脂肪因子对合并糖尿病的胰腺癌诊断和预后分析的价值  

Value of adipokines in the diagnosis and prognosis of pancreatic cancer complicated with diabetes

作　　者：庞文璟 贲其稳[2] 袁耀宗[2] 李雷 

机构地区：[1]上海交通大学医学院附属第九人民医院消化内科,200011 [2]上海交通大学医学院附属瑞金医院消化内科

出　　处：《中华消化杂志》2018年第1期32-37,共6页Chinese Journal of Digestion

摘　　要：目的 检测分析脂肪因子在胰腺癌伴糖尿病患者中的诊断及预后评估价值。 方法 收集2012年7月至2013年6月就诊的24例胰腺癌伴糖尿病（研究组）、30例胰腺癌不伴糖尿病（对照A组）和31例单纯糖尿病（对照B组）患者，分别检测血清脂联素、抵抗素、瘦素和内脏脂肪素的水平，并比较各组的差异。应用ROC曲线分析上述细胞因子的诊断价值。通过为期2～58个月的随访，应用Kaplan-Meier曲线分析上述脂肪因子对胰腺癌伴糖尿病患者无复发生存期的预测价值。采用卡方检验、t检验和Mann-Whitney U检验进行统计学分析。 结果 研究组血清脂联素和抵抗素的中位水平（下四分位数，上四分位数）均高于对照B组[分别为36.92 mg/L（15.80 mg/L，101.57 mg/L）比12.84 mg/L（5.64 mg/L，21.39 mg/L），9.07 μg/L（6.39 μg/L，12.19 μg/L）比5.93 μg/L（4.22 μg/L，7.68 μg/L）]，差异均有统计学意义（Z＝－3.462、－2.868，P＝0.001、0.004），研究组血清瘦素和内脏脂肪素中位水平（下四分位数，上四分位数）均低于对照B组[分别为1.02 μg/L（0.11 μg/L，2.06 μg/L）比1.92 μg/L（0.96 μg/L，2.72 μg/L），2.43 μg/L（0.48 μg/L，4.28 μg/L）比4.18 μg/L（2.43 μg/L，7.28 μg/L）]，差异均有统计学意义（Z＝－1.986、－2.336，P均〈0.05）。应用脂肪因子从糖尿病患者中鉴别胰腺癌的ROC曲线分析显示，血清脂联素、抵抗素、瘦素、内脏脂肪素诊断胰腺癌的AUC值（95%CI）分别为0.774（0.645～0.903）、0.727（0.593～0.861）、0.657（0.504～0.810）、0.685（0.543～0.826），差异均有统计学意义（P＝0.001、0.004、0.047、0.020）。将血清脂联素联合CA19-9用于胰腺癌伴糖尿病患者的诊断，敏感度达0.917，阴性预测值达0.940。进展期胰腺癌患者的瘦素中位水平（下四分位数，上四分位数）低于非进展期[0.61 μg/L（0.11 μg/L，2.28 μg/L）比1.86 μg/L（0.Objective To detect and analyze the value of adipokines in the diagnosis and prognosis of patients with pancreatic cancer complicated with diabetes. Methods From July 2012 to June 2013, 24 pancreatic ductal adenocarcinoma （PDAC） complicated with diabetes mellitus （DM） （study group）, 30 PDAC （control group A） and 31 DM （control group B） cases were collected. Serum levels of adiponectin, resistin, leptin and visfatin were tested and the differences were compared among different groups. Receiver operator characteristic （ROC） curves were used to analyze the diagnostic value of the above cytokines. The patients were followed up for two to 58 months. Kaplan-Meier survival curve was performed to analyze the prediction value of above cytokines in recurrence-free survivals （RFS） in patients with PDAC complicated with DM. Chi square test, t test and Mann-Whitney U test were used for statistical analysis. Results The median levels of serum adiponectin and resistin of study group were both higher than those of control group B （36.92 mg/L , 15.80 mg/L to 101.57 mg/L vs 12.84 mg/L, 5.64 mg/L to 21.39 mg/L; 9.07 μg/L, 6.39 μg/L to 12.19 μg/L vs 5.93 μg/L, 4.22 μg/L to 7.68 μg/L, respectively）, and the differences were statistically significant （Z=-3.462 and -2.868, P=0.001 and 0.004, respectively）. However the serum levels of leptin and visfatin of study group were both lower than those of control group B （1.02 μg/L, 0.11 μg/L to 2.06 μg/L vs 1.92 μg/L, 0.96 μg/L to 2.72 μg/L; 2.43 μg/L, 0.48 μg/L to 4.28 μg/L vs 4.18 μg/L, 2.43 μg/L to 7.28 μg/L）, and the differences were statistically significant （Z=-1.986 and -2.336, both P〈0.05）. The results of ROC curve analysis of adipokines in differential diagnosis of pancreatic cancer from diabetes indicated that the areas under the curve （95% confidence interval） of serum adiponectin, resistin, leptin and visfatin in the diagnosis of PDAC were 0.774 （0.645, 0.903）, 0.727 （0.593, 0.861）, 0.657 （0.504, 0.

关 键 词：脂肪因子类 胰腺肿瘤 糖尿病 生物学标记 

分 类 号：R587.1[医药卫生—内分泌] R735.9[医药卫生—内科学]