2型糖尿病患者血糖控制前后肿瘤标志物变化及其影响因素

Changes of tumor markers after blood glucosecontrol in patients with type 2 diabetes mellitus and influencing factors

  • 摘要:
      目的  观察2型糖尿病患者血糖控制前后的甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类相关抗原15-3(CA15-3)、糖类相关抗原19-9(CA19-9)、糖类相关抗原72-4(CA72-4)动态变化及其影响因素。
      方法  随机选取540例2型糖尿病患者纳入糖尿病组,以年龄匹配300例健康体检人员纳入健康组。比较2组血清肿瘤标志物水平,再根据受试者年龄和糖化血红蛋白(HbA1c)的不同进行亚组分析,比较亚组间血清肿瘤标志物水平。血糖控制后1个月复查相关指标,并对可能影响血清肿瘤标志物水平的其他混杂因素进行多元Logistic回归分析。
      结果  糖尿病组血清CEA、CA19-9水平高于健康组,差异有统计学意义(P < 0.05),2组间血清AFP、CA15-3、CA72-4水平比较,差异无统计学意义(P>0.05)。亚组分析显示,年龄越大、血糖水平越高,则血清CEA、CA19-9水平越高,差异有统计学意义(P < 0.05)。糖尿病组患者血糖控制达标1个月后复查结果显示,控制后血清CEA、CA19-9水平低于控制前,差异有统计学意义(P < 0.05)。多元Logistic回归分析显示,年龄大、糖尿病病程长、吸烟及饮酒均是血清CEA、CA19-9水平升高的危险因素,饮酒是血清AFP水平升高的危险因素;体质量指数(BMI)、血清肌酐、白蛋白、甘油三酯、低密度脂蛋白胆固醇水平均与血清肿瘤标志物水平无相关性。
      结论  在血糖控制达标前,2型糖尿病患者血清肿瘤标志物水平可一定程度升高,临床应充分评估相关指标,积极治疗原发疾病,长期随访观察,避免漏诊。

     

    Abstract:
      Objective  To observe the dynamic changes of alpha fetoprotein(AFP), cancer embryonic antigen(CEA), cancer antigen 15-3(CA15-3), cancer antigen 19-9(CA19-9) and cancer antigen 72-4(CA72-4) after blood glucose control in type 2 diabetic patients and to analyze the influencing factors.
      Methods  A total of 540 patients with type 2 diabetes were randomly selected as diabetes group, and 300 age-matched healthy people with physical examinations were enrolled into healthy group. The levels of tumor markers between the two groups were compared, and then subgroup analysis was performed based on subjects'age and different HbA1c level. Serum tumor markers of subgroups were compared. The related indicators one month after blood glucose control were rechecked, and multiple Logistic regression analysis was performed for other confounding factors that may affect the level of tumor markers.
      Results  CEA and CA19-9 levels of patients in the diabetes group were significantly higher than those in the healthy group (P < 0.05), and AFP, CA15-3 and CA72-4 levels showed no statistically significant differences between the two groups (P>0.05). Subgroup analysis showed that the higher the blood glucose and the older the age was, the higher the CEA and CA19-9 levels would be, which showed statistically significant between-group differences (P < 0.05). One month after the blood glucose control reaching the standard, the reexamination results of the diabetes group showed that the levels of serum CEA and CA19-9 after control were lower than before the control(P < 0.05). Multiple Logistic regression analysis showed that elder age, longer course of diabetes, smoking and alcohol drinking were all risk factors for the increase of serum CEA and CA19-9 levels, and alcohol drinking was a risk factor for the increase of serum AFP level. Body mass index (BMI), serum creatinine, albumin, triglyceride and low density lipoprotein cholesterol levels showed no correlations with serum tumor markers.
      Conclusion  Before reaching the goal of blood glucose control, the level of serum tumor markers in patients with type 2 diabetes may be increased to a certain extent. Relevant indicators should be fully evaluated clinically, the primary disease should be actively treated, long-term follow-up observation should be performed so as to avoid missed diagnosis.

     

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