常见肿瘤标记物与2型糖尿病患者血糖控制水平的关系

Relationship between Tumor Markers and Blood Glucose Control in Patients with Type 2 Diabetes Mellitus

目的:观察2型糖尿病(T2DM)患者常见肿瘤标记物糖类抗原199(CA199)、癌胚抗原(CEA)、糖类抗原125(CA125)、甲胎蛋白(AFP)的情况,探讨其与血糖控制水平的关系。方法:选取2017年我院内分泌科住院治疗的103例T2DM患者,并选50例健康体检者为对照组,记录各项临床资料。分析常见肿瘤标记物与T2DM患者血糖控制水平的关系。结果:103例T2DM患者中,36例CA199升高(35. 29%),6例CEA升高(5. 88%),其中1例CEA、CA199同时升高(0. 009 7%),无CA125、AFP升高者。T2DM患者的CA199水平明显高于健康对照组(35. 38±25. 28 VS12. 18±4. 31,P <0. 05)。CEA、CA125、AFP水平与健康对照组无明显差别。分层分析显示,CA199升高组的T2DM患者较CA199正常组糖化血红蛋白(HbA1c)、入院空腹血糖明显升高,差异有统计学意义(P <0. 05),且CA199升高与HbA1c、入院空腹血糖存在线性相关关系,相关系数分别为0. 498、0. 311(P <0. 05)。HbA1c <7. 5%组(A组)、7. 5%≤HbA1c <10%组(B组)、HbA1c≥10%组(C组)三组患者的CA199水平分别为(22. 57±13. 77) mmol/L、(29. 93±20. 41) mmol/L、(48. 66±28. 94) mmol/L,A、B组无明显差异(P> 0. 05),C组的CA199水平高于A、B组,差异有统计学意义(P <0. 05)。A、B、C三组中CA199高的例数分别为4例(4/25,16. 00%)、11例(11/40,27. 50%)、21例(21/38,55. 26%),三组之间两两比较差异均有统计学意义(P <0. 05)。血糖控制后CA199水平明显低于血糖控制前(P <0. 05)。结论:常见肿瘤标记物中CA199水平升高在血糖控制差的非肿瘤T2DM患者中较常见,且多为轻度升高,一般无其他肿瘤标志物同时升高,血糖控制后可明显下降。随着HbA1c水平提高,CA199高的患者所占比例越来越高,在HbA1c≥10%的T2DM患者中有一半以上CA199高。CA199水平与HbA1c、入院空腹血糖呈正相关。

Objective: To observe the level of the common tumor markers( CA199,CEA,CA125,AFP) in patients with type2 diabetes mellitus( T2 DM),and to explore its relationship with blood glucose control. Methods: 103 patients with T2 DM were selected in the endocrinology department of our hospital in 2017,and 50 healthy subjects were selected as the control group,the clinical data were recorded. Analyze the relationships between the common tumor markers with blood glucose control in T2 DM patients. Results: Among 103 patients with T2 DM,there were 6 cases with increased CEA( 5. 88%),36 patients with elevated CA199( 35. 29%),CA125 and AFP were normal in all cases. The CA199 levels of T2 DM patients were obviously higher than that of the healthy control group( 35. 38 ± 25. 28 VS 12. 18 ± 4. 31,P < 0. 05),while the levels of CEA,CA125 and AFP in the two groups had no differences( P > 0. 05). The CA199 level,Hb A1 c,fasting blood glucose of the high CA199 group were statistically higher than the normal group( P < 0. 05). The CA199 level was positively correlated with Hb A1 c and the fasting blood glucose,the correlation coefficients were 0. 498 and 0. 311 respectively( P < 0. 05). CA199 levels of group A( Hb A1 c < 7. 5%),B( 7. 5% ≤Hb A1 c < 10%) and C( Hb A1 c≥10%) were( 22. 57 ± 13. 77) mmol/L,( 29. 93 ± 20. 41)mmol/L,( 48. 66 ± 28. 94) mmol/L respectively,CA199 level of group A and B had no difference( P > 0. 05),CA199 level of group C was statistically higher than that of group A and B( P < 0. 05). The number of cases with high CA199 level in group A,B and C were 4( 4/25,16. 00%),11( 11/40,27. 50%) and 21( 21/38,55. 26%) respectively,there were statistically significant differences between any two groups( P < 0. 05). After blood glucose was well controlled,the CA199 level was significantly lower than before( P < 0. 05). Conclusion: It is very common that CA199 levels increase in T2 DM patients with poor blood glucose control,and the CA199 levels are always moderately elevated while other tumor markers are normal. There is a significant decrease in CA199 level after blood glucose well controlled. With the level of Hb A1 c increased,the proportion of patients with high CA199 level also increased,the CA199 levels are above normal in more than half of the T2 DM patients with Hb A1 c≥10%. The CA199 level is positively correlated with Hb A1 c and fasting blood glucose.