协和医学杂志

2015, v.6(06) 419-426

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合并不同糖尿病病程的胰腺癌患者临床特征及相关危险因素对胰腺癌发病年龄的影响
Clinical Characteristics of Pancreatic Cancer with Different Duration of Diabetes and Impact of Related Risk Factors on Onset Age of Pancreatic Cancer

马明磊;周美岑;杨婧;张太平;李玉秀;赵玉沛;
MA Ming-lei;ZHOU Mei-cen;YANG Jing;ZHANG Tai-ping;LI Yu-xiu;ZHAO Yu-pei;Department of Endocrinology,Key Laboratory of Endocrinology of Ministry of Health,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Endocrinology,First Hospital of Shanxi Medical University;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的分析胰腺癌(pancreatic cancer,PC)合并糖尿病(diabetes mellitus,DM)患者的临床特征及不同因素对PC发病年龄的影响。方法 1985年1月至2014年10月北京协和医院收治的PC合并DM且符合一定纳入标准的患者,先分析总体人群基本特征,再根据不同DM病程,将总体人群分为新发DM组(病程≤2年)和长病程DM组(病程>2年),分析不同亚组的临床特征、肿瘤特征、既往疾病史及用药情况,并分析不同因素包括性别、生活方式、家族史、既往史、用药情况对PC发病年龄的影响。结果共327例PC合并DM患者纳入本研究。总体人群及按病程分组人群中男性比例均较高,且发病年龄较女性更低[(60.2±9.5)岁比(65.7±8.5)岁,P<0.001]。新发DM组较长病程DM组PC发病年龄更低[(60.6±9.5)岁比(64.4±9.0)岁,P<0.001],有DM家族史者比例更低(13.8%比24.3%,P=0.016),平均体重下降程度更明显(9.0 kg比5.0 kg,P=0.003),空腹血糖水平更低(8.2 mmol/L比9.1 mmol/L,P=0.003),肿瘤平均直径更大(4.0 cm比3.5 cm,P=0.007),胰岛素和降压药的使用比例均较低(41.9%比71.3%,P<0.001;32.9%比49.6%,P=0.004)。男性(P<0.001)、吸烟(P<0.001)、饮酒(P<0.001)、有DM家族史(P=0.048)、使用二甲双胍(P=0.046)的患者PC发病年龄更低,而服用阿卡波糖者PC发病年龄更高(P=0.042)。结论无DM家族史、伴体重明显下降、有吸烟、饮酒史的新发DM患者,可能是患PC的高危人群,需格外警惕,注意早期筛查。
Objective To identify the clinical characteristics of pancreatic cancer( PC) with diabetes mellitus( DM) and to analyze impact of different factors on the onset age of PC. Methods We collected the patients with PC and DM who were treated in Peking Union Medical College Hospital within the period from January1985 to October 2014 and met the inclusion criteria. We collected and analyzed basic information of the patients.The patients were divided into two subgroups according to the duration of DM: new-onset DM( ≤2 years) and long-term DM( > 2 years). We analyzed the clinical characteristics,cancer features,medical history,and medication history of the two subgroups,and the association between the onset age of PC and various factors including sex,life style,family history,past history,and medication. Results A total of 327 cases of PC with DM were included in this study. The proportion of male was higher and with a younger age of onset compared with female[( 60. 2 ± 9. 5) years vs.( 65. 7 ± 8. 5) years,P < 0. 001]. Compared with the patients with long-term DM,the new-onset DM patients were younger at onset of PC [( 60. 6 ± 9. 5) years vs.( 64. 4 ± 9. 0) years,P <0. 001 ],with a lower proportion of positive family history of DM( 13. 8% vs. 24. 3%,P = 0. 016),more loss of weight( 9. 0 kg vs. 5. 0 kg,P = 0. 003),lower fasting blood glucose( 8. 2 mmol / L vs. 9. 1 mmol / L,P =0. 003),larger average tumor diameter( 4. 0 cm vs. 3. 5 cm,P = 0. 007),and a lower proportion of taking insulin and anti-hypertensive drugs( 41. 9% vs. 71. 3%,P < 0. 001; 32. 9% vs. 49. 6%,P = 0. 004). The onset age of PC were younger in patients who were male( P < 0. 001),smokers( P < 0. 001),drinkers( P < 0. 001),having family history of DM( P = 0. 048),and taking metformin( P = 0. 046),while the patients taking acarbose had older onset age of PC( P = 0. 042). Conclusions Patients newly diagnosed with DM might be at a high risk to develop PC if they have no family history of DM,experienced obvious weight loss,or are drinkers or smokers,thus demanding further investigation for PC.

关键词(KeyWords): 胰腺癌;糖尿病;新发;发病年龄
pancreatic cancer;diabetes mellitus;new-onset;onset age

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基金项目(Foundation): 国家重点基础研究发展计划(973计划)(2014BC542300)

作者(Author): 马明磊;周美岑;杨婧;张太平;李玉秀;赵玉沛;
MA Ming-lei;ZHOU Mei-cen;YANG Jing;ZHANG Tai-ping;LI Yu-xiu;ZHAO Yu-pei;Department of Endocrinology,Key Laboratory of Endocrinology of Ministry of Health,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Endocrinology,First Hospital of Shanxi Medical University;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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