摘要
目的探讨2型糖尿病(T2DM)患者血清肿瘤标志物水平及其影响因素。方法选取2014—2015年于南京市浦口区中医院及南京大学医学院附属鼓楼医院内分泌科住院治疗的2型糖尿病患者208例为研究对象。检测糖化血清清蛋白、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和血清肿瘤标志物CA125、CA199、甲胎蛋白(AFP)、癌胚抗原(CEA)、CA72-4、CA153、CA242、CA50、CYFRA21-1、神经元特异性烯醇化酶(NSE)、铁蛋白(SF)水平。馒头餐试验检测空腹血糖(FPG)、餐后2 h血糖(2 hPG)、空腹胰岛素(FINS)、餐后2 h胰岛素(2hINS)、空腹C肽(FC-P)、餐后2 hC肽(2 hC-P)水平。结果 T2DM患者中,CA125异常占2.9%(6/204),CA199异常占14.7%(30/204),AFP异常占1.0%(2/202),CEA异常占2.5%(5/202),CA72-4异常占11.6%(23/199),CA153异常占2.5%(5/202),CA242异常占8.5%(17/199),CA50异常占3.0%(6/199),CYFRA21-1异常占7.5%(15/199),NSE异常占6.0%(12/199),SF异常占5.4%(11/202)。>60岁者CEA、CA153、CYFRA21-1水平高于≤60岁者(P<0.05);病程>10年者CEA、CA153水平高于≤10年者,SF水平低于≤10年者(P<0.05);HbA1c>7.0%者CA199、CEA、CA242、CA50、SF水平高于≤7.0%者(P<0.05);FPG为<7.0、7.0~10.0、>10.0 mmol/L的T2DM患者CA199、CA72-4、CA242、CA50、SF水平比较,差异均有统计学意义(P<0.05);胰岛素抵抗指数(HOMA-IR)>8.90者CA199水平高于≤8.90者(P<0.05);胰岛素分泌指数(HOMA-HBCI)为<20.25、20.25~35.93、35.94~83.03、>83.03的T2DM患者CA199、SF水平比较,差异有统计学意义(P<0.05)。多因素线性回归分析显示,胰岛素用药史[β=-16.275,95%CI(-33.729,-1.179)]、HbA1c[β=3.495,95%CI(1.663,8.653)]、HDL-C[β=-48.374,95%CI(-85.373,-11.374)]、HOMA-IR[β=1.107,95%CI(0.309,1.906)]、HOMA-HBCI[β=-0.419,95%CI(-0.955,-0.194)]是T2DM患者CA199水平的影响因素(P<0.05)。结论 T2DM患者会出现多种肿瘤标志物水平的异常升高,肿瘤标志物水平与血糖控制水平、胰岛素抵抗、胰岛细胞功能有关,胰岛素抵抗、血糖水平控制不良是CA199水平升高的危险因素,而高HDL-C、胰岛细胞功能是CA199水平升高的保护因素。
Objective To investigate the levels of serum tumor markers and associated factors in type 2 diabetes mellitus（ T2DM）. Methods Two hundred and eight patients with T2DM who received inpatient treatment in Department of Endocrinology, Nanjing Pukou Hospital of TCM, and Department of Endocrinology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, were selected as the participants of study. The serum albumin,glycosylated hemoglobin（ HbA1c）, triglyceride（ TG）, total cholesterol（ TC）, low-density lipoprotein cholesterol（ LDL-C）,high-density lipoprotein cholesterol（ HDL-C） and serum tumor markers,such as CA125,CA199,alpha fetoprotein（ AFP）,carcino-embryonic antigen（ CEA）,CA72-4,CA153,CA242,CA50,CYFRA21-1,neuron-specific enolase（ NSE） and serum ferritin（ SF） levels were detected. In the steamed bun meal tolerance test,the levels of fasting plasma glucose（ FPG）,2 h postprandial plasma glucose（ 2 hPG）, fasting insulin（ FINS）, 2 h postprandial insulin（ 2hINS）,fasting C-peptide（ FC-P）,2 h postprandial C-peptide（ 2 hC-P） were detected. Results Among the 208 patients,there were 6 cases of abnormal CA125（ 2. 9%）,30 cases of abnormal CA199（ 14. 7%）,2 cases of abnormal AFP（ 1. 0%）,5 cases of abnormal CEA（ 2. 5%）,23 cases of abnormal CA72-4（ 11. 6%）,5 cases of abnormal CA153（ 2. 5%）,17 cases of abnormal CA242（ 8. 5%）,6 cases of abnormal CA50（ 3. 0%）,15 cases of abnormal CYFRA21-1（ 7. 5%）,12 cases of abnormal NSE（ 6. 0%） and 11 cases of abnormal SF（ 5. 4%）. The levels of CEA,CA153 and CYFRA21-1 were higher in patients aged 60 years old than in those aged ≤60 years old（ P〈0. 05）; patients with the course of T2DM 10 years had higher levels of CEA and CA153 but lower SF levels than those with the course of T2DM ≤10 years（ P〈0. 05）; the levels of CA199,CEA,CA242,CA50 and SF were higher in patients with HbA1c 7. 0% than in those with HbA1c≤7. 0%（ P〈0. 05）; there were statistically significant differences in the levels of CA199,CA72-4,CA242,CA50 and SF among T2DM patients with FPG 7. 0,7. 0-10. 0 and 10. 0 mmol/L（ P〈0. 05）; the level of CA199 in patients with HOMA-IR 8. 90 was higher than that in those with HOMA-IR ≤ 8. 90（ P〈0. 05）; there were statistically significant differences in the levels of CA199 and SF among patients with HOMA-HBCI 20. 25,20. 25-35. 93,35. 94-83. 03 and 83. 03（ P〈0. 05）. Multivariate linear regressions analysis showed that the medication history of INS [β =-16. 275,95% CI（-33. 729,-1. 179） ],HbA1c[β = 3. 495,95% CI（ 1. 663,8. 653） ],HDL-C [β =-48. 374,95% CI（-85. 373,-11. 374） ],HOMA-IR [β = 1. 107,95% CI（ 0. 309,1. 906） ]and HOMA-HBCI [β =-0. 419,95% CI（-0. 955,-0. 194） ]were associated factors of CA199 levels in T2DM patients（ P〈0. 05）. Conclusion The abnormally increased levels of a variety of tumor markers,found in T2DM patients,are related to the FPG levels under control,insulin resistance and islet cell function. Insulin resistance and poor blood glucose control are the risk factors of the increased CA199 level,while high HDL-C and islet cell function are its protective factors.
出处
《中国全科医学》
CAS
北大核心
2017年第32期3983-3990,共8页
Chinese General Practice
基金
江苏省医学重点学科(代谢病学)资助项目(XK201105)
江苏省中医药局科技项目(YB2015072)
南京市卫生青年人才第一层次人才培养工程(南京市医学科技发展资金资助)
南京市内分泌代谢病临床医学中心资助项目
南京市浦口区社会发展与科技项目(S2014-10)
