胰岛素抵抗与结直肠癌关系的临床研究

Clinical Research on the Relationship between Insulin Resistance and Colorectal Cancer

目的探讨胰岛素抵抗(IR)与结直肠癌(CRC)发病的关系,为CRC病因学探索及CRC的预防研究提供思路。方法收集新诊断的312例CRC患者的临床资料作为病例组,选择286名健康体检者作为对照组。比较两组人群间空腹血糖(FPG)、空腹胰岛素水平(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、体质指数(BMI)、腰臀比(WHR)、糖尿病家族史、结直肠癌家族史、吸烟、饮酒等生活行为以及血脂、血脂联素水平等方面的差异。结果 CRC组BMI、CRC家族史比例均高于对照组,差异有统计学意义(P<0.05,P<0.01),且CRC组和对照组lnFINS、lnHOMA-IR分别为(2.92±0.51)、(2.46±0.45)mU/L和(1.49±0.51)、(1.02±0.41),差异有统计学意义(P<0.05,P<0.01),而CRC组脂联素水平([10.1±2.9)mg/L]明显低于对照组([13.2±2.6)mg/L],差异有统计学意义(P<0.05);两组间FPG、甘油三酯、总胆固醇以及糖尿病家族史、吸烟率、饮酒率、合并高血压比例等方面的差异均无统计学意义(P>0.05)。多因素回归分析显示,年龄、性别、糖尿病家族史、高血压、吸烟、饮酒及血脂、FPG、BMI、WHR、脂联素未进人方程,对CRC未见显著影响;FINS与CRC(OR=4.37,95%CI=3.21～7.23)、HOMA-IR与CRC(OR=6.68,95%CI=3.79～9.53)、CRC家族史与CRC(OR=2.31,95%CI=1.83～5.64)之间的关系有统计学意义(P<0.05)。结论 IR与CRC存在一定的相关性,是CRC患病的独立危险因素。

Objective To investigate the relationship between insulin resistance and colorectal cancer（CRC）. Methods A case-control study was performed to compare the clinical data of the CRC group（patients with newly diagnosed CRC, n=312） and the control group （adults in healthy examination, n=286）, including blood fasting glucose and insulin levels, insulin resistance index （HOMA-IR）, body mass index（BMI）, family history of diabetes and CRC, personal habits of smoking and drinking, serum cholesterol, triglyceride and adiponectin levels. Results （1）Compared with the control group, BMI and the proportion of CRC family history in the CRC group increased markedly （P〈0.05 or P〈0.01）, and the serum fasting insulin（FINS） and HOMA-IR were higher in the CRC group [（2.92±0.51） mU/L, （1.49±0.51）] than in the control group [（2.46±0.45） mU/L, （1.02±0.41）] （P〈0.05, P〈0.01）, but the adiponenctin level decreased markedly [（10.1±2.9） mg/L vs （13.2±2.6） mg/L]（P〈0.05）. While none of the FPG, cholesterol, triglyceride, the proportions of diabetes family history, smoking, drinking and combination with hypertension, had shown significant differences between two groups（P〈0.05）. （2）Logistic analysis showed that the age, gender, diabetes history, smoking, drinking, blood lipid, FPG, BMI, WHR and adiponectin had no marked relationship with CRC, but FINS （OR=4.37, 95% CI=3.21～7.23）, HOMA-IR（OR=6.68, 95% CI=3.79～9.53）, colorectal cancer family history （OR=2.31, 95% CI=1.83～5.64） had significant relationship with CRC. Conclusion There may be some relationship between IR and CRC. IR is an independent risk factor for CRC.