不同时期胰腺癌易感因素分析与比较

目的分析胰腺癌患者易感因素,以期能确认胰腺癌危险因素. 方法采用回顾性分析的方法,分析了1985年10月～1991年11月(78例)及自1995年10月～2001年8月(194例)共272例胰腺癌病例.     

胰腺癌与糖尿病的流行病学研究

目的 探讨胰腺癌与糖尿病的流行病学关系.方法 收集1997年至2007年间收治的220例胰腺癌病例,以同期非消化系统、非肿瘤及非代谢异常类的300例患者作为对照组.比较两组糖尿病的发病率、糖尿病病程与胰腺癌的关系;比较胰腺癌组内糖尿病患者及血糖正常者在性别、年龄、肿瘤部位、肿瘤分化程度等方面的差异.结果 胰腺癌组和对照组糖尿病发病率分别为33.2%和9.7%.差异显著(P<0.05).胰腺癌组糖尿病病程<2年与≥10年者的比例分别为78.1%(57/73)和9.6%(7/73),显著高于对照组的62.1%(18/29)和6.9%(2/29),两组比较有统计学差异(χ2=46.15,P<0.01,OR=6.07;χ2=4.72,P<0.01,OR=4.90);胰腺癌组糖尿病病程2～<5年及5～<10年者比例与对照组无显著差异.胰腺癌组内糖尿病患者和非糖尿病患者性别、年龄、肿瘤部位比较差异无显著性,但糖尿病者肿瘤分化以乳头状或高分化腺癌为主,而无糖尿病者肿瘤以低分化腺癌为主.结论 糖尿病与胰腺癌关系密切,可能是胰腺癌的临床表现之一,也可能是胰腺癌的危险因素.     

糖尿病与胰腺癌关系的临床分析

目的　分析 47例胰腺癌合并糖尿病的临床和病理学特征 ,初步探讨糖尿病与胰腺癌之间的关系。方法　对胰腺癌合并糖尿病及同期收治的未合并糖尿病的胰腺癌患者进行回顾性对比分析。结果　 (1)胰腺癌合并糖尿病的患者 ,占本研究中胰腺癌的 2 5 % ;(2 )两组患者均主要发生于中老年人 ,以男性多见 ,主要临床表现为上腹痛、黄疸 ;(3)两组患者胰腺癌大小、部位、胰外浸润或远处转移以及肿瘤切除率无显著性差异 ;(4 )病理学检查糖尿病组以乳头状或高分化腺癌多见 ,非糖尿病组以中、低分化腺癌多见 ;(5 )糖尿病先于胰腺癌诊断者占 19.2 % ,与胰腺癌同时诊断者占 80 .8%。结论　 (1)糖尿病可能是胰腺癌的危险因素之一 ;(2 )对中老年糖尿病患者宜常规行胰腺B超检查 ,定期随访 ,以期早期诊断 ,及时治疗 ,对改善其预后十分重要     

胰腺癌相关危险因素研究及高危评分模型的建立

目的 探索胰腺癌相关危险因素，建立胰腺癌高危评分模型。方法 采用病例对照研究，收集2002年1月至2004年4月胰腺癌患者119例，正常对照238名。对所有研究对象进行流行病学问卷调查，通过两组比较确定胰腺癌相关危险因素。选择相关危险因素和症状进行多元Logistic回归分析，计算各变量的权重分数，建立高危评分模型。结果 高剂量吸烟（〉17包年）人群发生胰腺癌的风险增加（OR 1．98；95％CI 1．11～3．49），尤其是男性高剂量吸烟者（OR 2．11；95％CI 1．18～3．78）；饮酒对胰腺癌的危险性主要表现在高剂量饮洒中（OR 3．681；95％CI 1．604～8．443）。胰腺癌患者中以肉食为主者占31．03％，而对照组中仅为7．61％（P〈0．0001）；有糖尿病史的胰腺癌患者占18．49％，而对照组仅为5．77％（P=0．0003），胰腺癌组中患糖尿病时间中位数为0．5年，对照组为4年；临床症状中厌食、上腹痛、腹胀、黄疽及体重下降两组间差异有统计学意义。根据高危评分模型对两组进行评分，胰腺癌组和对照组平均分分别为80．6（95％CI，74．9～86．3）和7．4（95％CI 6．0～8．7），P〈0．001。初步确定≥45分为胰腺癌高危人群筛查界值。结论 高剂量吸烟、高剂量饮酒、肉食、糖尿病史为汉族人群的胰腺癌相关危险因素。该评分模型町用于胰腺癌高危人群的初筛．可能有助于发现早期胰腺癌患者，但还需进一步验证。     

我国胰腺癌部分发病危险因素的Meta分析

目的探讨我国胰腺癌发病的危险因素,为制定相关预防和控制策略提供参考依据.方法对国内外1978 ～ 2003年间公开发表的关于我国胰腺癌发病危险因素的独立病例对照研究进行综合定量分析,计算每个因素的综合OR值及95%可信区间.累积病例1 889例,对照10 304例.结果各危险因素与胰腺癌的OR值95%可信区间为:吸烟(总)2.43(1.27 ～ 4.63)、吸烟(男)1.86(1.23 ～ 2.83)、吸烟(女)1.97(1.06 ～ 3.64)、饮酒(总)1.10(0.72 ～ 1.67)(P ＞ 0.05)、饮酒(男)1.16(0.56 ～ 2.40)(P ＞ 0.05)、饮酒(女)0.89(0.45 ～ 1.78)(P ＞ 0.05)、男性每周摄入酒精量≥ 750 g 1.58(1.07 ～ 2.34)、糖尿病史4.65(3.16 ～ 6.85)、胆石症史4.13(2.92 ～ 5.83)、生育0 ～ 2胎1.23(0.88 ～ 1.72)(P ＞ 0.05)、生育3 ～ 4胎2.70(1.21 ～ 6.00)、生育数≥ 5胎2.57(1.64 ～ 4.01)、A型血1.02(0.66 ～ 1.57)(P ＞ 0.05)、B型血1.05(0.52 ～ 2.12)(P ＞ 0.05)、O型血0.99(0.84 ～ 1.17)(P ＞ 0.05)、AB型血0.92(0.72 ～ 1.17)(P ＞ 0.05).结论吸烟、大量饮酒(每周摄入酒精量≥ 750 g)、糖尿病史、胆石症史、多次生育(生育数≥ 3胎)为我国胰腺癌发病的部分危险因素.     

青年冠心病患者冠状动脉特点及相关危险因素分析

目的　探讨青年冠心病冠状动脉病变的特点和相关危险因素分析。方法　对 161例年龄小于 40岁胸痛患者行冠状动脉造影 ,发现 10 1例冠状动脉病变者为冠心病组 ,60例冠状动脉正常者为对照组 ,逐步回归分析 ,对两组间冠状动脉病变特点及相关危险因素进行对比分析。结果　冠心病组单支病变 5 8例 ( 5 7.4% ) ,双支病变 19例 ( 18.8% ) ,三支病变 2 4例 ( 2 3 .8% )。共侵犯血管167支 ,前降支最易受累共 73例 ( 4 3 .7% ) ,右冠状动脉 49例 ( 2 9.3 % ) ,回旋支 3 5例 ( 2 0 .9% )。两组间危险因素分析 :男性 ,吸烟 ,高血脂 ,糖尿病 ,冠心病家族史有显著性差异 ( P<0 .0 5 )。冠心病组危险因素 L ogistic多因素分析 ,男性 ,家族史 ,高血脂为独立的危险因素。结论　冠状动脉分布类型以右优势为主 ,青年冠心病人累及血管以单支血管为主 ,且前降支最易受累 ,和对照组对比 ,男性、吸烟、高血脂、糖尿病、冠心病家族史有显著性差异。冠心病组危险因素 L ogistic多因素分析 ,男性、冠心病家族史、血脂为独立的危险因素。     

胰腺癌的早期诊断

早期诊断是改善胰腺癌患者预后的关键因素之一,针对高危人群的定期筛查有望实现这一目标。遗传易感者、50岁后新发糖尿病、主胰管型导管内乳头状黏液瘤等病变均为胰腺癌的高危因素。随着流行病学研究的深入,未来可能将吸烟、饮酒、肥胖、慢性胰腺炎等因素一并纳入胰腺癌风险评估体系中,通过更精确的风险分级让更多个体从胰腺癌早期筛查中获益...     

胰腺癌和慢性胰腺炎的相关因素

目的:对比胰腺癌(pancreatic carcinoma,PC)和慢性胰腺炎(chronic pancreatitis,CP)的相关因素,为临床早期发现PC提供一定帮助.方法:对比分析新疆医科大学第一附属医院2005-01/2010-06住院胰腺癌(pancreaticcarcinoma,PC)患者265例及同期住院期间慢性胰腺炎(chronic pancreatitis,CP)患者294例,并进行单因素分析及多因素的非条件Logistic回归分析胰腺癌相关因素.结果:单因素分析显示:年龄、民族、吸烟、吸烟>20支/d、饮酒、饮酒>40g/d且>10年、糖尿病、胆石症、血、尿淀粉酶、空腹血糖水平、门冬氨酸氨基转移酶、丙氨酸氨基转移酶、CA19-9水平在2组间差异有统计学意义(P<0.05).多因素非条件Logistic回归分析显示:年龄(OR=1.607,P<0.05),CA19-9>35KU/L(OR=1.004,P<0.05),空腹血糖>6.4mmol/L(OR=1.453,P<0.05)是胰腺癌发生的独立危险因素.对265例胰腺癌患者用Logistic回归方程预测发现251例胰腺癌,正确率为94.7%;对294例慢性胰腺炎患者中用Logistic回归方程预测有282例非胰腺癌,正确率为95.9%;总正确率为95.3%.结论:对具备年龄、CA19-9、空腹血糖水平等高危因素的CP患者应定期监测空腹血糖及CA19-9,以期早期发现PC,对临床工作具有指导意义.     

冠心病三支病变54例危险因素的临床分析

目的:探讨冠心病三支病变与危险因素之间的关系。方法:对冠心病三支病变患者(观察组)54例与单支、双支病变患者(对照组)70例7种心血管危险因素(年龄、性别、吸烟、饮酒、高血压、糖尿病、高脂血症)进行统计学分析。结果:两组之间年龄、性别、饮酒、高血压、高甘油三酯血症无显著差异.而吸烟、高胆固醇血症、糖尿病差异显著(P<0.05～<0.01)。结论:糖尿病,高胆固醇血症,吸烟为冠心病三支病变的重要危险因素,防治中应作相关积极处理。     

72例脑卒中患者复发原因分析

目的分析脑卒中复发的相关因素。方法对本社区286例脑卒中患者进行调查并统计初次脑卒中发生2年内复发的人数,分析引起复发的原因。结果脑卒中2年内复发率为25%。(1)两组患者的性别构成间差别无显著性意义(P>0.05),年龄和神经功能损伤评分间差别均有显著性意义(P<0.05);(2)两组患者除饮酒、缺乏适当运动的发生率间差别无显著性意义(P>0.05)外,余危险因素的发生率间差别均有显著性意义(P<0.05);(3)两组患者危险度的构成间差别有显著性意义(P<0.01)。结论高血压及糖尿病控制不理想、血脂异常、心脏疾病、抑郁、肥胖、吸烟、饮食不合理为脑卒中复发的危险因素,同时存在多项危险因素的患者复发的危险性更大。及时有效的干预和控制这些因素对预防脑卒中复发有重要的临床意义。     

New-onset diabetes mellitus as a harbinger of pancreatic carcinoma. A case report and literature review

We report the case of a middle-aged man with a 6-month history of diabetes treated with insulin. He was referred for diabetes control and education. Six weeks after we saw him, he was euglycemic (hemoglobin, Hgb A1C 5.9%), but returned because of weight loss, diarrhea, and abdominal cramps. Pancreatic adenocarcinoma was diagnosed. We review the literature on the relationship between diabetes mellitus and pancreatic carcinoma with particular emphasis on situations in which recent-onset diabetes may be a harbinger of pancreatic carcinoma. Several reports are cited in which the onset of diabetes mellitus in middle-aged patients antedated by a short time the onset of clinically recognizable pancreatic carcinoma. An otherwise silent pancreatic carcinoma may present as new-onset diabetes. Although rare, pancreatic carcinoma should be considered in a recently diagnosed middle-aged diabetic person with unusual manifestations, e.g., abdominal symptoms and continuous weight loss despite euglycemia.     

血清尿酸水平与老年冠心病患者易感风险因素的相关性研究

目的分析血清尿酸水平与老年冠心病易感风险因素的相关性。方法回顾性采集2017年1月至2019年1月我医院老年冠心病患者200例(冠心病组)和同期医院门诊接诊的非冠心病老年患者150例(对照组)的临床资料。患者入院后即刻采集外周静脉血,测定血清尿酸水平;并记录各基线资料情况,将冠心病可能的易感风险因素纳入,经单因素与多因素分析找出风险因素,分析血清尿酸水平与老年冠心病患者各易感风险因素的相关性。结果初步单因素分析发现,吸烟、合并糖尿病、低高密度脂蛋白胆固醇(HDL-C)血症、冠心病家族史、肾小球滤过率等均可能是老年冠心病患者易感风险因素(χ^2=6.739、15.655、6.331、9.615、23.279,P均<0.05);多因素分析证实,吸烟、合并糖尿病、低HDL-C血症、冠心病家族史、肾小球滤过率均是老年冠心病易感风险因素(OR=1.777、2.381、1.883、1.967、3.205,均P<0.05);吸烟、合并糖尿病、低HDL-C血症、有冠心病家族史、肾小球滤过率<100 ml/min的老年冠心病患者,其血清尿酸水平均高于其他患者(t=8.017、5.907、8.509、7.164、13.839,均P<0.001);经Spearman相关性分析检验证实,血清尿酸水平与老年冠心病患者吸烟、合并糖尿病、冠心病家族史等易感风险因素均呈正相关(r=0.409、0.422、0.422,均P<0.001),与低HDL-C血症、肾小球滤过率呈负相关(r=-0.428、-0.481,均P<0.001)。结论血清高尿酸水平与吸烟、糖尿病等诸多冠心病易感风险因素有紧密联系,可能是冠心病发病的独立危险因素。     

慢性胰腺炎糖尿病的发生率及其风险因素分析

目的 分析慢性胰腺炎(CP)糖尿病发生率及可能风险因素.方法 分析和随访1997年1月-2007年7月疼痛性CP患者资料,寿命表法计算首次腹痛后累积糖尿病发生率,Cox比例风险模型逐步回归分析风险因素,包括年龄、性别、吸烟、饮酒、病因、胰腺肿块、胰腺钙化、治疗方案、伴腹泻、体重减轻和腹痛程度.结果 人组病例共354例,男:女=2.1:1,首发年龄(38.1±17.6)岁,随访时间(45.2±32.9)个月;酒精性CP 18.1%;总糖尿病发生率16.1%,其中需胰岛素治疗者40.3%.内镜介入和外科手术治疗前34例已确诊,治疗后新发23例;29.8%糖尿病发生于腹痛1年内;首次腹痛后1、3、5、10年内的累积糖尿病发生率分别为4.9%、6.5%、9.3%、20.7%;Cox风险比例模型回归分析显示,治疗前糖尿病组中吸烟量＞200年支(年支定义每天吸烟支数×吸烟年数)、轻度腹痛、体重减轻、胰腺钙化为风险因素,风险比分别为3.3、5.2、2.6、2.2;新发糖尿病组中,吸烟量＞200年支、持续或新发体重减轻、胰尾/体尾部切除术等因素为风险因素,风险比分别为3.0、2.8、7.3.结论 对吸烟量＞200年支、胰腺钙化、轻度腹痛、体重减轻以及接受胰尾/体尾部切除治疗的CP患者尤应注意伴发糖尿病的可能.     

Risk factors for pancreatic cancer: case-control study

OBJECTIVES: Although cigarette smoking is the most well-established environmental risk factor for pancreatic cancer, the interaction between smoking and other risk factors has not been assessed. We evaluated the independent effects of multiple risk factors for pancreatic cancer and determined whether the magnitude of cigarette smoking was modified by other risk factors in men and women. METHODS: We conducted a hospital-based case-control study involving 808 patients with pathologically diagnosed pancreatic cancer and 808 healthy frequency-matched controls. Information on risk factors was collected by personal interview, and unconditional logistic regression was used to determine adjusted odds ratios (AORs) by the maximum-likelihood method. RESULTS: Cigarette smoking, family history of pancreatic cancer, heavy alcohol consumption (>60 mL ethanol/day), diabetes mellitus, and history of pancreatitis were significant risk factors for pancreatic cancer. We found synergistic interactions between cigarette smoking and family history of pancreatic cancer (AOR 12.8, 95% confidence interval [CI] 1.6-108.9) and diabetes mellitus (AOR 9.3, 95% CI 2.0-44.1) in women, according to an additive model. Approximately 23%, 9%, 3%, and 5% of pancreatic cancer cases in this study were related to cigarette smoking, diabetes mellitus, heavy alcohol consumption, and family history of pancreatic cancer, respectively. CONCLUSIONS: The significant synergy between these risk factors suggests a common pathway for carcinogenesis of the pancreas. Determining the underlying mechanisms for such synergies may lead to the development of pancreatic cancer prevention strategies for high-risk individuals.     

Aging and the prevalence of cardiovascular disease risk factors in older American Indians: the Strong Heart Study

OBJECTIVES: To describe longitudinal changes in the prevalence of major cardiovascular disease (CVD) risk factors in aging American Indians. DESIGN: Population-based ongoing epidemiological study. SETTING: The Strong Heart Study is a study of CVD and its risk factors. Standardized examinations were repeated in 1993 to 1995 and again in 1997 to 1999. PARTICIPANTS: A diverse cohort of 4,549 American Indians aged 45 to 74 at the initial examinations in 1989 to 1991. MEASUREMENTS: Changes in the prevalence of hypertension, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), current smoking, and type 2 diabetes mellitus. RESULTS: The prevalence of hypertension rose rapidly and steadily with aging. A nonsignificant decrease in LDL-C was seen in men, and men and women initially had rapid increases in the prevalence of low HDL-C. The prevalence of smoking decreased, but the prevalence of diabetes mellitus continued to rise for men and women. CONCLUSION: Overall, unfavorable changes in CVD risk factors were seen in the aging participants and will likely be reflected in worsening morbidity and mortality.     

Risk factors for pancreatic cancer in Orientals

In order to assess what the risk factors for patients with pancreatic cancer (PC) in Taiwan are, a retrospective study was undertaken among 282 consecutively enrolled inpatients with confirmed pancreatic cancer within the past 5 years. For comparison, 282 age- and sex-matched controls were consecutively enrolled. A history of smoking, consumption of alcohol, diabetes mellitus, cholecystectomy and gastric surgery were thoroughly reviewed. Smoking and diabetes mellitus were very common among patients with pancreatic cancer compared with controls (P< 0.01). A significant linear trend towards an increased odds ratios (OR) for the development of PC with a higher level of smoking was seen (P<0.001). Diabetes mellitus (DM) also exhibited an increased risk (OR: 2.84; P<0.01), while this risk still existed among those patients who had a diabetic history of more than 3 years. Among 129 histologically established PC patients, smoking remained as a risk factor for PC, while the linear trend with an increasing OR with increasing levels of smoking was confirmed again (P<0.01). DM, particularly over the long-term, was also a risk factor for those histologically established PC patients. In summary, cigarette smoking and existing diabetes mellitus are probable risk factors for the development of pancreatic cancer in Taiwan.     

慢性胰腺炎胰腺钙化与烟酒关系初探

目的 探讨国内慢性胰腺炎(CP)患者烟酒摄入量与发生胰腺钙化间的关系.方法 按入院时有无胰腺钙化分为两组进行比较分析,再将无胰腺钙化者出院后有无新发胰腺钙化分为新发组和持续无钙化组.Logistic回归或Cox比例风险模型进行逐步回归分析胰腺钙化的风险因素.结果 1997年1月到2007年7月共收治并成功随访449例CP患者,248例有胰腺钙化;201例无胰腺钙化,其中13例出院后新发生胰腺钙化.入院时胰腺钙化者的发病年龄小、病史长、糖尿病和腹泻发生率高.首发年龄≤40岁、酒精摄入量>20 g/d、糖尿病和腹泻为胰腺钙化风险因素;过量饮酒为无胰腺钙化CP 患者新发生钙化的唯一风险因素(OR 3.2).结论 饮酒增加CP患者胰腺钙化风险,建议戒酒;吸烟的作用需进一步研究.     

Risk factors for development of endocrine insufficiency in chronic pancreatitis

Endocrine insufficiency is a common and frequent complication of chronic pancreatitis. Identifying the role of pancreatic damage in the development of diabetes is important for early identification and appropriate management.MethodsAll consecutive CP patients between January 2019 and May 2020 were retrospectively studied. Relevant statistical tests were performed. A two sided p value < 0.05 was considered statistically significant.ResultsTotal 587 chronic pancreatitis patients were included of which 118 (20.1%) patients developed diabetes with duration of 12 (IQR 4–48) months. Older age (OR 1.079; 95% CI 1.045–1.113; p < 0.001), presence of pancreatic parenchymal (OR 2.284; 95% CI 1.036–5.038; p = 0.041) and ductal (OR 2.351; 95% CI 1.062–5.207; p = 0.035) calcifications, exocrine insufficiency (OR 6.287; 95% CI 2.258–17.504; p < 0.001), and pancreatic duct stricture (OR 3.358; 95% CI 1.138–9.912; p = 0.028) were independently associated with development of diabetes mellitus in chronic pancreatitis patients. On cox-regression analysis, smoking (HR 2.370; 95% CI 1.290–4.354; p = 0.005) and pancreatic ductal calcification (HR 2.033; 95% CI 1.286–3.212; p = 0.002) were independently associated with earlier onset of diabetes mellitus in patients with chronic pancreatitis.ConclusionPancreatic calcification, pancreatic duct stricture and pancreatic exocrine insufficiency are associated with development of diabetes mellitus in chronic pancreatitis indicating disease progression. Smoking is the modifiable risk factors associated with early onset of diabetes mellitus in CP patients.