胰腺癌合并糖尿病24例临床分析

The clinical study on 24 cases of diabetes mellitus complicated by pancreatic carcinoma

目的 总结胰腺癌合并糖尿病的临床特点 ,以提高早期胰腺癌的诊断率。方法 回顾性分析我院 10年来胰腺癌合并糖尿病患者的临床特点 ,分析其一般情况、合并症、糖尿病家族史、肿瘤指标、糖耐量和诊治过程 ,并与单纯 2型糖尿病患者比较。结果 胰腺癌合并糖尿病血糖水平和胰岛素水平与 2型糖尿病相似 ,有高胰岛素血症 ,但又有独特的临床特点 :①发病年龄相对较大 ,常大于 6 0岁 ,女性多见 ;②基本无DM家族史 ;③无三多症状 ,但短期内体重下降较明显 ;④起病时常有腹痛或腹部不适感 ;⑤合并高血压和冠心病 ,尤其是高脂血症相对少见 ;⑥肿瘤指标CA19 9和CEA常有异常。胰腺癌所致的糖尿病常在胰腺癌早期即可出现。结论 胰腺癌所致糖尿病有一定的发病特点 ,借助此特点 ,有望提高早期胰腺癌的诊断率。

Objective To study the clinical characteristics of diabetes mellitus complicated by pancreatio carcinoma(DMPC) and to improve the diagnosis of the early pancreatic carcinoma.Methods To analysis retrospectively all patients suffered from diabetes mellitus complicated by pancreatic carcinoma,including general presentation,accompanying diseases,diabetes family history,tumor marker and glucose intolerance.Results The patients of DMPC had hyperinsulinemia similar to those of diabetes mellitus type,but also had distinct characteristics as follows:①The onset of mean age was often more than 60 years.And the ratio of femal to male was 2∶1.②There was almost no family history of diabetes.③The typical symptoms such as polyphagia,polyposia and polyuria was rare,but weight loss(more than 5 kg in three moths) was significant.④Abdominal pain was common in the onset.⑤The accompanying diseases including hypertension,conorary heart disease and hyperlipidemia were less common.⑥The tumor marker CA19 9 and CEA were often abnormal.Diabetes was often presented at the early stage of pancreatic carcinoma,but most of them were misdiagnosed as diabetes mellitus type 2.Conclusions The patients of DMPC had distint characteristics compared with those of diabetes mellitus type 2.It is possible to improve the diagnosis of the early pancreatic carcinoma by these characteristics.