糖代谢水平与恶性肿瘤发病风险的相关性研究

Study on the relationship between level of glucose metabolism and risk of cancer incidents

目的 探讨糖代谢水平和恶性肿瘤发病风险之间的相关性.方法 采用多阶段整群抽样方法,2011年回顾性调查浙江省嘉善县10 079名≥40岁居民糖尿病、恶性肿瘤患病情况,分析不同糖代谢水平与恶性肿瘤患病率,并采用趋势x2进行统计学检验.结果 糖尿病患者恶性肿瘤患病率女性（268.79/万）高于男性（124.31/万）（x2=4.012 2,P＜0.05）;血糖正常人群、糖调节受损人群、糖尿病患者的恶性肿瘤患病率分别为77.32/万、115.40/万、204.08/万,随着血糖调节能力的下降,≥40岁居民恶性肿瘤患病率呈上升趋势（P＜0.001）,且随着FPG、2h-PG和HbA1c等血糖水平三分位递增,恶性肿瘤的患病风险分别增加30.0％、39.0％和62.4％;与一般人群相比,糖尿病患者恶性肿瘤患病风险增加1.67倍,女性增加2.62倍,男性的差异则无统计学意义（X^2=0.524 0,P＞0.05）;糖尿病患者伴随发生的恶性肿瘤以乳腺癌、结直肠癌比例最高,随着血糖调节能力的下降,乳腺癌、结直肠癌患病率升高;2型糖尿病患者发生乳腺癌和结直肠癌风险是正常人群的2.36倍和1.87倍,女性分别增加2.53倍和6.74倍.结论 糖尿病患者发生恶性肿瘤的风险较非糖尿病者高,糖代谢水平与乳腺癌和结直肠癌等恶性肿瘤发病风险存在一定相关性.

Objective To explore the relationship between level of glucose metabolism and risk of cancer incidents.Methods 10 079 aged ≥40,local residents in Jiashan were enrolled by stratified cluster sampling method in 2011.All the subjects accepted retrospective investigation on incidents of diabetes mellitus and cancers plus blood testing for level of glucose metabolism.Differences between glucose metabolism level and cancer incidence were analyzed by trend Chi-square test.Results The prevalence of cancers in female diabetes mellitus patients was 268.79 per 100 000,higher than in males-124.31 per 100 000 （X^2=4.012 2,P〈0.05）.The incidence rates of cancers in groups of normal glucose regulation （NGR）,impaired glucose regulation （IGR）,and diabetes mellitus （DM） patients were 77.32 per 100 000,115.40 per 100 000 and 204.08 per 100 000,respectively.The incidence of cancers in local residents who were older than 40 years had increased with the decrease of glucose regulation ability.The subjects were divided into three groups by FPG,2h-PG and HbA1c levels respectively and the incident risks on cancers under each index increased 30.0%,39.0% and 62.4%,respectively.Compared to the general population,the cancer incidence in DM group increased 1.67 times and 2.62 times increase in women but did not show significant difference in men （x2=0.524 0,P〉0.05）.Breast and colorectal cancers were the most common tumors that accompanied with DM,and their incidence increased along with the decrease of glucose regulation ability.The incidence rates of breast and colorectal cancer in T2DM were 2.36 and 1.87 times more than in general population,and the incidence rates of female patients had an increase of 2.53 and 6.74 times,respectively.Conclusion The cancer incidence was higher in DM group than in the non-DM group while the incidence rates of both breast and colorectal cancer were relevant to the levels of glucose metabolism.