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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

马明磊,  周美岑,  杨婧,  张太平,  李玉秀,  赵玉沛

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文章导航 > 协和医学杂志  > 2015 >  6(6): 419-426
马明磊, 周美岑, 杨婧, 张太平, 李玉秀, 赵玉沛. 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[J]. 协和医学杂志, 2015, 6(6): 419-426. doi: 10.3969/j.issn.1674-9081.2015.06.005
引用本文: 马明磊, 周美岑, 杨婧, 张太平, 李玉秀, 赵玉沛. 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[J]. 协和医学杂志, 2015, 6(6): 419-426. doi: 10.3969/j.issn.1674-9081.2015.06.005
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Ming-lei MA, Mei-cen ZHOU, Jing YANG, Tai-ping ZHANG, Yu-xiu LI, Yu-pei ZHAO. Clinical Characteristics of Pancreatic Cancer with Different Duration of Diabetes and Impact of Related Risk Factors on Onset Age of Pancreatic Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(6): 419-426. doi: 10.3969/j.issn.1674-9081.2015.06.005
Citation: Ming-lei MA, Mei-cen ZHOU, Jing YANG, Tai-ping ZHANG, Yu-xiu LI, Yu-pei ZHAO. Clinical Characteristics of Pancreatic Cancer with Different Duration of Diabetes and Impact of Related Risk Factors on Onset Age of Pancreatic Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(6): 419-426. doi: 10.3969/j.issn.1674-9081.2015.06.005
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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

doi: 10.3969/j.issn.1674-9081.2015.06.005
  • 1.

    中国医学科学院 北京协和医学院 北京协和医院 内分泌科 卫生部内分泌重点实验室, 北京 100730

  • 2.

    山西医科大学附属第一医院内分泌科, 太原 030000

  • 3.

    中国医学科学院 北京协和医学院 北京协和医院 基本外科, 北京 100730

基金项目: 

国家重点基础研究发展计划(973计划) 2014BC542300

详细信息
    通讯作者:

    李玉秀 电话:010-69155088, E-mail:liyx@pumch.cn

    赵玉沛 电话:010-69156014, E-mail:zhao8028@263.net

  • 中图分类号: R3-3

Clinical Characteristics of Pancreatic Cancer with Different Duration of Diabetes and Impact of Related Risk Factors on Onset Age of Pancreatic Cancer

  • 1.

    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, Beijing 100730, China

  • 2.

    Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan 030000, China

  • 3.

    Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   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。
    Abstract:   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.
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  • 表  1  总体及不同DM病程PC患者的基本特征

    特征 总体人群
    (n=327)    		 DM病程 P值
    ≤2年(n=167) ＞2年(n=151)
    年龄  $\left( {\overline x \pm s} \right)$，岁 62.5±9.5 60.6±9.5 64.4±9.0 < 0.001
    性别  [例 (%)] 0.682
      男 192(58.7) 100(59.9)87(57.6)
      女 135(41.3)67(40.1) 64(42.4)
    吸烟  [例 (%)] 0.386
      是 126(42.3)66(44.6)57(39.6)
      否 172(57.7) 82(55.4)87(60.4)
      不详29
    饮酒  [例 (%)]0.266
      是93(31.4)50(34.0)40(28.0)
      否203(68.6)97(66.0)103(72.0)
      不详31
    高血压  [例 (%)]0.005
      有154(51.9)67(44.7)84(60.4)
      无143(48.1)83(55.3)55(39.6)
      不详30
    血脂异常  [例 (%)]0.397
      有164(55.8)84(57.1)78(54.9)
      无130(44.2)63(42.9)64(45.1)
      不详33(10.1)
    DM家族史  [例 (%)]0.016
      有56(19.0)20(13.8)35(24.3)
      无239(81.0)125(86.2)109(75.7)
      不详32
    PC家族史  [例 (%)]0.168
      有8(2.5)6(3.8)2(1.4)
      无306(97.5)153(96.2)245(98.6)
      不详13
    Wt  ($ {\overline x \pm s} $，kg)64.4±10.064.5±1.764.3(10.5)0.794
    ΔWt  [M(QR)，kg]7.0(5.0)9.0(7.0)5.0(5.0)0.003
    Ht  ($ {\overline x \pm s} $，cm)166.2±7.7165.2±7.54166.3(7.3)0.305
    BMI  (${\overline x \pm s} $，kg/m2) 23.1±3.0 23.2±3.1 23.1±2.9 0.701
    FPG  [M(QR)，mmol/L] 8.6(3.5) 8.2(3.1) 9.1(3.5) 0.003
    HbA1c  (${\overline x \pm s} $，%) 7.9±1.8 8.1±2.0 7.8±1.6 0.470
    DM：糖尿病；PC：胰腺癌；Wt：体重；ΔWt：体重变化；Ht：身高；BMI：体重指数；FPG：空腹血糖；HbA1c：糖化血红蛋白
    下载: 导出CSV

    表  2  总体及不同DM病程PC患者的肿瘤相关特征

    特征 总体人群
    (n=327)    		 DM病程 P值
    ≤2年(n=167) ＞2年(n=151)
    手术 [例 (%)] 0.210
      根治性手术100(32.4)60(38.0)40(28.0)
      姑息性手术44(14.2)23(14.6)20(14.0)
      内镜下治疗58(18.8)29(18.4)27(18.9)
      无107(34.6)46(29.1)56(39.2)
      缺失18
    化疗 [例 (%)]0.461
      有112(81.8)59(84.3)50(79.4)
      无25(18.2)11(15.7)13(20.6)
      缺失190
    病理 [例 (%)]0.574
      高分化腺癌22(11.6)11(10.8)11(13.6)
      中分化腺癌56(29.6)35(34.3)19(23.5)
      低分化腺癌35(18.5)18(17.6)17(21.0)
      瘤细胞67(35.4)34(33.3)29(35.8)
      其他9(4.8)4(3.9)5(6.2)
      缺失138
    肿块位置 [例 (%)]0.574
      胰头176(55.5)87(54.4)83(55.7)
      胰颈14(4.4)7(4.4)7(4.7)
      胰体31(9.8)14(8.8)17(11/4)
      胰尾30(9.5)13(8.1)16(10.7)
      体尾部66(20.8)39(24.4)26(17.4)
      不详10
    肿瘤直径 [M(QR)，cm] 4.0(2.0) 4.0(2.0) 3.5(1.8) 0.007
    CA19-9 [M(QR)，U/ml]229.3(423.0)214.6(366.3)240.0(419.0)0.110
    CEA [M(QR)，ng/ml]5.0(8.1)4.4(6.7)5.4(10.4)0.117
    CA242 [M(QR)，U/ml] 62.8(135.9) 47.7(140.8) 81.5(130.8) 0.169
    DM、PC：同表 1；CA19-9:癌抗原19-9；CEA：癌胚抗原；CA242:癌抗原242
    下载: 导出CSV

    表  3  总体及不同DM病程PC患者的用药情况[例(%)]

    用药 总体人群
    (n=327)    		 DM病程 P值
    ≤2年
    (n=167)    		 ＞2年
    (n=151)
    二甲双胍 0.554
      有52(25.9)27(26.2)25(26.0)
      无149(74.6)76(73.8)71(74.0)
      不详126
    阿卡波糖0.330
      有51(25.4)23(22.3)28(29.2)
      无150(74.6)80(77.7)68(70.8)
      不详126
    磺脲类0.272
      有46(14.1)21(20.4)24(25.0)
      无155(77.1)82(79.6)72(75.0)
      不详126
    胰岛素< 0.001
      有129(58.6)39(41.9)87(71.3)
      无91(41.4)54(58.1)35(28.7)
      不详107
    降压药0.004
      有113(40.6)46(32.9)66(49.6)
      无165(59.4)94(67.1)67(50.4)
      不详49
    降脂药0.356
      有10(3.7)4(3.0)6(4.6)
      无 259(96.3) 130(97.0) 124(95.4)
      不详 58
    DM、PC：同表 1
    下载: 导出CSV

    表  4  不同因素对PC发病年龄的影响

    因素 例数 平均年龄
    ($\left( {\overline x \pm s} \right)$，岁)    		 95%可信区间 P值
    DM病程 < 0.001
      新发 167 60.6±9.5 59.2~62.1
      长病程 151 64.4±9.0 63.0~65.9
    性别 < 0.001
      男19260.2±9.558.9~61.6
      女13565.7±8.564.3~67.1
    吸烟< 0.001
      有12659.5±9.457.9~61.1
      无17265.0±8.763.6~66.3
    饮酒< 0.001
      有9357.2±8.655.4~59.0
      无20365.0±8.763.9~66.2
    DM家族史0.048
      有5660.2±9.557.8~62.6
      无23963.0±9.561.7~64.2
    PC家族史0.067
      有856.5±9.849.8~63.8
      无30662.7±9.561.7~63.9
    高血压0.052
      有15465.5±9.861.9~65.0
      无14361.3±9.258.7~62.8
    血脂异常0.381
      有16462.2±9.060.9~63.5
      无13063.2±10.361.4~65.0
    胰岛素0.411
      有12962.7±8.761.2~64.3
      无9163.7±10.061.6~76.8
    二甲双胍0.046
      有5260.4±1.457.8~62.91
      无14963.5±0.861.2~65.0
    磺脲类 0.103
      有4664.8±9.5 61.9~68.0
      无 15562.1±0.8 60.6~63.6
    阿卡波糖 0.042
      有 51 65.1±8.7 62.8~67.5
      无 150 61.9±10.1 60.2~63.5
    PC、DM：同表 1
    下载: 导出CSV
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