胰腺癌与糖尿病关联的探讨

背景与目的:在十九世纪早期,人们即认识到胰腺癌与糖尿病(DM)的关系,但至今两者的因果关系仍有争论,本文探讨两者的关联,从而提高胰腺癌早期诊断水平。方法:对2003年12月-2005年2月收住我院的胰腺癌合并DM患者及非合并DM患者共83例进行回顾性分析,并将其中13例以DM为首发症状或DM病情加重胰腺癌患者与另外20例病程匹配的2型糖尿病(T2DM)进行年龄、体重指数、DM家族史及实验室指标的比较。结果:①83例胰腺癌中,35例(42.17%)合并DM,其中24(68.57%)例DM病程小于2年(其中14(40%)例与胰腺癌同时发现),8(22.86%)例DM病程大于2年,3例DM病程不详。胰腺癌合并DM患者高血压的患病率高于非DM患者(45.71%vs25%,P<0.05)。②胰腺癌合并DM患者腹痛(χ2=5.332,P<0.01)、纳差(χ2=3.867,P<0.01)的发生率低于非DM患者。③胰腺癌合并DM患者直接胆红素(DB)(χ2=23.46,P<0.01)升高发生率较低。④两组患者在肿瘤的部位、转移、手术情况和生存期差异无统计学意义。⑤13例以DM为首发症状或DM病情加重胰腺癌患者与20例T2DM进行比较,胰腺癌患者发病年龄较大(68.93±10.62vs55.6±11.14岁,P<0.01)且体型更消瘦(BMI21.51±1.98vs23.87±3.04kg/m2,P<0.01)。结论:胰腺癌为进展较快的肿瘤,即使合并DM,也不影响胰腺癌临床表现及预后。对于高龄且消瘦初发DM患者及血糖短期恶化DM患者,要警惕胰腺癌的发生。     

The relationship between new-onset diabetes mellitus and pancreatic cancer risk: A case-control study

Diabetes mellitus (DM) is widely considered to be associated with pancreatic cancer, however, whether DM is a cause or consequence of pancreatic cancer is controversial. In the present study, 1458 patients with pancreatic ductal adenocarcinoma (PDAC) and 1528 age-, sex- and sociodemographic variables-matched controls were recruited in two university-affiliated hospitals from 1st January 2000 to 31st December 2009. DM was defined as fasting blood glucose (FBG) level of 7.0 mmol/L or greater. An unconditional multivariable logistic regression analysis was used to estimate adjusted odds ratios (AORs) and 95% confidence interval (CI). Compared with controls, a moderate increased risk of PDAC was observed among cases with long-standing diabetes (?2-year duration), with an AOR (95% CI) of 2.11 (1.51-2.94). Interestingly, a significant higher risk was observed among cases with new-onset DM (<2-year duration), with an AOR of 4.43 (3.44-5.72) compared to controls without DM. In addition, we found a synergistic interaction between cigarette smoking and DM on modifying the risk of pancreatic cancer development (AOR = 6.17, 95% CI 3.82-9.94). Similarly, a synergistic interaction between new-onset DM and family history of pancreatic cancer was found for pancreatic cancer risk, with an AOR (95% CI) of 11.04 (2.51-48.53). This study suggested that DM could be both an early manifestation of pancreatic cancer and an aetiologic factor. Possible effect modification on DM by family history of pancreatic cancer and smoking status should be further explored in future aetiologic studies.     

2型糖尿病与肝癌关系的探讨

我国是肝癌的高发病区.有研究表明,2型糖尿病与肝癌的发生发展有关.本文拟从2型糖尿病对肝癌的发生影响、可能的机制、药物治疗的影响及预后几方面对两者的关系进行综述.     

Exploring the link between diabetes and pancreatic cancer

Introduction: Epidemiological studies indicate an association between type 2 diabetes and pancreatic cancer but the complex and multidirectional relationship between them remains unclear.

Areas covered: We summarized epidemiological evidence on diabetes and pancreatic cancer exploring the time–risk relationship. We described mechanisms linking long-standing diabetes to pancreatic cancer. We discussed pancreatic cancer-associated diabetes and its implication in the early detection of pancreatic cancer.

Expert opinion: The markedly increased risk of pancreatic cancer in patients with new-onset diabetes compared with long-standing diabetes observed in several epidemiological studies indicates a complex and bidirectional connection, with long-standing diabetes being a predisposing factor for pancreatic cancer (increasing the risk of the malignancy 1.5- to 2-fold) and new-onset diabetes an early manifestation of the tumor. Identifying clinical features and biomarkers to distinguish pancreatic cancer-associated diabetes from type 2 diabetes is an important goal to improve management and survival of this cancer. Imaging (MRI) for middle-age patients with new-onset diabetes may be considered.     

胰腺癌与糖尿病及肥胖的流行病学相关性

目的探讨胰腺癌与糖尿病及肥胖的流行病学相关性。方法采用整群随机抽样的方法选取2016年2月至2018年2月间内蒙古医科大学附属医院收治的30例胰腺癌患者,将这些患者作为研究组,另选取同期收治的30例非肿瘤、非激素代谢异常且非消化系统类疾病患者作为对照组,分析比较两组患者糖尿病和肥胖发生情况。结果研究组患者中发生糖尿病8例,未发生糖尿病22例,糖尿病发生率为26. 7%。对照组患者中发生糖尿病3例,未发生糖尿病27例,糖尿病发生率为10. 0%。研究组的糖尿病发生率显著高于对照组,差异有统计学意义(P <0. 05)。研究组患者中发生肥胖5例,未发生肥胖25例,肥胖发生率为16. 7%。对照组患者中发生肥胖2例,未发生肥胖28例,肥胖发生率为6. 7%。研究组患者的肥胖发生率显著高于对照组(P <0. 05),差异有统计学意义。结论糖尿病及肥胖与胰腺癌的发生在流行病学上密切相关,糖尿病及肥胖可能是胰腺癌发生的危险因素。     

胰腺癌18 F-FDG摄取程度与血管内皮生长因子及微血管密度的关系

目的初步探讨胰腺癌病灶的^18F-FDG摄取程度（SUV）与手术切除标本的血管内皮生长因子（VEGF）表达及微血管密度（MVD）之间的关系，考察SUV是否能够于疗前在体评估胰腺癌的血管生成状态。方法纳入2008年5月至2011年9月于我科行PET—CT检查后行手术切除的10例胰腺导管腺癌患者，术前均未行放疗或化疗。记录PET—CT图像中病灶的最大标准摄取值（SUVmax），并使用免疫组织化学染色检查胰腺癌标本的MVD及VEGF表达。结果10例胰腺癌病灶的中位SUVmax为4．7（3．3～5．9），中位MVD为67（49～110），VEGF（-）4例，VEGF（＋）3例，VEGF（＋＋）3例。取中位SUVmax=4．7为界值点分组对比可知，VEGF（＋＋）患者的SUVmax高于VEGF（＋）／（-）患者，且MVD计数较高与SUVmax偏高存在一定正相关趋势。结论本组小样本结果初步表明，胰腺导管腺癌的SUVmax越高，发生转移的可能性越大。SUVmax与VEGF表达和MVD计数存在正相关趋势的可能，初步提示^18F—FDG PET—CT检查有可能于疗前在体评估胰腺癌的血管生成状态，有望为临床是否行分子靶向治疗提供更名右价值的信息。     

The relationship between diabetes,prostate-specific antigen screening tests,and prostate cancer

Purpose

Men with diabetes have been found to have a reduced risk of prostate cancer (PCa), potentially due to detection bias from lower prostate-specific antigen (PSA) levels or inhibition of tumor growth. Understanding if lower PCa rates are due to a lower risk of the disease or a detection bias from PSA testing can help inform the benefits and harms from prostate cancer screening.

Methods

We used data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial to assess the impact of PSA screening on PCa in men with diabetes and the potential role of detection bias and/or slower tumor growth. Comparing men by diabetes status, we calculated age-adjusted incidence rates by tumor grade and compared screening results, PSA levels, and tumor characteristics.

Results

Men with diabetes had lower rates of PCa but was limited to low- and intermediate-grade tumors. Men with diabetes were less likely to be biopsied after their first positive screening test and men diagnosed with low/intermediate-grade tumors had significantly more advanced tumors with higher PSA levels.

Conclusions

Our findings provide additional evidence that detection bias is likely contributing to the lower rates of low- and intermediate-grade prostate cancers.

     

蛙皮素与胰腺癌的相关性研究进展

蛙皮素与肿瘤增殖关系密切,在多种人胰腺癌细胞系及其移植瘤中均发现其高表达,但在人胰腺肿瘤组织中的表达仍存在争议,因此人们对其表达及作用机制进行了广泛研究,并探讨了蛙皮素及其受体拮抗剂与胰腺癌治疗间的关系。多种放射性标记的蛙皮素类似物的出现也使得在蛙皮素受体阳性的胰腺癌中的放射性显像及靶向治疗成为可能。现就蛙皮素及其同类物与胰腺癌的关系作一综述。     

肿瘤相关中性粒细胞与胰腺癌关系的研究进展

胰腺癌是一种起病隐匿、预后不良的消化系统恶性肿瘤,具有早期诊断困难、进展期生存时间短等特点。胰腺癌的肿瘤微环境(Tumor microenvironment, TME)中常常伴有大量免疫细胞的浸润,而肿瘤相关中性粒细胞(Tumor-associated neutrophils, TANs)作为TME的重要组成部分,在肿瘤的进程中起着重要作用。相关研究表明,TANs在胰腺癌的TME中发挥多种作用。本文从TANs与胰腺癌的关系进行综述,为理解胰腺癌发生机制与提出新疗法提供思路。     

Management of diabetes and pancreatic cancer

A 54-year-old male patient named D.N. developed type 2 diabetes mellitus (T2DM) 10 months ago. At the time, he weighed 225 pounds and had a body mass index of 35.2. D.N. was started on metformin with poor control and, within two months, glimepiride was added to his regimen. Six months later, D.N.'s hemoglobin A1c (HbA1c) was still above 8% (normal is less than 6%), so his endocrinologist added exenatide. He had a fairly well controlled fasting blood glucose and HbA1c ranging from 6.5%-7.3% after exenatide was added. One month later, however, D.N. developed abdominal pain and anorexia with a 20-pound weight loss. His blood glucose became extremely labile despite his poor oral intake and good compliance with his oral hypoglycemic agents.     

趋化因子与乳腺癌

趋化因子参与乳腺癌细胞的生长、血管生成及远处转移过程。然而,近年来单靶点趋化因子受体拮抗剂的临床试验多以失败告终,彰显了肿瘤微环境中趋化因子网络的复杂性,因此基于多向药理学原理确立多靶点调控策略势在必行。多靶点非典型性趋化因子受体(ACR)作为内源性和生理性的调节分子,有可能成为捕获高表达的多种促肿瘤性趋化因子、有效控制乳腺癌的利器。     

雌激素与甲状腺癌

甲状腺癌是目前最常见的内分泌相关恶性肿瘤。虽然临床上大多数治疗效果良好,但其具有易复发转移的特点。越来越多的研究表明,雌激素通过结合其受体,参与并影响甲状腺癌的发生和发展。雌激素及其受体已经成为目前甲状腺癌研究的一大热点,本文将雌激素在甲状腺癌中的作用做一综述。     

肛门隐血与肝胆胰腺癌普查的关系

目的：用棉棒涂抹肛门方法代替大便隐血试验,不仅可以初筛大肠癌,还可以作为筛肝胆胰腺癌的辅助手段。方法：２２３例肝胆胰腺癌病人做肛门隐血试验。其中有１２１例呈阳性反应,阳性率为５４．２％。在４０～６０岁健康人群中筛查１４６４５人,５１１人肛门隐血呈阳性反应,阳性率为３．４％。结果：检出消化道癌６例（食管癌１例,胃癌２例,肝癌２例）。结论：提示肛门隐血阳性时,应进一步用超声波检查肝胆胰有无肿瘤。     

2型糖尿病与结直肠癌关系的回顾性分析

目的探讨结直肠癌患者中伴发2型糖尿病的比例,比较合并糖尿病的结直肠癌患者与普通结直肠癌患者发生淋巴结或远处转移的比率,了解糖尿病是否为结直肠癌发病的重要危险因素,为做好结直肠癌的一级预防提供思路。方法回顾分析286例住院结直肠癌患者的血糖情况,计算2型糖尿病患病率,分别计算合并糖尿病的结直肠癌患者与普通结直肠癌患者发生淋巴结或远处转移的比率。结果结直肠癌患者中2型糖尿病的患病率为8．04％,标准化患病率为3．97％,与全国糖尿病标准化患病率比较差异有显著性（P〈0．01）;合并糖尿病的结直肠癌患者淋巴结或其他组织器官转移率为69．6％（16／23）,高于无糖尿病的结直肠癌患者（42．2％,111／263）。结论糖尿病与结直肠癌患病存在一定的相关性,糖尿病增加了患结直肠癌的风险性。预示2型糖尿病可能是结直肠癌发生的独立危险因素,加强糖尿病的防治将对预防结直肠癌患病和改善预后有重要的作用。     

代谢综合征与乳腺癌的关系

代谢综合征(metabolic syndrome,MS)是以肥胖和胰岛素抵抗为中心的多种代谢性危险因素在个体内集结的状态,主要组分包括肥胖、高血糖、高胰岛素血症、血脂异常和高血压等。研究表明代谢综合征不仅是心血管病的危险因素,还与乳腺癌的发生和预后相关。本文综述代谢综合征与乳腺癌患病风险的关系及其致乳腺癌的可能机制,为乳腺癌的预防、治疗及预后提供新的策略。     

炎症标志物与肺癌关系的研究进展

肺癌是最常见的恶性肿瘤,发病率高、生存率低、死亡率高,预后差.自1863年Virchow提出肿瘤可能是由慢性炎症引起的假设后,人们进行了很多研究.研究表明,炎症标志物与肺癌的发生、发展、预后都有密切关系,对炎症标志物的研究可能为肺癌患者提供另一个评价预后的指标,且其检测简单方便,标准化,并可排除主观因素的影响,是一个很好的客观评价系统.本文对炎症介质白细胞介素-6、肿瘤坏死因子-α、白细胞介素-8、白细胞介素-10、白细胞介素-2及炎症蛋白C反应蛋白、纤维蛋白原与肺癌的关系进行综述.     

HPIP与胰腺癌的相关性

胰腺癌是一种致死率极高的恶性肿瘤,总体五年生存率不及5%。就目前状况而言,胰腺癌的治疗方式有限、效果欠佳、前景堪忧,任何能够改善治疗的探索都是必要的。研究发现,雌激素受体（ER）在胰腺癌中广泛表达;HPIP是一种新型的支架蛋白。近年来相关文献已证实,HPIP与肿瘤细胞的增殖、转移密切相关,有可能成为肿瘤治疗的新靶点。本文就HPIP与胰腺癌的相关性进行初步探讨。