结直肠癌代谢紊乱与胰岛素抵抗的研究

目的 探讨结直肠癌患者是否存在胰岛素抵抗及其临床意义.方法 前瞻性收集2007年6月至2010年6月间温州医学院附属第三医院135例结直肠癌患者作为结直肠癌组,选择同期进行查体的120名健康人为对照组,测量身高、体质量、血压,抽空腹血测量血糖、三酰甘油、HDL-C和胰岛素,计算胰岛素抵抗指数（lnHOMA-IR）.结果 结直肠癌组和对照组胰岛素抵抗指数分别为0.84±0.38和0.42±0.08,代谢综合征发生率分别为34.1%（46/135）和22.5%（27/120）,差异均有统计学意义（P＜0.05）.结直肠癌代谢综合征与非代谢综合征患者的胰岛素抵抗指数分别为0.98±0.41和0.74±0.22,差异无统计学意义（P＞0.05）.胰岛素抵抗指数与结直肠癌分化程度、浸润深度、淋巴结转移、远处转移及TNM分期均无关（P＞0.05）.结论 结直肠癌患者存在胰岛素抵抗,原因可能与代谢综合征及肿瘤本身有关.     

肥胖促进恶性肿瘤发生的机制探讨及研究进展

肥胖及肥胖相关代谢功能紊乱是多种恶性肿瘤发生、发展的危险因素。结直肠癌、乳腺癌(尤其绝经后妇女)、子宫内膜癌等多种恶性肿瘤与肥胖关系密切。脂肪细胞因子、慢性炎症反应、胰岛素抵抗以及性激素水平异常等可能是肥胖促肿瘤作用的重要机制。本文拟综述肥胖与肿瘤发生、发展的分子联系机制。     

应重视及加强对代谢综合征肾损害的研究

代谢综合征(metabolic syndrome,MS)是1999年世界卫生组织(WHO)正式命名的一组代谢异常疾病,主要包括内脏性肥胖(体重增加、腰围增粗、腰臀围比增大)、胰岛素抵抗(高胰岛素正糖钳夹试验检测或公式计算)、糖代谢异常(糖调节受损或糖尿病)、脂代谢异常(甘油三酯升高、高密度脂蛋白-胆固醇减低)及高血压,并能出现高尿酸血症、内皮功能紊乱(出现微量白蛋白尿)、微炎症及高凝血状态.其中肥胖常为MS的启动因素,而胰岛素抵抗是MS中心环节(MS的各种代谢异常都与其相关).     

腹型肥胖与多囊卵巢综合征

腹型肥胖、超重和肥胖是多囊卵巢综合征（PCOS）的常见症状。腹型肥胖和胰岛素抵抗可能引起卵巢和肾上腺分泌过多的雄激素,而雄激素过多分泌本身就可引起脂肪向腹部沉积。PCOS患者内脏脂肪的最新基因组学和蛋白组学研究发现其基因表达和蛋白质组成存在异常。本文综述了有关雄激素过多引起腹壁脂肪沉积,进一步促进PCOS患者卵巢和肾上腺雄激素的过多分泌的机制。     

代谢综合征与结直肠癌临床病理指标相关性探讨

目的 探讨代谢综合征与结直肠癌临床病理指标的相关性.方法 收集分析2002年1月至2007年3月507例结直肠癌患者和277例非肿瘤患者的临床资料.将结直肠癌患者按代谢综合征诊断标准分为代谢综合征组和非代谢综合征组.将体质指数(BMI)、血糖(GLU)、三酰甘油(TG)、胆固醇(CHO)、高密度脂蛋白(HDL)、乳酸脱氢酶(LDH)、尿酸(uA)、癌胚抗原(CEA)和CA19-9等指标以及发病年龄、血压、肿瘤家族史、高血压史、糖尿病史、肿瘤部位、肿瘤分期、分化程度等进行组间统计学比较.结果 结直肠癌组代谢综合征发生率明显高于对照组,其中BMI为评价结直肠癌伴发代谢综合征最重要的指标;代谢综合征组肝转移发生率和肿瘤复发率明显高于非代谢综合征组.结论 了解代谢综合征与结直肠癌的相关性,对减少代谢综合征发生、降低结直肠癌发生率以及减少肿瘤复发和肝转移,提高肿瘤远期疗效可能具有一定指导意义.     

代谢综合征与结直肠癌的相关性研究

目的探讨代谢综合征与结直肠癌的关系。方法采用多中心病例对照研究,收集2000—2009年间景德镇市第一、第二、第三人民医院收治的资料完整、年龄在30-75岁之间的1506例结直肠癌患者（病例组,男936例,女570例）,以及同期在上述3间医院接受住院治疗、年龄30～75岁且资料完整的3354例非慢性、非肿瘤性、非消化道疾病患者（对照组．男1766例．女1588例）。采用多因素逻辑回归分析对代谢综合征及其各单一病种（中心型肥胖、2型糖尿病、高血压和高胆固醇血症）与结直肠癌的关系进行分析,并按性别进一步分层分析。结果病例组和对照组分别有48例（3．2％）和59例（1．8％）最终诊断为代谢综合征。与非代谢综合征相比．代谢性综合征患者发生结直肠癌的风险增高了1．64倍（95％CI：1．14．2．49,P〈0．05）;对于男性,代谢综合征患者发生结直肠癌的风险增高了1．92倍（95％CI：1．27．3．78,P〈0．05）;而对于女性,代谢综合征与结直肠癌的发生并无关联（P〉0．05）。男性患者代谢综合征单一病种数量越多。出现结直肠癌的风险越高（P〈0．01）;而女性患者则未呈现此种趋势（P〉0．05）。结论代谢综合征与结直肠癌的关联性存在于男性而非女性中。     

减肥能够降低老年人结直肠癌的患病风险

【据《BMJ》2014年3月报道】题：通过全国性筛查研究体重及体力活动干预对结直肠癌发病风险的影响——一项随机对照研究（作者Anderson AS等） 结直肠癌排在英国常见肿瘤的第3位，约95％的患者年龄超过50岁，而这类人群常有一些不好的生活方式和合并症，如肥胖、糖尿病和心血管疾病。这些疾病都有共同的危险因素，如腹型肥胖、葡萄糖代谢改变以及血脂水平异常等。英国关于肿瘤可预防性研究认为，12％的结直肠癌可以通过增加体力活动而预防，体力活动真能降低结直肠癌的患病风险吗？来自英国公共卫生与营养组织的Anderson AS等对此进行了相关研究。     

内脏脂肪组织与结直肠癌发病风险及预后关系研究进展

内脏脂肪组织比皮下脂肪组织有更高的代谢活性,促进胰岛素抵抗和分泌促炎细胞因子,可视为一个内分泌和旁分泌器官。大量的内脏脂肪组织阻挡手术视野,促进胰岛素抵抗和炎症通路,直接或间接影响结直肠癌的发生风险、术后并发症发生率、生存时间以及辅助治疗疗效。外科医生通过健康体检和术前检查评估内脏脂肪组织数量,有助于向病人提供更适合的预防建议、手术规划以及预后预测。     

视黄醇结合蛋白4与肾脏疾病的研究进展

视黄醇结合蛋白4（retinol binding protein4,RBP4）属于视黄醇结合蛋白（RBP）家族中的分泌型RBP,主要由肝细胞和脂肪细胞分泌,在协助视黄醇发挥生理功能中起着不可替代的作用。同时RBP4作为一种循环性脂肪细胞因子,在许多研究中均发现其在肾脏疾病、肥胖、胰岛素抵抗、代谢综合征及肝功能损伤中均发挥了重要作用,并有望为相关疾病的发病机制及治疗靶点提供新的线索。     

代谢综合征与肾细胞癌相关性的研究进展

代谢综合征是一组代谢异常疾病, 包括肥胖、高血压、高脂血症和高血糖, 胰岛素抵抗是其病理和主要特征。近年来, 关于代谢综合征与各类肿瘤的研究也逐渐成为热点。肾细胞癌(RCC)是起源于肾实质泌尿小管上皮系统的恶性肿瘤, 占恶性肾肿瘤的80%～90%。肾癌在我国泌尿生殖系统肿瘤中占第2位, 仅次于膀胱肿瘤, 占成人恶性肿瘤的2%～3%。大量的文献提示代谢综合征及其组分与肾细胞癌的发病、疾病的发展、预后等方面密切相关。本文通过对代谢综合征与RCC相关的研究进展进行最新综述, 以期为RCC的预防、筛查及治疗提供循证医学的依据。     

The Phenotypic Approach to Osteoarthritis: A Look at Metabolic Syndrome-Associated Osteoarthritis

Metabolic syndrome-associated osteoarthritis (Met-OA) is a clinical phenotype defined by the role of obesity and metabolic syndrome as risk factors and by chronic low-grade inflammation. Obesity is an established risk factor for osteoarthritis not only at the knee, but also at the hands. Metabolic syndrome is also a risk factor for osteoarthritis, and a cumulative effect of the various syndrome components combines with an independent effect of each individual component (diabetes, dyslipidemia, and/or hypertension). The higher incidence of osteoarthritis in patients with obesity is related to several factors. One is the larger fat mass, which imposes heavier loads on the joints. Another is endocrine production by the adipose tissue of proinflammatory mediators (cytokines, adipokines, fatty acids, and reactive oxygen species) that adversely affect joint tissues. Obesity-related dysbiosis and sarcopenia were more recently implicated in the association between obesity and osteoarthritis. Finally, patients who have osteoarthritis, with or without metabolic syndrome, are at increased risk for cardiovascular mortality due not only to a sedentary lifestyle, but also to shared risk factors. Among these is the low-grade inflammation seen in patients with metabolic disorders. Thus, primary prevention and appropriate management of obesity and metabolic syndrome may delay the development and slow the progression of osteoarthritis.     

Diabetes and cancer: Epidemiological and biological links

The incidence of diabetes and cancer has increased significantly in recent years. Furthermore, there are many common risk factors for both diabetes and cancer, such as obesity, sedentary lifestyle, smoking, and ageing. A large body of epidemiological evidence has indicated that diabetes is considered as an independent risk factor for increased rates of heterogeneous types of cancer occurrence and death. The incidence and mortality of various types of cancer, such as pancreas, liver, colorectal, breast, endometrial, and bladder cancers, have a modest growth in diabetics. However, diabetes may work as a protective factor for prostate cancer. Although the underlying biological mechanisms have not been totally understood, studies have validated that insulin/insulin-like growth factor (IGF) axis (including insulin resistance, hyperinsulinemia, and IGF), hyperglycemia, inflammatory cytokines, and sex hormones provide good circumstances for cancer cell proliferation and metastasis. Insulin/IGF axis activates several metabolic and mitogenic signaling pathways; hyperglycemia provides energy for cancer cell growth; inflammatory cytokines influence cancer cell apoptosis. Thus, these three factors affect all types of cancer, while sex hormones only play important roles in breast cancer, endometrial cancer, and prostate cancer. This minireview consolidates and discusses the epidemiological and biological links between diabetes and various types of cancer.     

Metabolic syndrome in children with chronic kidney disease and after renal transplantation

Visceral obesity and metabolic abnormalities typical for metabolic syndrome (MS) are the new epidemic in adolescence. MS is not only the risk factor for cardiovascular disease but also for chronic kidney disease (CKD). Thus, there are some reasons to recognize MS as a new challenge for pediatric nephrologists. First, hypertensive and diabetic nephropathy, the main causes of CKD in adults, both share the same pathophysiological abnormalities associated with visceral obesity and insulin resistance and have their origins in childhood. Secondly, as the obesity epidemic also affects children with CKD, MS emerges as the risk factor for progression of CKD. Thirdly, metabolic abnormalities typical for MS may pose additional risk for cardiovascular morbidity and mortality in children with CKD. Finally, although the renal transplantation reverses uremic abnormalities it is associated with an exposure to new metabolic risk factors typical for MS and MS has been found to be the risk factor for graft loss and cardiovascular morbidity after renal transplantation. MS is the result of imbalance between dietary energy intake and expenditure inducing disproportionate fat accumulation. Thus, the best prevention and treatment of MS is physical activity and maintenance of proper relationship between lean and fat mass.     

大肠癌根治术后胃瘫综合征的临床分析

目的:探讨大肠癌术后发生胃瘫综合征(PGS)及危险因素及诊疗方法。方法:收集2013年1月—2014年9月行手术治疗的大肠癌患者806例临床资料,对PGS发生的影响因素行统计学分析。结果:全组PGS的发生率为1.36%(11/806),分别发生于7例右半结肠癌患者(63.6%),3例左半结肠癌患者(27.3%),1例直肠癌患者(9.1%)。单因素分析显示,术前血糖水平(P=0.002)、术前电解质紊乱与否(P=0.023)、术前肠梗阻与否(P=0.009)、术后进食时间(P=0.018)与PGS的发生有关;多因素Logistic回归分析显示,术前血糖水平(P=0.002)与术后进食时间(P=0.028)是PGS发生的独立危险因素。结论:PGS是多因素引起的胃功能性紊乱,应予以综合治疗措施。控制好患者血糖水平,根据患者围手术期一般情况适当延迟进食时间有利于减少大肠癌根治术后PGS的发生。     

同时性结直肠癌肝转移一期切除术后并发症相关因素分析

目的:探讨同时性结直肠癌肝转移一期切除术后并发症的相关影响因素及预防措施。方法:2009年6月至2018年6月解放军总医院普通外科行同时性结直肠癌肝转移一期切除术的241例,统计并发症发生情况,分析影响因素,对危险因素进行评估分析。结果:241例行同时性结直肠癌肝转移一期切除术的患者术后共42例发生并发症,发生率为17.4%。其中,吻合口瘘19例(7.9%),腹腔出血7例(2.9%),肠梗阻15例(6.2%),切口感染21例(8.7%),腹腔感染6例(2.5%),肺部感染3例(1.2%)。单因素分析结果显示,高龄、手术方式、术前合并症、原发肿瘤位置、术中失血量是腹同时性结直肠癌肝转移一期切除术后并发症发生的相关因素(P<0.05)。Logistit回归分析显示,影响同时性结直肠癌肝转移一期切除术后并发症发生的独立危险因素为高龄、术前合并症、手术出血量(P<0.05),腹腔镜手术则是其保护因素(P<0.05)。结论:吻合口瘘和出血是同时性结直肠癌肝转移一期切除术后常见并发症,高龄、术前合并疾病、手术出血量较多是同时性结直肠癌肝转移一期切除术后并发症发生的危险因素,而采取腹腔镜手术则可减少并发症的发生。     

The impact of obesity in urology

The incidence and progression of urologic diseases, as well as several urologic cancers.depend on many interrelated factors, such as obesity, diet, genetics, environment, age, and the immune system. Obesity is a risk factor for stress urinary incontinence, ED, infertility, and renal calculi. Numerous publications have demonstrated that a high dietary intake of fat increases prostate cancer risk, although the mechanisms are not clear. Although some reports may demonstrate an association between obesity and prostate cancer, it may be hard to establish because, in general, men with obesity have a high-fat diet. Obesity, recurrent urinary tract infections, increased intake of protein and fried foods, and female sex seem to increase the risk of renal cancer. Environmental toxins seem to be the major factors affecting the incidence of bladder cancers. Thus, dietary modification and other public health measures directed at reducing weight may reduce the incidence of urologic illnesses. More studies are necessary to determine the therapeutic effects of weight loss and dietary modification on the incidence and progression of urologic tumors.     

Metabolic syndrome and leptin are associated with adverse pathological features in male colorectal cancer patients

Aim Metabolic syndrome (MetS) describes a clustering of factors including central obesity, hypertension and raised plasma glucose, triglycerides and high‐density lipoprotein (HDL) cholesterol. Central obesity is associated with a risk for colorectal cancer, but the impact of MetS on colorectal cancer biology and outcomes is unclear. Method A prospective observational study of colorectal cancer patients was carried out in an Irish population. Patients underwent metabolic and anthropometric assessment before treatment, including measurement of serum hormones and adipokines and CT measurement of visceral fat. MetS was defined according to the International Diabetes Federation definition³. Results One‐hundred and thirty consecutive colorectal cancer patients (66 men and 64 women) were recruited. MetS was diagnosed in 38% patients compared with the population norms reported at 21%²¹. Male patients had a significantly greater visceral fat area compared with female patients. MetS was associated with node‐positive disease (P = 0.026), percentage nodal involvement (P = 0.033) and extramural vascular invasion (P = 0.049) in male patients but no significant association was observed in female patients. HDL cholesterol was also significantly associated with a more advanced pathological stage (P = 0.014) and node‐positive disease (P = 0.028). Leptin was associated with nodal status (P = 0.036), microvascular invasion (P = 0.054), advanced pathological stage (P = 0.046) and more advanced Dukes stage (P = 0.042). Conclusion We report a high prevalence of MetS and visceral obesity in a colorectal cancer population. MetS and plasma leptin are associated with a more aggressive tumour phenotype in male patients only.     

Age,lifestyle, health risk indicators,and prostate-specific antigen scores in men participating in the world senior games

BACKGROUND: A number of risk factors have been implicated for prostate cancer, with dietary fat intake the most commonly accepted modifiable risk. OBJECTIVE: To assess the relationship between health risk indicators (e.g., cholesterol, blood pressure, blood sugar, and percent body fat), which are related to dietary fat intake, and prostate-specific antigen (PSA) scores. Relationships between demographics and select behaviors (e.g., cigarette smoking and physical activity) with PSA scores are also considered. The setting was the 1999 Huntsman World Senior Games in St. George, Utah. Subjects' analysis is based on 536 men aged 50 years and older completing a questionnaire and receiving free screening, including a PSA. METHODS: Frequency distributions, multiple regression techniques, and the Spearman correlation coefficients. RESULTS: A positive relationship was observed between increasing age groups and mean PSA scores (Cochran-Mantel-Haenszel Chi-Square: 53.8, p < 0.0001). After adjusting for age, none of the personal risk factor indicators (i.e., cholesterol, blood pressure, blood sugar, and percent body fat) were related to PSA scores. Other factors not related to PSA scores after adjusting for age were race, marital status, education, history of chronic disease, cigarette smoking, alcohol use, and physical activity. CONCLUSION: Because risk indicators such as cholesterol, blood pressure, blood sugar, and percent body fat are associated with dietary fat intake, their failure to be related with PSA scores makes it further unclear how this commonly accepted modifiable risk factor for prostate cancer may influence the disease.