摘要
目的 探讨2型糖尿病与原发性肝癌(HCC)及血清甲胎蛋白(AFP)之间的关联.方法回顾性分析2010年1月至2016年12月期间收治的508例[年龄(59±12)岁,男性406例(79.92%)]初诊HCC患者的空腹血糖、肝功能指标、AFP等资料.将所有研究对象分为2型糖尿病组(n=233)和非糖尿病组(n=275),肝功能分级依据Child-Pugh分级标准分为A、B、C级,肝癌病理分级根据Edmondson-Steiner标准分为1~4级,肝癌临床分期根据巴塞罗那分期分为0~4期,年龄按<50岁、50~59岁、60~69岁、≥70岁分为4组.分析HCC合并糖尿病患者血清AFP水平的特点,采用多元Logistic回归、线性回归、协方差分析分别探讨2型糖尿病与HCC和血清AFP水平的关联.结果与非糖尿病组相比,糖尿病组AFP阴性率显著升高[54.51%(127/233)比37.82%(104/275),χ^2=14.17,P<0.001],AFP水平显著降低[11(4~249)比89(8~1132)μg/L,Z=-4.32,P<0.001],肝功能分级更差(χ^2=9.60,P=0.012);校正年龄等混杂因素后,糖尿病组AFP水平仍显著低于非糖尿病组(H=10.15,P=0.002).2型糖尿病显著增加高级别(3、4级)肝癌患病风险(OR=1.80,95%CI 1.08~3.00,P=0.025).在HCC人群中AFP水平与2型糖尿病和年龄呈负相关(β=-0.151,P=0.001;β=-0.162,P=0.003).结论2型糖尿病患者AFP阴性率升高,AFP水平降低,可能延误HCC的早期诊断,导致高级别肝癌患病风险增加.
Objective To investigate the relationship of type 2 diabetes mellitus with hepatocellular carcinoma (HCC) and alpha fetal protein (AFP). Methods A total of 508 patients [(59 ± 12) years old, 406 males (79.92%)] with HCC from January 2010 to December 2016 were retrospectively evaluated. All patients were divided into type 2 diabetic group (n=233) and non-diabetic group (n=275). Fasting blood glucose, liver function and AFP level were compared and analyzed. Liver function was assessed according to the Child-Pugh classification criteria (Grade A, B and C). The pathological grade of hepatocellular carcinoma was divided according to Edmondson-Steiner pathology (Grade 1, 2, 3 and 4). The cancer stage of HCC was obtained at the time of diagnosis based on the Barcelona Clinic Liver Cancer classification (stage 0, 1, 2, 3 and 4). Patients were further divided into different groups based on age:<50 years, 50-59 years, 60-69 years and ≥70 years. The multivariate linear regression, multivariate logistic regression and covariance analysis were applied to investigate the relationship of type 2 diabetes with AFP in HCC. Results Compared to non-diabetic group, the diabetic group had higher negative rate of AFP [54.51%(127/233) vs 37.82%(104/275),χ^2=14.17, P<0.001] and worse liver function (χ^2=9.60, P=0.012). Serum AFP level in type 2 diabetics was remarkably lower than that in non-diabetics [11 (4-249) vs 89 (8-1132) μg/L, Z=-4.32, P<0.001]. After adjustment for age, the AFP level in type 2 diabetics was still significantly lower than that in non-diabetics (H=10.15, P=0.002). Type 2 diabetes was significantly correlated with increased incidence risk of high-grade (grade 3 and 4) HCC (OR=1.80, 95%CI 1.08-3.00, P=0.025). In the HCC patients, the serum level of AFP was negatively correlated with age and T2DM (β=-0.151, P=0.001;β=-0.162, P=0.003). Conclusion Type 2 diabetes mellitas contributes to lower serum AFP level and worse liver function, which is more likely to delay and interfere with HCC diagnosis, leading to higher malignant degree of HCC.
作者
杨绍玲
陈铭
罗伊丽
刘璐
徐璐
李楠
王严茹
周雪
李鸿
曲伸
Yang Shaoling;Chen Ming;Luo Yili;Liu Lu;Xu Lu;Li Nan;Wang Yanru;Zhou Xue;Li Hong;Qu Shen(Department of Endocrinology,Shanghai Tenth People's Hospital,Tongji University School of Medicine,Shanghai 200072,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2018年第11期724-728,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
国家自然科学基金(81500687)
国家重点研发计划项目(2016YFC1305601).
关键词
糖尿病
2型
肝肿瘤
甲胎蛋白类
Diabetes mellitus,type 2
Liver neoplasms
alpha-Fetoproteins