高血糖与胆囊癌浸润转移的关系

Effect of hyperglycemia on infiltration and metastasis of gallbladder cancer

目的流行病学调查显示糖尿病患者中胆囊癌的发病率显著增高。本研究通过对胆囊癌高血糖组和胆囊癌血糖正常组临床病理特征的分析和血清学指标的检测,探讨高血糖与胆囊癌浸润转移的关系。方法选取2010-04-01-2015-04-15广西医科大学第一附属医院诊治的住院胆囊癌患者233例,按照空腹血糖分为血糖正常组128例(3.9mmol/L≤血糖<6.1mmol/L)和高血糖组105例(≥6.1mmol/L)。分别比较两组患者的肿瘤相关血清学指标(AFP、CEA、CA125、CA19-9、CA15-3)和各项临床病理特征(肿瘤分化程度、淋巴结转移、静脉癌栓、远处脏器转移、Nevein分期)。结果胆囊癌高血糖组与胆囊癌血糖正常组相比,高血糖组低分化或未分化癌发生的比率,以及淋巴结转移、静脉癌栓和远处脏器转移发生的比率均高于血糖正常组,差异有统计学意义,χ2分别为11.288、9.117、14.224和11.797,均P<0.05;高血糖组高分化癌发生的比率低于血糖正常组,差异有统计学意义,χ2=25.010,P<0.05;高血糖组和血糖正常组在中分化癌发生的比率及Nevein分期Ⅰ或Ⅱ期(即早期)所占比率差异无统计学意义,χ2=0.023,P>0.05;高血糖组和血糖正常组血清中甲胎蛋白(alpha fetoprotein,AFP)、癌胚抗原(carcino-embryonic antigen,CEA)、糖蛋白抗原CA125、糖蛋白抗原CA19-9、糖蛋白抗原CA15-3的浓度均差异无统计学意义,Z值分别为-0.379、-1.125、-1.360、-1.391和-1.701,均P>0.05。对胆囊癌血糖正常/异常的相关因素进行Logistic回归分析,纳入方程的自变量有高分化、中分化、低分化和淋巴结转移。其中低分化和淋巴结转移是危险因素,与胆囊癌伴高血糖正相关,但由于OR值较小,是低度相关危险因素。结论高血糖能促进胆囊癌的浸润和转移,尽早将血糖控制在正常范围,将改善合并高血糖的胆囊癌患者的预后。

OBJECTIVE The objective of this study was to discuss the relationship between hyperglycemia and gall- bladder cancer infiltration and metastasis from the clinical point of view through analyzing the clinical pathological features and detecting the serological indexes of gallbladder cancer high blood sugar group and gallbladder normal blood sugar group. METHODS Totally 233 cases of hospitalized patients with gallbladder cancer in the First Affiliated Hospital of Guangxi Medical University from 2010-04-01 to 2015-04-15 were chosen, and divided into normal blood glucose group （3.9-6.1 retool/L, 128 cases） and high blood sugar group （≥6.1 retool/L, 105 cases） according to their FBG（fasting blood-glucose）. In this two groups of patients, tumor related serological indexes （AFP, CEA, CA125, CA19-9, CA15-3） and the clinical pathological features （degree of tumor differentiation, lymph node metastasis, venous cancerous embolus, distant organ metastasis and Nevein stage） were compared. RESULTS Compared the gallbladder cancer high blood sugar group with gallbladder cancer normal blood sugar group, the ratio of developing poorly differentiated or undif- ferentiated cancer, lymph node metastasis, venous cancerous embolus and distant organ metastasis of the high blood glu- cose group were higher than that of normal blood glucose group, and the differences were statistically significant （χ2 val- ues were respectively 11. 288, 9. 117, 14. 224, 11. 797,ali P〈0.05）. The radio of highly differentiated cancer of the high blood glucose group was lower than that of normal blood glucose group, and the difference was statistically significant （χ2 = 25. 010,P〈0.05）. The differences in the ratio of developing moderately differentiated cancer and Nevein stage Ⅰ or Ⅱ （early stage） were no statistical significance χ2 = 0. 023, P〉0.05）. There was no difference between the two groups in the concentration of AFP,CEA,CA125 ,CA19-9 and CA15 3 （Z values were respectively - 0. 379, - 1. 125, - 1. 360, -1. 391, -1. 701 ,all P〉0. 05）. In logistic regression analysis of normal/abnormal related factors of gallbladder carcino- ma blood glucose, according to the results, the independent variables included into the equation were high differentiation, middle differentiation, low differentiation and lymph node metastasis. Among them, low differentiation and lymph node metastasis were risk factors, and had positive correlation of gallbladder with hyperglycemia, but because of the small OR, they were low-related risk factors. CONCLUSIONS This study confirms that hyperglycemia to a certain extent can pro- mote the invasion and metastasis of gallbladder cancer. Controlling the blood sugar levels within the normal range as early as possible will improve the prognosis of patients with gallbladder cancer merging hyperglycemia.