胰腺癌发病的危险因素及其临床意义研究

包雪青; 黄芬; 王丽娟; 夏捷; 王兆洪

doi:10.16766/j.cnki.issn.1674-4152.002813

胰腺癌发病的危险因素及其临床意义研究

doi: 10.16766/j.cnki.issn.1674-4152.002813

1.
温州医科大学附属第二医院肝胆胰外科, 浙江温州 325000
2.
温州医科大学附属第二医院脊柱外科

基金项目:

浙江省基础公益研究计划项目 Q18H290010

详细信息

通讯作者:
王兆洪，E-mail：wangzhaohong55@163.com

中图分类号: R735.9
计量
- 文章访问数: 229
- HTML全文浏览量: 83
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-11
- 网络出版日期: 2023-04-07

Risk factors and clinical significance of pancreatic cancer

1.
Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的收集胰腺癌(PC)患者发病的相关资料，通过统计学方法分析影响PC发病的危险因素，并针对其危险因素采取防治措施。方法选取2019年1月—2020年12月在温州医科大学附属第二医院治疗的256例PC患者作为观察组，另选取同期在该院住院治疗的非PC患者256例作为对照组，收集2组患者的相关临床资料，采用单因素分析法和多因素logistic回归分析研究影响PC发病的危险因素，并探讨其临床意义。结果单因素分析结果显示观察组男性、伴有糖尿病(DM)、PC家族史、胰腺炎病史、DM家族史以及肥胖的人数比例均明显高于对照组(均P＜0.05)，但观察组中使用二甲双胍治疗的DM患者人数比例明显低于对照组(28.77% vs. 58.97%，P＜0.05)；多因素logistic回归分析显示，伴有DM、DM家族史、PC家族史、胰腺炎病史、肥胖为PC发病的独立危险因素(OR分别为3.251、2.208、2.252、3.373、3.257，95%CI分别为1.383~7.640、1.016~4.797、1.067~4.752、1.279~8.899、1.257~8.443)，二甲双胍是糖尿病患者发生PC的保护因素(OR为0.451，95%CI为0.239~0.853)。结论伴有DM、DM家族史、PC家族史、胰腺炎病史、肥胖是PC发病的独立危险因素，临床应对伴有上述危险因素的人群警惕PC的发生，特别是对同时伴有DM家族史、PC家族史、肥胖的DM患者应采取积极防治措施；而二甲双胍能有效降低DM患者发生PC的风险，是DM患者发生PC的保护因素。
- 胰腺癌 /
- 糖尿病 /
- 二甲双胍 /
- 危险因素 /
- 临床意义
Abstract: Objective To collect the data on pancreatic cancer (PC), and to analyze the risk factors for pancreatic cancer, and to develop preventive measures. Methods A total of 256 cases of patients with PC treated in our hospital from January 2019 to December 2020 were selected as the observation group, and a total of 256 cases of patients without PC who were hospitalised in the Second Affiliated Hospital of Wenzhou Medical University during the same period were selected as the control group. Relevant clinical data of the two groups were collected, and the risk factors affecting the incidence of PC were analysed by univariate analysis and multivariate logistic regression. The clinical significance of such data was also explored. Results Univariate analysis showed that the proportion of men, patients with diabetes mellitus (DM), family history of PC, history of pancreatitis, family history of DM and obesity in the observation group were significantly higher than those in the control group (all P < 0.05). But the proportion of patients with DM treated with metformin in the observation group was significantly lower than that in the control group (28.77% vs. 58.97%, P < 0.05). Multivariate logistic regression analysis showed that DM, family history of DM, family history of PC, history of pancreatitis and obesity were independent risk factors for PC (OR were 2.251, 2.208, 2.252, 3.373, 3.257, respectively). 95%CI were 1.383 to 7.640, 1.016 to 4.797, 1.067 to 4.752, 1.279 to 8.899, 1.257 to 8.443, respectively. Metformin was a protective factor for PC in diabetic patients (OR was 0.451, 95%CI was 0.239 to 0.853). Conclusion DM, family history of DM, family history of PC, history of pancreatitis, and obesity are independent risk factors for the development of PC. Patients with these risk factors should be vigilant about the occurrence of PC, especially those with family history of DM, family history of PC, and obesity should take active prevention and treatment measures. Metformin can effectively reduce the risk of PC in DM patients, which is a protective factor for PC in DM patients.
- Pancreatic cancer /
- Diabetes mellitus /
- Metformin /
- Risk factors /
- Clinical significance

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表 1 PC患者发病的单因素分析

Table 1. Univariate analysis of morbidity in patients with PC

组别	例数	年龄(x ±s，岁)	性别[例(%)]		BMI[例(%)]					伴有DM[例(%)]
组别	例数	年龄(x ±s，岁)	男性	女性	正常		超重	肥胖		是	否
观察组	256	61.62±2.73	164(64.06)	92(35.94)	131(51.17)		69(26.95)	56(21.88)		73(28.52)	183(71.48)
对照组	256	61.85±2.82	142(55.47)	114(44.53)	189(73.83)		48(18.75)	19(7.42)		39(15.23)	217(84.77)
统计量		-0.938^a	3.931^b		12.895^b					13.211^b
P值		0.349	0.047		＜0.001					＜0.001

组别	例数	使用药物降糖方案[例(%)]			PC家族史[例(%)]			DM家族史[例(%)]		胰腺炎病史[例(%)]
组别	例数	二甲双胍	其他降糖药		有	无		有	无	有	无
观察组	256	74(28.91)	182(71.09)		25(9.77)	231(90.23)		23(8.98)	233(91.02)	51(19.92)	205(80.08)
对照组	256	151(58.98)	105(41.02)		11(4.30)	245(95.70)		11(4.30)	245(95.70)	18(7.03)	238(92.97)
统计量		47.009^b			5.856^b			4.537^b		18.241^b
P值		＜0.001			0.016			0.033		＜0.001
注：^a为t值，^b为χ²值。

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表 2 影响PC患者发病的各变量赋值方法

Table 2. Methods of assigning variables affecting the morbidity of PC patients

变量	赋值方法
性别	男=0，女=1
BMI	正常=1，超重=2，肥胖=3
是否伴有糖尿病	否=0，是=1
药物降糖方案	二甲双胍=1，其他降糖药物=2
PC家族史	无=0，有=1
DM家族史	无=0，有=1
胰腺炎病史	无=0，有=1
是否患PC	无=0，有=1

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表 3 影响PC患者发病的多因素分析

Table 3. Multivariate analysis of affecting the morbidity of PC patients

变量	B	SE	Wald χ²	P值	OR值	95% CI
性别	0.589	0.317	3.695	0.055	1.802	0.968~3.354
伴有DM	1.179	0.436	15.587	＜0.001	3.251	1.383~7.640
DM家族史	0.792	0.396	7.685	0.015	2.208	1.016~4.797
PC家族史	0.812	0.381	8.997	0.006	2.252	1.067~4.752
胰腺炎病史	1.216	0.495	16.591	＜0.001	3.373	1.279~8.899
肥胖	1.181	0.486	15.986	＜0.001	3.257	1.257~8.443
二甲双胍治疗DM	-0.796	0.325	5.568	0.018	0.451	0.239~0.853

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参考文献(19)

[1]	ZENG H M, CHEN W Q, ZHENG R S, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5): 555-567. doi: 10.1016/S2214-109X(18)30127-X
[2]	余静, 李晓燕, 李瑞珺, 等. 糖尿病与胰腺癌关系的Logistic回归分析[J]. 保健文汇, 2021, 22(1): 215-216. https://www.cnki.com.cn/Article/CJFDTOTAL-SSYE202101134.htm YU J, LI X Y, LI R J, et al. Logistic regression analysis of the relationship between diabetes mellitus and pancreatic cancer[J]. Fashion Baby, 2021, 22(1): 215-216. https://www.cnki.com.cn/Article/CJFDTOTAL-SSYE202101134.htm
[3]	许峰晟, 封凡, 杜飞, 等. 2型糖尿病作为危险因素诱发胰腺癌的相关机制研究进展[J]. 生命科学, 2020, 32(12): 1391-1400. https://www.cnki.com.cn/Article/CJFDTOTAL-SMKX202012016.htm XU F S, FENG F, DU F, et al. Advances on the related mechanism of type 2 diabetes as a risk factor inducing pancreatic cancer[J]. Chinese Bulletin of Life Sciences, 2020, 32(12): 1391-1400. https://www.cnki.com.cn/Article/CJFDTOTAL-SMKX202012016.htm
[4]	吴万龙, 彭兵. 胰腺癌流行病学及危险因素[J]. 中国普外基础与临床杂志, 2019, 26(12): 1500-1504. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL201912019.htm WU W L, PENG B. Epidemiology and risk factors of pancreatic cancer[J]. Chinese Journal of Bases and Clinics in General Surgery, 2019, 26(12): 1500-1504. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL201912019.htm
[5]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志, 2018, 38(4): 292-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm Diabetics Branch of Chinese Medical Association. Guidelines for the prevention and control of type 2 diabetes in China(2017 Edition)[J]. Chinese Journal of Practical Internal Medicine, 2018, 38(4): 292-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm
[6]	ZENG H, CHEN W, ZHENG R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5): 555-567. doi: 10.1016/S2214-109X(18)30127-X
[7]	田明, 严峻, 胡进静, 等. 胰腺癌流行现状及危险因素分析[J]. 中国社会医学杂志, 2016, 33(2): 137-140. TIAN M, YAN J, HU J J, et al. Analysis on the prevalence and risk factors of pancreatic cancer[J]. Chinese Journal of Social Medicine, 2016, 33(2): 137-140.
[8]	魏萌, 杨旭庆, 程露阳, 等. 肥胖相关癌症的研究进展[J]. 承德医学院学报, 2017, 34(4): 336-339. https://www.cnki.com.cn/Article/CJFDTOTAL-CDYX201704032.htm WEI M, YANG X Q, CHENG L Y, et al. Research progress in obesity-related cancers[J]. Journal of Chengde Medical College, 2017, 34(4): 336-339. https://www.cnki.com.cn/Article/CJFDTOTAL-CDYX201704032.htm
[9]	赵志国, 聂春燕, 赵春霞. 胰腺癌与糖尿病及肥胖的流行病学相关性[J]. 中国肿瘤临床与康复, 2019, 26(2): 181-183. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201902015.htm ZHAO Z G, NIE C Y, ZHAO C X. Epidemiological correlations between pancreatic cancer and diabetes and obesity[J]. Chinese Journal of Clinical Oncology and Rehabilitation, 2019, 26(2): 181-183. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201902015.htm
[10]	王傑, 陈启龙. 胰腺癌与糖尿病关联性分析的研究进展[J]. 中国普外基础与临床杂志, 2020, 27(2): 245-251. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202002022.htm WANG J, CHEN Q L. Research progress of correlation between pancreatic cancer and diabetes mellitus[J]. Chinese Journal of Bases and Clinics in General Surgery, 2020, 27(2): 245-251. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202002022.htm
[11]	孔莫维, 高宇. 糖尿病与癌症的关联机制及研究进展[J]. 医学综述, 2019, 25(22): 4498-4503, 4508. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201922027.htm KONG M W, GAO Y. Correlative Mechanism between Diabetes and Cancer and Its Research Progress[J]. Medical Recapitulate, 2019, 25(22): 4498-4503, 4508. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201922027.htm
[12]	黄爱, 沈薇. 胰腺癌患者危险因素及其临床意义分析[J]. 重庆医学, 2018, 47(8): 1064-1067. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201808017.htm HUANG A, SHEN W. Analysis on risk factors and clinical significance in patients with pancreatic cancer[J]. Chongqing Medicine, 2018, 47(8): 1064-1067. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201808017.htm
[13]	吕小斌, 罗和生. 胰腺癌危险因素及其与糖尿病相关性研究进展[J]. 胃肠病学和肝病学杂志, 2020, 29(12): 1425-1430. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX202012025.htm LYU X B, LUO H S. Advance in the risk factors for pancreatic cancer and its correlation with diabetes[J]. Chinese Journal of Gastroenterology and Hepatology, 2020, 29(12): 1425-1430. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX202012025.htm
[14]	李彩丽, 顾小艺, 钱磊, 等. 胰腺癌与糖尿病相互作用机制的研究进展[J]. 山东医药, 2017, 57(29): 104-106. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201729035.htm LI C L, GU X Y, QIAN L, et al. Advances in the mechanism of interaction between pancreatic cancer and diabetes mellitus[J]. Shandong Medical Journal, 2017, 57(29): 104-106. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201729035.htm
[15]	赵贝, 李光慧, 张晓丹, 等. 二甲双胍用于治疗胰腺癌的研究进展[J]. 中国药房, 2017, 28(24): 3453-3456. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYA201724040.htm ZHAO B, LI G H, ZHANG X D, et al. Research progress of metformin in the treatment of pancreatic cancer[J]. China Pharmacy, 2017, 28(24): 3453-3456. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYA201724040.htm
[16]	张亚娜, 马望, 王峰, 等. 二甲双胍对胰腺癌和胰腺癌干细胞中ALDH1表达的作用[J]. 肿瘤防治研究, 2017, 44(3): 177-183. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLFY201703005.htm ZHANG Y N, MA W, WANG F, et al. Effects of Metformin on ALDH1 Expression in Pancreatic Cancer and Pancreatic Cancer Stem Cells[J]. Cancer Research on Prevention and Treatment, 2017, 44(3): 177-183. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLFY201703005.htm
[17]	彭战利, 宿华威. 二甲双胍在Ⅱ型糖尿病合并胰腺癌中的研究进展[J]. 胃肠病学和肝病学杂志, 2017, 26(7): 729-731. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX201707003.htm PENG Z L, SU H W. The progress of metformin in type Ⅱ mellitus diabetes with pancreatic cancer[J]. Chinese Journal of Gastroenterology and Hepatology, 2017, 26(7): 729-731. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX201707003.htm
[18]	生佳男, 金爱花. 胰腺癌相关危险因素研究进展[J]. 延边大学医学学报, 2020, 43(1): 73-76. https://www.cnki.com.cn/Article/CJFDTOTAL-YBYB202001023.htm SHENG J N, JIN A H. Research progress on risk factors related to pancreatic cancer[J]. Journal of Medical Science Yanbian University, 2020, 43(1): 73-76. https://www.cnki.com.cn/Article/CJFDTOTAL-YBYB202001023.htm
[19]	王菁. 中晚期胰腺癌患者生存预后临床观察及证候相关研究[D]. 北京: 北京中医药大学, 2021. WANG J. Clinical observation of survival prognosis and related study of syndromes in patients with advanced pancreatic cancer[D]. Beijing: Beijing University of Chinese Medicine, 2021.