CAJ | 학술논문

目的分析胰腺癌 ( pancreatic cancer, PC) 合并糖尿病 ( diabetes mellitus, DM) 患者的临床特征及不同因素对PC发病年龄的影响. 方法 1985年1月至2014年10月北京协和医院收治的PC合并DM且符合一定纳入标准的患者,先分析总体人群基本特征, 再根据不同DM病程, 将总体人群分为新发DM组 (病程≤2年) 和长病程DM组 (病程>2年), 分析不同亚组的临床特征、肿瘤特征、既往疾病史及用药情况, 并分析不同因素包括性别、生活方式、家族史、既往史、用药情况对PC发病年龄的影响. 结果共327例PC合并DM患者纳入本研究. 总体人群及按病程分组人群中男性比例均较高, 且发病年龄较女性更低 [(60. 2 ± 9. 5) 岁比 (65. 7 ± 8. 5) 岁, P<0. 001]. 新发DM组较长病程DM组PC发病年龄更低 [(60. 6 ±9. 5) 岁比 (64. 4 ± 9. 0) 岁, P <0. 001], 有 DM 家族史者比例更低 (13. 8%比24. 3%, P =0. 016), 平均体重下降程度更明显 (9. 0 kg比5. 0 kg, P=0. 003), 空腹血糖水平更低 (8. 2 mmol/L比9. 1 mmol/L, P=0. 003), 肿瘤平均直径更大 (4. 0 cm比3. 5 cm, P=0. 007), 胰岛素和降压药的使用比例均较低 (41. 9%比71. 3%, P<0. 001; 32. 9%比49. 6%, P=0. 004). 男性 (P <0. 001)、吸烟 (P <0. 001)、饮酒 (P <0. 001)、有 DM 家族史 (P =0. 048)、使用二甲双胍 (P=0. 046) 的患者PC发病年龄更低, 而服用阿卡波糖者PC发病年龄更高 (P=0. 042). 结论无DM家族史、伴体重明显下降、有吸烟、饮酒史的新发DM患者, 可能是患PC的高危人群, 需格外警惕, 注意早期筛查.
목적 분석이선암 ( pancreatic cancer, PC) 합병당뇨병 ( diabetes mellitus, DM) 환자적림상특정급불동인소대PC발병년령적영향. 방법 1985년1월지2014년10월북경협화의원수치적PC합병DM차부합일정납입표준적환자,선분석총체인군기본특정, 재근거불동DM병정, 장총체인군분위신발DM조 (병정≤2년) 화장병정DM조 (병정>2년), 분석불동아조적림상특정、 종류특정、 기왕질병사급용약정황, 병분석불동인소포괄성별、 생활방식、 가족사、 기왕사、 용약정황대PC발병년령적영향. 결과 공327례PC합병DM환자납입본연구. 총체인군급안병정분조인군중남성비례균교고, 차발병년령교녀성경저 [(60. 2 ± 9. 5) 세비 (65. 7 ± 8. 5) 세, P<0. 001]. 신발DM조교장병정DM조PC발병년령경저 [(60. 6 ±9. 5) 세비 (64. 4 ± 9. 0) 세, P <0. 001], 유 DM 가족사자비례경저 (13. 8%비24. 3%, P =0. 016), 평균체중하강정도경명현 (9. 0 kg비5. 0 kg, P=0. 003), 공복혈당수평경저 (8. 2 mmol/L비9. 1 mmol/L, P=0. 003), 종류평균직경경대 (4. 0 cm비3. 5 cm, P=0. 007), 이도소화강압약적사용비례균교저 (41. 9%비71. 3%, P<0. 001; 32. 9%비49. 6%, P=0. 004). 남성 (P <0. 001)、 흡연 (P <0. 001)、 음주 (P <0. 001)、 유 DM 가족사 (P =0. 048)、 사용이갑쌍고 (P=0. 046) 적환자PC발병년령경저, 이복용아잡파당자PC발병년령경고 (P=0. 042). 결론 무DM가족사、 반체중명현하강、 유흡연、 음주사적신발DM환자, 가능시환PC적고위인군, 수격외경척, 주의조기사사.
Objective To identify the clinical characteristics of pancreatic cancer ( PC ) with diabetes mellitus ( DM) and to analyze impact of different factors on the onset age of PC. Methods We collected the pa-tients with PC and DM who were treated in Peking Union Medical College Hospital within the period from January 1985 to October 2014 and met the inclusion criteria. We collected and analyzed basic information of the patients. The patients were divided into two subgroups according to the duration of DM: new-onset DM (≤2 years) and long-term DM ( >2 years) . We analyzed the clinical characteristics, cancer features, medical history, and medi-cation history of the two subgroups, and the association between the onset age of PC and various factors including sex, life style, family history, past history, and medication. Results A total of 327 cases of PC with DM were included in this study. The proportion of male was higher and with a younger age of onset compared with female [(60. 2 ± 9. 5) years vs. (65. 7 ± 8. 5) years, P<0. 001]. Compared with the patients with long-term DM, the new-onset DM patients were younger at onset of PC [ ( 60. 6 ± 9. 5 ) years vs. ( 64. 4 ± 9. 0 ) years, P <0. 001], with a lower proportion of positive family history of DM (13. 8% vs. 24. 3%, P=0. 016), more loss of weight ( 9. 0 kg vs. 5. 0 kg, P =0. 003 ) , lower fasting blood glucose ( 8. 2 mmol/L vs. 9. 1 mmol/L, P =0. 003), larger average tumor diameter (4. 0 cm vs. 3. 5 cm, P=0. 007), and a lower proportion of taking in-sulin and anti-hypertensive drugs (41. 9% vs. 71. 3%, P<0. 001;32. 9% vs. 49. 6%, P=0. 004). The onset age of PC were younger in patients who were male ( P<0. 001 ) , smokers ( P<0. 001 ) , drinkers ( P<0. 001 ) , having family history of DM ( P=0. 048 ) , and taking metformin ( P=0. 046 ) , while the patients taking acar-bose had older onset age of PC ( P=0. 042 ) . Conclusions Patients newly diagnosed with DM might be at a high risk to develop PC if they have no family history of DM, experienced obvious weight loss, or are drinkers or smokers, thus demanding further investigation for PC.