身高和体重计算BMI指数,根据BMI指数将患者分为BMI25(正常/低体重组),25~29.9(超重组)和≥30(肥胖组)三组。对比观察三组患者的基础信息、临床特征、组织学分类和总生存期(OS)。结果患者平均随访期28.4±16.4个月,其中12例复发(11.4%),4例死亡(3.8%)。肥胖组患者的年龄大于其他两组(P0.05),肥胖患者与超重患者、正常/低体重组患者的OS无显著差异;考虑绝经因素,绝经前患者的平均BMI水平显著低于绝经后患者(P0.05);绝经后TNBC患者中,肥胖患者相比超重患者、正常/低体重组更易获得较短的OS(P0.05)。结论肥胖是绝经后TNBC患者获得更短OS的相关因素。     

高敏C-反应蛋白与肥胖及非肥胖儿童相关指标关系的探讨

目的了解高敏C-反应蛋白（hs-CRP）在肥胖及非肥胖儿童体内的水平,探讨高敏C-反应蛋白与体重指数（BMI）、临床及实验室相关指标的关系。方法设计两平行组,将114例非肥胖儿童作为对照组,131例肥胖儿童作为研究对象,测量高敏C-反应蛋白水平及相关指标。结果肥胖组高敏C-反应蛋白水平明显高于对照组（P〈0．001）。生化指标空腹血糖和三酰甘油在肥胖组和对照组中有统计学意义（P〈0．01）。高敏C-反应蛋白与BMI之间呈明显相关性（P〈0．05）。结论高敏C-反应蛋白与BMI呈明显正相关;大部分非肥胖儿童的高敏C-反应蛋白浓度不超过2mg／L。     

超重或肥胖乳腺癌患者化疗期间体质量管理体验的质性研究

目的了解超重或肥胖乳腺癌患者化疗期间体质量管理体验, 为制订针对性护理干预措施提供参考。方法采用质性研究中的现象学研究方法, 采用目的抽样法, 于2023年3—5月选择山东第一医科大学附属省立医院和山东第一医科大学第一附属医院乳腺外科化疗期间10例超重或肥胖乳腺癌患者进行半结构式访谈。运用Colaizzi 7步分析法对资料进行整理分析, 提炼主题。结果 10例超重或肥胖乳腺癌患者平均年龄为43.2岁。提炼出3个主题8个亚主题, 分别为:体质量管理动力不足(认知不足、内驱力不足、激励不足)、体质量管理困扰体验(疾病不确定感、化疗期症状困扰、无法识别信息的正确性)、体质量管理调控与支持(掌握正确的体质量调控方法、各方面支持)。结论乳腺癌肥胖患者化疗期间体质量管理动力不足、困扰较多, 医护人员可以从明晰体质量管理的重要意义、提供针对性的信息支持、建立良好的社会支持系统以及提供有效的体质量管理指导等方面采取有效措施, 以提高乳腺癌肥胖患者化疗期间体质量管理的有效性。     

每周严格节食两天乳腺癌危险减四成

近日,《国际肥胖杂志》刊登了英国的一项发现-每星期严格节食两天可以使妇女患乳腺癌的风险降低40％.研究人员发现,控制饮食热量几乎可以使乳腺癌高危妇女体内致癌激素水平降低近一半.     

The relationship between obesity and breast cancer.

Obesity and breast cancer are major health problems for African American women. Obesity has almost reached epidemic proportions in the United States and is more prevalent among African American women. The breast cancer mortality rate continues to rise in African Americans. A review of the recent literature was conducted to bring into focus the relationship of these two health problems as they relate to African American women. The discussion is divided into three topics, breast cancer incidence and mortality, obesity prevalence and incidence and the relationship between obesity and breast cancer. All of the studies reviewed revealed evidence of a linkage between obesity and breast cancer. The high prevalence of obesity among African American makes it likely that they bear a disproportionate burden of co-morbidities attributable to obesity including breast cancer.     

人乳腺珠蛋白基因表达和趋化因子CXCL16及CA153在乳腺癌诊断中的应用

目的探讨人乳腺珠蛋白(HMAM)、趋化因子CXCL16及CA153在乳腺癌诊断和治疗监测中的应用。方法采用实时荧光定量PCR(FQ-PCR)检测50例女性体检者、134例良性乳腺肿瘤患者、129例乳腺癌患者和104例其他肿瘤患者外周血中HMAM mRNA,化学发光法检测CA153,ELISA检测CXCL16,分析三种标志物与乳腺癌患者临床组织学分期的关系、手术前后的差异及联合检测在乳腺癌诊断中的应用。结果乳腺癌组HMAM、CA153和CXCL16水平高于对照组和良性乳腺肿瘤组,HMAM和CA153水平高于其他肿瘤组(P<0.05)。乳腺癌组HMAM、CA153和CXCL16水平在手术后均下降,Ⅲ+Ⅳ期高于Ⅰ+Ⅱ期(P<0.05)。HMAM的检测特异性最强,CXCL16的检测灵敏度最高;CA153和CXCL16联合检测可提高灵敏度和阴性预测值;HMAM、CA153和CXCL16联合检测的特异性和阳性预测值高于CA153和CXCL16联合检测,HMAM、CA153和CXCL16联合检测的灵敏度、阳性预测值和阴性预测值高于单一指标检测(P<0.05)。结论HMAM和CA153对乳腺癌预后有一定的预测作用,HMAM、CA153、和CXCL16对术后随访有意义,联合检测有助于提高对乳腺癌诊断的早期诊断。     

EMA和EGP-2在乳腺癌组织中的表达及临床意义

目的通过检测上皮膜抗原（EMA）、表皮糖蛋白基因（EGP-2）在乳腺癌组织中的表达，分析它们与乳腺癌临床病理指标的关系，并研究两者表达的相关性。方法采用免疫组化SP法检测69例乳腺癌及28例乳腺增生组织中EMA和EGP-2的表达水平。结果EMA和EGP-2在癌组织中的表达水平明显高于增生组织，在癌组织中阳性表达率分别为88．41％和91．30％，而在增生组织中则分别为21．43％和25．00％，差别有统计学意义；两种指标的强阳性表达率与肿瘤TNM分期明显相关，TⅢ＋Ⅳ组明显高于TⅠ＋Ⅱ组；在癌组织中EMA和EGP-2的表达呈明显正相关（r=0．374，P〈0．01）。结论EMA和EGP-2的高表达对于乳腺癌的诊断具有重要意义，临床检测两者有助于乳腺癌的预后判断及治疗。     

Accuracy of body mass index to determine obesity in women with breast cancer: An observational study of Taiwanese sample

Background

Obesity is common in women with breast cancer. The risk of obesity-induced metabolic syndrome is higher in Asians than in Caucasians. Excessive body fat accumulation has been associated with a worse prognosis. However, the most popular clinical indicator of obesity is not fat itself, but body mass index (BMI).

Objectives

The purposes of this study were to determine the consistency of BMI and body fat percentage (BF%) in determining obesity and to identify the best BMI cutoffs for identifying obesity in Taiwanese women with breast cancer.

Methods

Body fat and fat-free mass were measured by bioelectrical impedance 1 day before breast surgery for 200 women with breast cancer. BMI was calculated as weight (in kilograms) divided by height (in meters) squared.

Results

BMI and BF% were highly correlated (r = 0.91; p < 0.001). However, BMI exhibited poor sensitivity for identifying obesity (47%). The sensitivity of BMI to detect obesity was better in women over age 60. The best BMI cutoff for obesity was 22.3 kg/m² with a sensitivity and specificity of 89% (95% CI = 83-94%) and 87% (95% CI = 77-93%) respectively, and the total accuracy rate improved from 65% to 89%.

Conclusions

Using BMI to identify obesity in Taiwanese women with breast cancer requires careful attention to the diagnostic criterion chosen. The World Health Organization criterion tends to underestimate the prevalence of obesity, especially for younger women with breast cancer (under age 40).     

Cancer and comorbidity: The role of leptin in breast cancer and associated pathologies

Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine (or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.     

上海市妇女对乳腺癌及其早期筛查认知情况的调查

目的了解上海市妇女对于乳腺癌及早期筛查的认知情况和获取相关信息的来源。方法采用乳腺癌及其早期筛查的知识问卷和有关信息来源的问卷对739名妇女进行调查。结果92%的妇女知道乳房肿块是乳腺癌的早期症状,有98.1%和95.7%的妇女认为乳腺自我检测和乳腺临床检查可以早期发现乳腺癌,只有26.7%和24.6%的妇女知道肥胖和年龄是乳腺癌的高危因素。居住在市区、文化程度高的妇女,乳腺癌的认知情况较好(P<0.01)。目前妇女了解乳腺癌早期筛查知识的渠道主要是通过报纸或杂志(43.3%),55.2%的人最想从医师或护士处得到相关信息,同时也有45.3%的人认为从医师或护士处得到的信息最有助于她们做出早期筛查的决定。结论妇女对于乳腺癌及早期筛查知识的掌握程度分布不均,传媒要加强对乳腺癌早期筛查的宣传,护理人员要加强有关的健康教育,针对不同人群实施有效的健康指导,以提高妇女的认知水平。     

La leptine: un lien entre obésité et cancer du sein

Links between obesity and breast cancer could result from the action of adipokines produced by adipocytes. Among these adipokines, leptin appears to have an important role. The presence of its receptors on breast cancer cells shows that it can act directly on these cells: it is able to stimulate their proliferation. There are three distinct modes of action through endocrine-, paracrine-, and autocrine-mediated pathways. Moreover, leptin would appear to be able to counteract anti-estrogenic treatments. These observations suggest that it could be of therapeutic interest to target leptin in breast cancer.     

乳腔镜辅助下腋窝淋巴清扫对乳腺癌患者炎性应激及免疫应激的影响

目的观察及分析乳腔镜辅助下腋窝淋巴清扫对乳腺癌手术患者炎性应激及免疫应激的影响程度。方法选取本院进行手术治疗的60例乳腺癌患者,按照随机数字表法分为对照组(开放式手术)30例和观察组(乳腔镜辅助治疗)30例,比较2组患者术前与术后12、48及72 h的炎性应激及免疫应激指标。结果术后12、48及72 h,观察组的炎性应激及免疫应激指标均显著好于对照组(P0.05)。结论乳腔镜辅助下腋窝淋巴清扫对乳腺癌手术患者炎性应激及免疫应激的影响好于开放式手术。     

超声在小乳腺癌中的诊断价值

目的探讨高频二维超声、彩色及能量多普勒血流成像（CDFI、PDI）对小乳腺癌的诊断价值。方法对86例小乳腺肿块（〈2．0cm）的二维超声声像图特征,CDFI、PDI等项指标进行对照分析。结果小乳腺癌与良性肿块在边界、后方回声情况、纵横比、有无钙化灶等四个方面均有统计学差异（P均〈0．05）。41例小乳腺癌中38例（92．7％）具有血流特征,其中穿入性血流23例（56．1％）,25例伴有同侧腋窝淋巴结转移;45例良性病变中9例伴有同侧腋窝淋巴结反应性肿大。结论小乳腺癌的二维图像、CDFI、PDI在诊断小乳腺癌及转移性腋窝淋巴结方面均有特征性表现,其特征性表现对提高小乳腺癌的早期诊断准确率,具有较高的临床应用价值。     

14. Breast cancer prevention

Increased risk of breast cancer may result from potentially modifiable causes such as endogenous hormone levels, obesity, HRT, and non-lactation, or non-modifiable factors including genetic susceptibility and increasing age. The Gail model, based on known factors, may be useful for estimating lifetime risk in some individuals, but those risk factors that are easier to modify may have a limited impact on the totality of breast cancer. Tamoxifen prevention still remains contentious, with a significant reduction in risk of breast cancer in women given tamoxifen in the NSABP P1 study but no effect in the Italian and Royal Marsden trials. Raloxifene, tested in the MORE trial, reduced the incidence of breast cancer by 65% but this was restricted to oestrogen receptor positive tumours. Lifestyle factors such as diet, obesity, exercise and age at first full term pregnancy and number of pregnancies have a mild to moderate impact on risk, so may have little effect on the incidence of breast cancer. Reduction of alcohol intake could lead to a modest reduction in the risk of breast cancer but possibly adversely affect other diseases. Fat reduction and GnRH analogue reduce mammographic density but have not yet been shown to affect risk. For women with BRCA1/2 mutation, options include unproven surveillance and prophylactic mastectomy with an unquantified risk reduction. Interesting new candidates for chemoprevention include aromatase inhibitors, new generation SERMs, demethylating agents, non-selective COX inhibitors, tyrosine kinase inhibitors and polyamine synthetic inhibitors.