胰腺癌与糖尿病关联的探讨

The study of the relationship between diabetes mellitus and pancreatic cancer

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。

Background and purpose： In early nineteen century, the relationship between diabetes mellitus（DM） and pancreatic cancer（PC） was recognized, until now it still remains a question whether DM is the cause or the consequence of PC. The study was to explore the relationship between DM and PC so it could help the early diagnosis of PC. Methods： The 83 cases of PC with and without DM were treated at our hospital during Dec, 2003-Feb, 2005 and were retrospectively reviewed. Among the diabetics, 13 patients of PC who were newly diagnosed DM or had advanced DM were matched with another 20 patients with type 2 diabetics（T2DM） in terms of age, BMI, diabetic family history and lab data. Results： ①Among 83 patients with PC, 35（42.17% ） of them were accompanied by DM （ DM group） and 48 had PC without DM （non-DM group）. 24 （68.57%） patients had less than 2 years DM history, 8（22.86% ）patients had more than 2 years DM history and the DM history for 3 patients was unknown. DM and PC were diagnosed at the same time for 14 （40%） patients. The morbidity of hypertension in DM group was higher than one in non-DM group（45.71% vs. 25%, P 〈0.05）. ② The prevalence of abdominal pain（ （ X^2 = 5. 332, P 〈 0.01） and bad appetite（ （ X^2 = 3. 867, P 〈 0.01） was lower in DM group . ③And there was less abnormal direct bilirubin （DB） （ （ X^2= 23.46, P 〈 0.01） in DM group. ④There was no significant differences in terms of tumor location , metastasis, operation and life span between two groups. ⑤The patients of PC with DM were elder（ 68 . 93 ±10. 62 vs. 55.6±11.14y, P〈0.01） and leaner （BMI 21.51 ±1.98 vs. 23.87 ±3.04 Kg/m^2, P 〈 0.05） in the comparison of 13 cases of PC with DM and 20 cases of T2DM. Conclusions： Clinically, PC is a progressive cancer. DM occurs frequently in patients with PC and does not influence its clinical feature and prognosis. For the elder, leaner patients with DM and having recently deterioration of blood sugar, PC should be screened.