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目的流行病学调查显示糖尿病患者中胆囊癌的发病率显著增高。本研究通过对胆囊癌高血糖组和胆囊癌血糖正常组临床病理特征的分析和血清学指标的检测,探讨高血糖与胆囊癌浸润转移的关系。方法选取2010-04-01-2015-04-15广西医科大学第一附属医院诊治的住院胆囊癌患者233例,按照空腹血糖分为血糖正常组128例(3.9mmol/L≤血糖<6.1mmol/L)和高血糖组105例(≥6.1mmol/L)。分别比较两组患者的肿瘤相关血清学指标(AFP、CEA、CA125、CA19-9、CA15-3)和各项临床病理特征(肿瘤分化程度、淋巴结转移、静脉癌栓、远处脏器转移、Nevein分期)。结果胆囊癌高血糖组与胆囊癌血糖正常组相比,高血糖组低分化或未分化癌发生的比率,以及淋巴结转移、静脉癌栓和远处脏器转移发生的比率均高于血糖正常组,差异有统计学意义,χ2分别为11.288、9.117、14.224和11.797,均P<0.05;高血糖组高分化癌发生的比率低于血糖正常组,差异有统计学意义,χ2=25.010,P<0.05;高血糖组和血糖正常组在中分化癌发生的比率及Nevein分期Ⅰ或Ⅱ期(即早期)所占比率差异无统计学意义,χ2=0.023,P>0.05;高血糖组和血糖正常组血清中甲胎蛋白(alpha fetoprotein,AFP)、癌胚抗原(carcino-embryonic antigen,CEA)、糖蛋白抗原CA125、糖蛋白抗原CA19-9、糖蛋白抗原CA15-3的浓度均差异无统计学意义,Z值分别为-0.379、-1.125、-1.360、-1.391和-1.701,均P>0.05。对胆囊癌血糖正常/异常的相关因素进行Logistic回归分析,纳入方程的自变量有高分化、中分化、低分化和淋巴结转移。其中低分化和淋巴结转移是危险因素,与胆囊癌伴高血糖正相关,但由于OR值较小,是低度相关危险因素。结论高血糖能促进胆囊癌的浸润和转移,尽早将血糖控制在正常范围,将改善合并高血糖的胆囊癌患者的预后。
The purpose of epidemiological survey showed that the incidence of gallbladder cancer in diabetic patients was significantly higher. In this study, gallbladder cancer and hyperglycemia of gallbladder and gallbladder cancer normal blood glucose and histopathological features of the detection of serological tests to explore the relationship between hyperglycemia and gallbladder cancer invasion and metastasis. Methods Totally 233 inpatients with gallbladder cancer diagnosed and treated in the First Affiliated Hospital of Guangxi Medical University from April 2010 to April 2010 were divided into two groups based on fasting glucose: 128 cases (3.9mmol / L≤glucose <6.1mmol / L) and hyperglycemia group 105 cases (≥6.1mmol / L). Tumor-associated serological markers (AFP, CEA, CA125, CA19-9, CA15-3) were compared between the two groups, and their clinicopathological characteristics (tumor differentiation, lymph node metastasis, vein tumor thrombus, distant organ metastasis, Nevein staging). Results The rate of poorly differentiated or undifferentiated carcinoma in gallbladder hyperglycemia group and normal glucose tolerance group were higher than those in normal glucose group , The difference was statistically significant (χ2 = 11.288, 9.117, 14.224 and 11.797, respectively, P <0.05). The rate of well-differentiated cancers in hyperglycemia group was lower than that in normal glucose group, the difference was statistically significant (χ2 = 25.010, P < 0.05). There was no significant difference in the rates of differentiated carcinomas and Nevein staging Ⅰ or Ⅱ (ie, early stage) in hyperglycemia group and normal blood glucose group (χ2 = 0.023, P> 0.05) The serum concentrations of alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), glycoprotein antigen CA125, glycoprotein antigen CA19-9 and glycoprotein antigen CA15-3 had no statistical difference Significance, Z values were -0.379, -1.125, -1.360, -1.391 and -1.701, all P> 0.05. Logistic regression analysis of the factors related to the normal / abnormal glycemia in gallbladder cancer included in the equation of the high differentiation, moderate differentiation, poor differentiation and lymph node metastasis. Among them, poorly differentiated and lymph node metastasis are risk factors, which are positively correlated with gallbladder cancer with hyperglycemia. However, due to the small OR, they are the low risk factors. Conclusion Hyperglycemia can promote the infiltration and metastasis of gallbladder carcinoma. As soon as possible, the control of blood glucose in the normal range will improve the prognosis of gallbladder cancer patients with hyperglycemia.