胰腺癌合并新发糖尿病患者的临床特征分析

Clinical characteristics of patients with pancreatic cancer combined with new onset diabetes mellitus

目的探讨胰腺癌(PC)合并新发糖尿病(DM)患者的临床特征,为定义PC高危人群提供依据。方法回顾性选取2016年1月—2021年12月山西医科大学第一医院收治的426例PC病例,将其分为新发DM组(病程≤2年,n=74)、长期DM组(病程>2年,n=50)及单纯PC组(无DM,n=302),收集其基本人口学资料、吸烟饮酒史、既往史、家族史、DM用药情况、临床特征(首发症状、肿瘤直径、肿块位置、胰管扩张、手术切除情况)及生化指标(FPG、CA19-9、CA125),同时对PC合并DM行手术切除者的血糖情况进行随访,时间为术后半年。正态分布的计量资料组间比较采用t检验;非正态分布的计量资料组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ^(2)检验或Fisher精确检验。结果426例PC患者中,68.3%为男性,31.7%为女性,PC合并DM人群中,新发DM占59.7%。较长期DM组,新发DM组发病年龄低(t=-2.041,P=0.043),合并高血压(χ^(2)=3.950,P=0.047)、DM家族史(χ^(2)=3.893,P=0.048)比例低,FPG水平低(Z=-2.740,P=0.005),吸烟者比例高(χ^(2)=7.032,P=0.008),体质量变化明显(Z=-2.161,P=0.031),肿瘤直径大(Z=-2.269,P=0.023),伴胰管扩张者比例高(χ^(2)=4.870,P=0.027),两组患者在DM用药方面差异有统计学意义(χ^(2)=1.976,P<0.05)。对目标人群随访半年后,新发DM手术组血糖改善者7例(36.8%),长期DM手术组0例。较单纯PC组,新发DM组发病年龄低(t=-0.273,P=0.039),BMI水平稍高(t=-2.139,P=0.033),体质量变化明显(Z=-2.262,P=0.024),合并高血压比例高(χ^(2)=17.438,P<0.001),FPG水平高(Z=-8.322,P<0.001),胰管扩张者比例高(χ^(2)=3.983,P=0.046)。结论PC患者中,合并新发DM者发病年龄相对较低,有吸烟史、无DM家族史、伴体重明显下降、FPG水平难控制、伴胰管扩张的新发DM患者可能是PC高危人群,应注意早期筛查。

Objective To investigate the clinical characteristics of patients with pancreatic cancer(PC)complicated with new-onset diabetes mellitus(DM),and to provide a basis for defining a high-risk group for PC.Methods The 426 PC cases admitted to the First Hospital of Shanxi Medical University from January 2016 to December 2021 were retrospectively selected and divided into new DM group(disease duration≤2 years,n=74),long-term DM group(disease duration>2 years,n=50)and simple PC group(no DM,n=302).We collected their basic demographic information,smoking and drinking history,disease history,family history,DM medication,clinical characteristics(first symptoms,tumor diameter,mass location,pancreatic duct dilatation,surgical resection)and biochemical indexes(FPG,CA19-9,CA125).The glycemic status of those who underwent surgical resection was monitored for six months after surgery.The t-test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test and the Fisher’s exact test were used for comparison of categorical data between two groups.Results Of the 426 PC patients,68.3%were male and 31.7%were female.New-onset DM accounted for 59.7%of the PC patients with DM.Compared with the long-term DM group,the new-onset DM group had a lower age of onset(t=-2.041,P=0.043),a lower proportion of combined hypertension(χ^(2)=3.950,P=0.047),a lower family history of DM(χ^(2)=3.893,P=0.048),a lower FPG level(Z=-2.740,P=0.005),a higher proportion of smokers(χ^(2)=7.032,P=0.008),significant weight change(Z=-2.161,P=0.031),larger tumor diameter(Z=-2.269 P=0.023),high proportion of those with pancreatic duct dilatation(χ^(2)=4.870,P=0.027),and significant differences in DM medication(χ^(2)=1.976,P<0.05).At six months of follow-up,7 patients(36.8%)in the new-onset DM surgery group had glycemic improvement,but none in the long-term DM surgery group.Compared with the PC-only group,the new-onset DM group had a lower age of onset(t=-0.273,P=0.039),a slightly higher BMI level(t=-2.139,P=0.033),a significant weight change(Z=-2.262,P=0.024),a higher proportion of complicated hypertension(χ^(2)=17.438,P<0.001),a higher FPG level(Z=-8.322,P<0.001),and a high proportion of dilated pancreatic ducts(χ^(2)=3.983,P=0.046).Conclusion Among PC patients,the onset age is relatively young in those complicated with new-onset DM.Patients with new-onset DM who smoke,have no family history of DM,have significant weight loss,have difficulty in controlling FPG levels,and pancreatic duct dilatation may be at high-risk for PC and should be screened early.