代谢性疾病作为胰腺癌危险因素的回顾性研究

目的 分析血糖、血压及体重与胰腺癌(PC)发生间关系,探讨胰腺癌发生的代谢相关的危险因素.方法 采用回顾性分析的方法,收集上海交通大学医学院附属瑞金医院2002年12月-2009年2月间收治的548例术后病理确诊的PC病例,分析PC与血糖、血压、体重等代谢因素间的关系.结果 使用主成分归因分析可知,血糖、血压、体重指数(BMI)增高、代谢综合征(MS)与PC密切相关,其贡献率分别为33.614%、25.236%、15.418%和12.918%.单因素统计分析发现,新发糖尿病(DM,病程≤2年)与PC的关联显著高于长期DM患者.平素血糖控制良好而近期血糖控制不佳的长期DM患者发生PC人数显著多于非PC患者(44.6%比5.6%,P<0.05),且这部分PC患者的空腹血糖(13.87±3.49)mmol/L]显著高于新发DM和其他长期DM者,OR为13.46(95%CI为4.560,39.731).BMI增高是PC的危险因素,但危险度与增高程度差异无统计学意义.上述代谢性疾病是PC的危险因素,但对PC的病理、部位、分期方面的差异无统计学意义.结论 MS及其包括的DM、BMI增高、高血压等代谢性疾病是发生PC的危险因素.其中新发DM及近期血糖控制不良的长期DM需警惕发生胰腺癌的可能.早期治疗密切随访代谢性疾病对于PC的早期诊断及预后可能有益.

A retrospective study on metabolic diseases as a risk factor for pancreatic cancer PING Jing-na, YAO

Objective To analyze the relationship between blood glucose level, blood pressure and weight with pancreatic cancer genesis. Then to explore the metabolism associated risk factors in pancreatic cancer genesis. Methods Form December 2002 to September 2009 in Ruijin Hospital, 548 pancreatic cancers with pathology diagnosis after pancreatectomy were collected for the study with retrospective analysis method. The association of pancreatic cancer with blood glucose level, blood pressure, weight and other metabolic factors were analyzed. Results With principal component analysis, it suggested that there were strong correlation between blood glucose level, blood pressure and weight index (BMI) increasing with pancreatic cancer. The contribution rates were 3. 614%,25. 236%, 15. 418% and 12. 918%, respectively. Single factor analysis indicated that the association between pancreatic cancers and new onset diabetes mellitus (duration≤ 2 years) was stronger than that of long-term diabetes mellitus. The occurrence rate of pancreatic cancer in patients with long-term diabetes whose blood glucose level was not well controlled recently while well controlled previously (44.6 % ) was significant hister than that in patients without diabetes (5. 6% , P＜0.05). The fasting blood glucose level of these PC patients ( 13.87± 3. 49 mmol/L) was significantly higher than new onset and other long-term diabetes patients, the comparative risk was 13.46 (95% CI 4. 560,39. 731). BMI increasing was a risk factor of pancreatic cancer, but there was no significant statistical difference between risk degree and BMI increasing level. All above metabolic diseases were risk factors of pancreatic cancer, but for pathology, location and stage of pancreatic cancer there was no statistical difference in theses factors. Conclusion This study suggested diabetes, BMI increasing and hypertension were high risk factors of pancreatic cancer genesis. New onset and long-term diabetes patients whose blood glucose not controlled well recently should be watched carefully for pancreatic cancer. Early treatment and intensive follow-up of metabolic disease might be helpful to early diagnosis and prognosis of pancreatic cancer.