2型糖尿病与前列腺癌病理分级及前列腺特异性抗原之间的关联性  

Association of type 2 diabetes mellitus with pathological grade of prostate cancer and prostate-specific antigen

作　　者：陈铭[1] 罗伊丽 杨绍玲 徐璐 李楠[1] 杨篷[1] 林紫薇 卜乐[1] 李鸿[1] 曲伸[1] Chen Ming;Luo Yili;Yang Shaoling;Xu Lu;Li Nan;Yang Peng;Lin Ziwei;Pu Le;Li Hong;Qu Shen(Department of Endocrinology, Shanghai Tenth People＇s Hospital, Shanghai 200072, Chin)

机构地区：[1]同济大学附属上海第十人民医院内分泌科,200072

出　　处：《中华糖尿病杂志》2018年第5期334-339,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金资助项目（81500687）;国家重点研发计划项目（2016YFC1305601）

摘　　要：目的探讨2型糖尿病（T2DM）与前列腺癌病理分级及前列腺特异性抗原（PSA）之间的关联性。方法回顾性分析2012至2016年上海市第十人民医院收治的1 688例初次行前列腺穿刺活检术患者的临床资料，并根据前列腺癌病理分级（Gleason评分≤6分为低级别，7分为中级别，8-10分为高级别）、糖尿病病程（0-5年，6-10年，〉10年）及糖化血红蛋白（HbA1c）（〈6.5%，6.5%-7.5%，≥7.5%）进行分层比较。采用多元Logistic回归和协方差分析分别探讨T2DM与前列腺癌病理分级、PSA的相关性。结果T2DM增加前列腺癌患病风险（OR=1.41，95%CI：1.03-1.93，P=0.032），尤其是高级别前列腺癌（OR=2.54，95%CI：1.49-4.24，P=0.001），低、中级别前列腺癌风险未增加（均P〉0.05）；随着糖尿病病程和HbA1c的增加，高级别前列腺癌患病风险逐渐升高。T2DM患者血清PSA水平低于非糖尿病者[（6.5±4.5）比（8.5±3.7） μg/L，t=-3.380，P=0.001]，且随着病程的增加，PSA降低幅度逐渐增大；前列腺癌人群中，糖尿病患者PSA低于非糖尿病者[（18.1±3.5）比（23.9±3.0） μg/L，t=-2.667，P=0.021]。结论T2DM与前列腺癌发生呈正相关。T2DM患者PSA水平降低，可能延误前列腺癌的早期诊断，导致高级别前列腺癌风险增加；PSA的阈值（4 μg/L）可能不适用于T2DM人群中前列腺癌的早期筛查和随访。ObjectiveTo investigate the relationship of type 2 diabetes mellitus （T2DM） with prostate cancer （PCa） pathological grade and prostate-specific antigen （PSA）.MethodsWe retrospectively evaluated the data from 1 688 patients who underwent prostate biopsy in Shanghai Tenth People＇s Hospital from 2012 to 2016. These patients were grouped according to PCa pathological grade （low-grade： Gleason score （GS） ≤6; intermediate-grade： GS=7; high-grade： GS 8-10）, diabetes duration （0-5 years, 6-10 years and〉10 years） and HbA1c （〈6.5%, 6.5%-7.5% and ≥7.5%） for future analysis. The multivariate logistic regression and covariance analysisi were applied to investigate the relationship of T2DM with PCa grade and PSA.ResultsT2DM was significantly correlated with increased incidence risk of overall （OR=1.41, 95%CI： 1.03-1.93, P=0.032） and high-grade PCa （OR=2.54, 95%CI： 1.49-4.24, P=0.001）, but not with low-or intermediate-grade PCa. Also, the risk of high-grade PCa increased with diabetes duration and HbA1c. Serum PSA level in T2DM was lower than that in non-diabetics [（6.5±4.5） vs （8.5±3.7） μg/L, t=-3.380, P=0.001], and the difference increased with duration. Of PCa men, PSA was also lower in diabetics compared to non-diabetics [（18.1±3.5） vs （23.9±3.0） μg/L, t=-2.667, P=0.021].ConclusionsA positive correlation was found between T2DM and PCa. T2DM contributes to lower serum PSA levels, which is more likely to delay and interfere with PCa diagnosis, leading to higher malignant degree of PCa. The current PSA threshold （4 μg/L） may not be suitable for early screening and follow-up of PCa in the T2DM population.

关 键 词：糖尿病 2型 前列腺肿瘤 前列腺特异抗原 

分 类 号：R737.25[医药卫生—肿瘤]