胰岛素过来背锅!高胰岛素水平可使无T2DM人群的这种结直肠癌前病变风险增加3成!

2022-09-01 MedSci原创 MedSci原创

Medicine (Baltimore):胰岛素水平与结肠腺瘤风险相关,而非腺瘤性息肉:一项基于医院的回顾性研究

根据2018年全球癌症发病率报告,结直肠癌分别是女性和男性中第二和第三大常见癌症(10.9%)。在各种类型的结肠息肉中,结肠腺瘤传统上被认为是癌症的前奏,已知没有恶性潜能的增生性息肉,最近被报道通过锯齿状肿瘤途径进展为恶性息肉。据报道,结肠息肉在2型糖尿病(T2DM)或代谢综合征患者中发病率较高。胰岛素抵抗是 T2DM 和代谢综合征发作的关键机制,它通过对内源性胰岛素的异常血糖反应引起代偿性高胰岛素血症。但过去关于胰岛素浓度与结直肠癌和结肠腺瘤发病率之间关系的研究结果并不一致。

因此,本研究旨在调查在大学医院接受结肠镜检查作为健康检查的部分患者的血液胰岛素浓度与结肠腺瘤和非腺瘤性息肉的关联。

201812日至20191231日,本研究纳入了3277名访问大学医院健康检查中心并接受结肠镜检查的成年人。测量胰岛素、糖化血红蛋白 HbA1c 和空腹血糖水平,并使用自我给药问卷评估既往病史、饮酒、吸烟和体力活动。

结果显示,最终共3277例参与者入组。参与者平均年龄为38.53±6.87岁,平均胰岛素浓度为5.92±3.9 uIU / mL。腺瘤性和非腺瘤性病变的患病率分别为22.2%726名)和11.5%378名)。

非腺瘤性息肉组(6.48±4.38 uIU/mL)和腺瘤组(6.32±4.35 uIU/mL)的胰岛素浓度显著高于正常组(P < .001)。两组的HbA1cFBG、年龄和TG均明显高于正常组,两组的HDL-C水平均明显低于正常组。

Logistic回归分析显示,高胰岛素水平组(≥7.36 uIU/mL)的腺瘤(比值比[OR]1.483;95%可信区间[CI]1.170–1.878)和非腺瘤性息肉(OR 1.415;95% CI1.038~1.929)的风险均有增加,调整干扰变量后,腺瘤(OR 1.312;95%CI1.003~1.718)的风险显著升高。

总之,胰岛素浓度升高与非腺瘤性结肠息肉风险增加无关,仅与无DM成人结肠息肉风险增加有关。胰岛素水平升高是结肠腺瘤的一个重要危险因素。未来应进行大规模的前瞻性研究,以阐明胰岛素浓度与结肠息肉之间的因果关系。

 

原文来源:

Shin HS, Cho YJ. Insulin levels are associated with risk of colon adenoma and not nonadenomatous polyps: A retrospective, hospital-based study. Medicine (Baltimore). 2022 Aug 26;101(34):e30200. doi: 10.1097/MD.0000000000030200. PMCID: PMC9410615.

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