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目的 :探讨2型糖尿病(type 2 diabetes mellitus,T2DM)及糖尿病前期血糖代谢紊乱与鼻咽癌(nasopharyngeal carcinoma,NPC)临床病理特征及治疗后发生放射性口腔黏膜炎(oral mucositis,OM)的相关性。方法 :回顾性分析2011年1月至2012年12月期间收治的1 674例NPC患者的临床资料,根据治疗前空腹血糖水平将患者分为T2DM组、糖尿病前期组和血糖代谢正常组,比较3组NPC患者的临床病理特征及治疗后OM的发生率和严重程度。结果:1 674例NPC患者的男女比例为2.86∶1,平均年龄为(48±12)岁,其中合并T2DM患者166例(9.9%),合并糖尿病前期糖代谢紊乱患者372例(22.2%)。合并T2DM或糖尿病前期的NPC患者相对于血糖代谢正常NPC患者具有以下特点,1年龄相对较大,吸烟、饮酒者较多,高血压、心脏病病史相对常见;2N分期及临床分期较晚。T2DM组及糖尿病前期组的OM总发生率及Ⅱ级、Ⅲ级的比例明显高于正常组(P<0.01,见表1)。多因素Logistic回归分析发现,糖尿病(OR=1.614,P<0.05)、糖尿病前期(OR=1.444,P<0.05)是NPC患者治疗后发生OM的独立影响因素。结论:合并T2DM、糖尿病前期的NPC患者初治时有较晚的局部淋巴结分期,临床分期也相对较晚,提示血糖代谢紊乱可能与NPC转移有关,在其病情进展中起作用。不仅是合并T2DM的NPC患者易发生严重的治疗后OM,糖尿病前期血糖代谢紊乱也是NPC患者治疗后OM的独立影响因素,临床应严格控制合并T2DM或糖尿病前期的NPC患者的血糖水平。
Objective: To investigate the relationship between type 2 diabetes mellitus (T2DM) and pre-diabetes glucose metabolism and the clinicopathological features of nasopharyngeal carcinoma (NPC) and oral mucositis (OM) after treatment . Methods: The clinical data of 1 674 NPC patients admitted from January 2011 to December 2012 were retrospectively analyzed. Patients were divided into T2DM group, pre-diabetes group and normal glucose metabolism group according to pre-treatment fasting blood glucose level. The clinical and pathological features of patients with NPC and the incidence of OM after treatment and the severity. Results: The male to female ratio of 1 674 NPC patients was 2.86:1, with a mean age of (48 ± 12) years. Of the 166 patients (9.9%) with T2DM, 372 (22.2%) had premalignant glucose metabolism disorders. Patients with T2DM or pre-diabetic NPC have the following characteristics relative to NPC patients with normal glucose metabolism: 1 age is relatively large, smoking, drinkers, hypertension and heart disease are relatively common; 2N staging and clinical stage are late. The overall incidence of OM, grade II and grade III in T2DM group and pre-diabetes group were significantly higher than those in normal group (P <0.01, Table 1). Multivariate Logistic regression analysis found that diabetes (OR = 1.614, P <0.05) and pre-diabetes (OR = 1.444, P <0.05) were independent risk factors for OM in patients with NPC. CONCLUSIONS: Patients with T2DM and pre-diabetic NPC have a later local lymph node staging at the time of initial treatment and a relatively late clinical stage, suggesting that the disturbance of glucose metabolism may be related to NPC metastasis and play a role in the progression of the disease. Not only the patients with NPC complicated by T2DM are prone to severe post-treatment OM, the disorder of pre-diabetes glycometabolism is also an independent factor of OM after treatment in patients with NPC, and the blood glucose level should be strictly controlled in patients with T2DM or pre-diabetic NPC.