糖代谢异常与胰腺癌的早期临床表现

Abnormal metabolism of glucose as clue for early diagnosing panvreatic cancer

目的 研究胰腺癌患者合并糖代谢异常的发生率、特点和病程 ,探讨是否可将新近出现糖代谢异常视为胰腺癌的早期临床表现。方法 检查 98例胰腺癌患者 (靠B型超声波、CT、内镜等诊断 )的空腹血糖、血浆胰岛素、C肽。收集其糖尿病家族史 ,计算其体重指数。分析异常糖代谢出现到胰腺癌确诊之间的时间间隔和其异常糖代谢与胰腺癌诊断之间的关系。 1 1 5例胃癌患者、87例结肠癌患者及 1 4 6例 2型糖尿病患者用作对照。结果 98例胰腺癌患者中 ,1 7例 (1 7 4% )表现有空腹血糖、血胰岛素、C肽等检测异常 ,显著高于胃癌组 (2例 ,1 7% ,P <0 0 0 5)或大肠癌组 (5例 ,5 8% ,P <0 0 2 5) ;非胰腺癌的 2型糖尿病患者确诊时体重指数 >2 4的有 38例 (39 0 % ) ,明显多于胰腺癌合并糖代谢异常患者 (0 /1 7;P <0 0 0 5) ;1 7例胰腺癌患者发现糖代谢异常到确诊时间 1 0 8± 7 4个月 ,≤ 2年者 1 5例 (88 2 % ) ,而 1 4 6例 2型糖尿病患者病程≤ 2年者仅 2 1例 (1 4 4% ;P <0 0 0 5) ;前者糖尿病阳性家族史 (1 /1 7)比率显著低于后者 (97/1 4 6 ,66 4% ;P <0 0 0 5) ;1 7例胰腺癌患者空腹血糖、血胰岛素和C肽等与非胰腺癌 2型糖尿病组比较差异无显著意义。结论 约 1 7%的胰腺癌患者在发现肿瘤占位病灶之前可能?

Objective To investigate the incidence, features, and course of abnormal metabolism of glucose in patients with pancreatic cancer and the possibility of using the abnormal metabolism of glucose as early precursory manifestation of pancreatic cancer. Methods Fasting plasma sugar (FPG), plasma insulin and C peptide were examined in 98 patients with pancreatic cancer diagnosed by B mode ultrasonography, CT, endoscopy, and patholigical examination. The family history of DM was collected. The body mass index (BMI) was calculated. The relation between abnormal metabolism of glucose and diagnosis of pancreatic cancer was analyzed. One hundred and fifteen patients with advanced gastric cancer (AGC), 87 patients with colon cancer, and 146 patients with type 2 diabetes mellitus (DM) were used as controls. Results Abnormality of FPG, insulin and C peptide was found in 17 out of the 98 patients with pancreatic cancer, with an incidence rate of 17.4%, significantly higher than that in patients with AGC (1/115, 1.7%, P <0.05), and patients with colon cancer (5/87, 5.8%, P <0.025). Thirty eight patients with type 2 DM (39.0%) had their BMI >24, while no pancreatic cancer patients with abnormality of metabolism of glucose had his BMI >24 (0/17, 0%, P <0.05). The duration between the discovery of abnormal metabolism of glucose and the diagnosis of cancer in the 17 patients was 10.8 ± 7.4 months, and was < 2 years in 15 of them (88.2%), significantly longer than the duration between the appearance of symptoms and the diagnosis in the 146 type 2 DM patients (21/146, 14 4%, P <0 05). The proportion of positive DM family history was 1/17 in patients with pancreatic cancer, significantly lower than in patients with type 2 DM (97/146, 66.4%, P <0.05). However, the values of FPG, insulin, and C peptide between the groups with and without pancreatic cancer were not significantly different. Conclusion Clinical manifestations of abnormal metabolism of glucose appear prior to the discovery of space occupying lesions in pancreas in about 17% patients with pancreatic cancer. Newly appearing abnomalities in metabolism of glucose in patients without DM family history and without symptom of obesity should be regarded as important clues for early diagnosing pancreatic cancer.