子宫内膜癌患者体重指数、胰岛素抵抗及炎性因子的检测及其对预后的影响

Detection of body mass index,insulin resistance and inflammatory factor in patients with endometrial carcinoma and its effects on the prognosis

目的观察子宫内膜癌患者体重指数(body mass index,BMI)、胰岛素抵抗(insulin resistance,IR)及炎性因子表达水平的变化,并探讨其对远期预后的影响。方法选取2011年8月至2014年3月于本院就诊的新发子宫内膜癌患者110例作为观察组,另以60例同期体检的健康妇女作为对照组,观察两组研究对象的BMI、空腹血糖(fasting glucose,FG)、空腹胰岛素(fasting insulin,FIN)及炎性因子水平。采用稳态模型评估法计算胰岛素抵抗指数(HOMA-IR),Pearson相关分析BMI、IR与炎性因子的相关性,多因素Logistic回归分析BMI、IR及炎性因子与预后的关系。结果与健康对照组比较,观察组患者BMI、HOMA-IR、CRP、TNF-α、IL-6及IFN-γ水平均明显高于对照组(P均<0.05)。不同分期时,Ⅲ、Ⅳ期子宫内膜癌患者BMI、IR及血清炎症因子水平较Ⅰ期时均显著增加(P均<0.05)。Pearson相关分析结果显示,BMI与CRP呈正相关(r=1.72,P=0.033),而与其他炎性因子未见明显相关性;IR与CRP、TNF-α、IL-6和IFN-γ均呈正性相关(P均<0.05)。多因素Logistic回归分析显示BMI、IR、CRP、TNF-α、IL-6及IFN-γ水平均为影响子宫内膜癌预后的危险因素(P均<0.05)。结论代谢及炎症等因素导致机体出现IR,促进肿瘤生长与转移,影响子宫内膜癌的进展和预后。

Objective To observe the body mass index（BMI）,insulin resistance（IR）and expressive levels of inflammatory factor in patients with endometrial carcinoma（EC）,and to investigate its effects on the long-term prognosis.Methods One hundred and ten patients with new onset of endometrial carcinoma,who were admitted to our hospital from August 2011 to March 2014,were included in the study.In addition,sixty healthy women with physical examination at the same time were enrolled as control group.Then BMI,fasting blood glucose（FBG）,fasting insulin（FIN）and the serum inflammatory factor were observed in two groups.Homeostasis model of assessment for insulin resistance index（HOMA-IR）was determined,and Pearson correlation analysis was used to analyze the reciprocity,and Logistic regression analysis was used to analyze the relationship between above-mention indexes and long-term prognosis of patients with endometrial carcinoma.Results Compared with the control group,the BMI,HOMA-IR and the levels of CRP,TNF-α,IL-6and IFN-γwere significantly increased in the patients with EC（all P〈0.05）.On the different stage of EC,BMI and IR and serum inflammatory factors of patients with Ⅲ orⅣstage of EC were higher than patients with Ⅰ orⅡ stage（all P〈0.05）.Pearson correlation analysis showed that BMI was positively correlated with CRP（r=1.72,P=0.033）,while there was no correlation with other inflammatory factors.In addition,IR was positively correlated with CRP,TNF-α,IL-6and IFN-γ（all P〈0.05）.The multinomial Logistic regression analysis showed that BMI,HOMA-IR and the levels of CRP,TNF-α,IL-6and IFN-γwere independent hazard factors against prognosis.Conclusion The factors,such as metabolism and inflammation can lead to enhancement of insulin resistance and promote the proliferation and transformation,which effects the development and prognosis of endometrial carcinoma.