2型糖尿病患者血清9项肿瘤标志物水平的研究

Study on the level of 9 serum tumor markers in type 2 diabetes mellitus

目的:探索2型糖尿病患者9种肿瘤标志物的水平,及其与HbA1c的相关性。方法:选取2017年12月~2019年3月泉州市第一医院确诊并住院进行正规治疗的2型糖尿病患者197例,选取同期健康对照组40例。2型糖尿病患者根据HbA1c水平分为A组(6"%~7"%,47"例)、B组(7"%~8"%,50"例)、C组(8"%~9"%,49"例)、D组(≥9"%,51"例)。疾病各组以及健康对照组两两之间性别、年龄差异均无统计学意义。使用电化学发光法检测糖尿病组和健康对照组(40"例)血清CA19-9、AFP、CEA、CA724、CYFRA21-1、NSE、CA125、CA153和HE4的水平。Spearmman相关分析糖尿病组和健康对照组肿瘤标志物与HbA1c是否存在相关性;并用logistic线性回归分析肿瘤标志物升高的危险因素。结果:糖尿病组血清CA19-9(7.28"~21.55"U/ml)、CEA(1.89~3.95"ng/ml)、CA125(8.60~15.80"U/ml)和HE4(51.86~90.26"pmol/L)较健康对照组CA19-9(2.72~7.35"U/ml,P=0.000)、CEA(1.18~2.76Ong/ml,P=0.002)、CA125(7.76~12.42"U/ml,P=0.035)和HE4(44.21~65.48"pmol/L,P=0.003)明显升高。糖尿病四组之间D组CA19-9(9.00~41.86"U/ml)、CEA(2.88~5.56"ng/ml)水平显著升高,D组血清CA125(10.50~19.00"U/ml)水平明显高于A(7.36~13.16"U/ml,P=0.000)、B(7.90~14.53"U/ml,P=0.014)组,但和C(8.67~16.94"U/ml,P=0.064)组无差异;B组的血清HE4(55.76~102.80"pmol/L)水平明显高于A(48.54~80.43"pmol/L,P=0.048)组,其余组间无差异。Spearmman相关性分析显示血清CA19-9(r=0.246,P=0.002)、CEA(r=0.334,P=0.000)、CA125(r=0.287,P=0.000)与HbA1c水平存在相关性;血清HE4(r=-0.015,P=0.849)水平变化与HbA1c无关。logistic线性回归分析显示HbA1c水平是血清CA19-9(P=0.000)、CEA(P=0.000)、CA125(P=0.015)水平升高的独立危险因素。结论:2型糖尿病患者血清CA19-9、CEA、和CA125水平可出现异常升高,且水平升高与HbA1c水平密切相关。临床诊疗时应注意该现象与恶性肿瘤的区别。

Objective:To study the levels of 9 tumor markers in patients with type 2 diabetesmellitus and their correlation with HbA1c.Methods:197 patients with type 2 diabetes who were diagnosed and admitted to Quanzhou First Hospital from December 2017 to March 2019 were selected,and a total of 40 healthy controls were selected.According to the level of HbA1c,197 patients with type 2 diabetes were divided into group A(6~7%),group B(7~8%),group C(8~9%),and group D(≥9%).The levels of serum CA19-9,AFP,CEA,CA724,CYFRA21-1,NSE,CA125,CA153 and HE4 in diabetic group and healthy control group were detected by electrochemiluminescence.Spearmman correlation analysis was used to analyze the correlation between tumor markers and clinical data,and logistic linear regression was used to analyze the possible risk factors of elevated tumor markers.Results:Compared with the healthy control group,the levels of serum CA19-9(7.28~21.55 U/ml,P=0.000),CEA(1.89~3.95 ng/ml,P=0.002),CA125(8.60~15.80 U/ml,P=0.035)and HE4(51.86~90.26 pmol/L,P=0.003)were significantly higher in the diabetic group than that in healthy control group.However,the levels of serum CA19-9(9.00~41.86 U/ml)and CEA(2.88~5.56 ng/ml)in group D increased significantly among the four groups of diabetes mellitus;the levels of serum CA125(10.50~19.00 U/ml)in group D group were significantly higher than those of group A(7.36~13.16 U/ml,P=0.000)and B(7.90~14.53 U/ml,P=0.014),but there was no difference between group C and group D;the levels of serum HE4(55.76~102.80 pmol/L)in group B were significantly higher than those of group A(48.54~80.43 pmol/L,P=0.048),and there was no difference among other groups.Spearmman correlation analysis showed that serum CA19-9(r=0.246,P=0.002),CEA(r=0.334,P=0.000),CA125(r=0.287,P=0.000)were correlated with HbA1c level,but serum HE4(r=-0.015,P=0.849)level was not correlated with HbA1c level.Logistic linear regression analysis showed that HbA1c level was an independent risk factor for elevated serum CA19-9(P=0.000),CEA(P=0.000)and CA125(P=0.015)levels.Conclusion:The levels of serum CA19-9,CEA and CA125 in patients with type 2 diabetes mellitus can be abnormally increased,and the levels are closely related to the levels of HbA1c.We should pay attention to the difference between this phenomenon and malignant tumors in clinical diagnosis and treatment.