术前胰岛素水平对非糖尿病胶质细胞瘤预后的预测价值  

Theprognostic value of preoperative insulin levels in patients with non-diabetic glioma

作　　者：冯清林[1] 范仕兵[1] 赵锐[1] 胡建娥[2] 冉住国[1] FENG Qinglin;FAN Shibing;ZHAO Rui;HU Jian＇e;RAN Zhuguo(）Department of Neurosurgery,Sanxia Central Hospital,Chongqing 404000,China;）Department of Clinical Laboratory,Sanxia Central Hospital,Chongqing 404000,China)

机构地区：[1]重庆三峡中心医院神经外科,重庆404000 [2]重庆三峡中心医院临床检验科,重庆404000

出　　处：《中国实用神经疾病杂志》2018年第12期1314-1319,共6页Chinese Journal of Practical Nervous Diseases

基　　金：重庆市卫生计生委医学科研项目面上项目(编号:2016MSXM121)

摘　　要：目的探讨术前血清胰岛素(insulin)水平在非糖尿病胶质瘤患者中的表达水平及临床意义。方法选择2010—2017重庆三峡中心医院治疗的286例胶质细胞瘤患者,其中216例非糖尿病胶质瘤患者纳入研究,设为胶质瘤组,按12比例匹配年龄、血脂、体重指数的健康者为对照组,比较2组临床资料及血糖指标;采用工作特征曲线(ROC)分析胶质瘤组患者血清胰岛素的截断值,按最佳节点值分为高低2组,比较2组临床资料;采用Kaplan-Meier分析胶质瘤的无进展生存期情况,COX比例风险模型单因素及多因素分析无进展生存时间的预后因素。结果胶质瘤组与对照组空腹血糖及胰岛素比较差异有统计学意义(P<0.05),糖化血红蛋白差异无统计学意义(P>0.05)。工作特征曲线(ROC)确定血清胰岛素=10.3mU/L为胶质瘤患者疾病进展的最佳截断点,胰岛素高低2组肿瘤分级、进展与否差异有统计学意义(P<0.05);Kaplan-Meier分析显示,2组无进展生存时间比较差异有统计学意义(P<0.05),血清胰岛素≥10.3 mU/L组无进展生存期更短,预后差;COX单因素分析与无进展生存时间(progression-free survival,PFS)相关(P<0.05)的有肿瘤分级(HR=1.37,95%CI 1.08~1.76)、肿瘤分期(HR=1.36,95%CI 1.15~1.62)、空腹胰岛素(HR=2.11,95%CI 1.19~3.77);COX多因素分析与无进展生存时间相关(P<0.05)的有肿瘤分级(HR=1.31,95%CI 1.03~1.65)、肿瘤分期(HR=1.42,95%CI 1.09~1.86)、空腹胰岛素(HR=1.98,95%CI 1.06~3.69)。结论术前血清胰岛素水平对非糖尿病胶质瘤患者的无进展生存时间的预测有临床意义。Objective To evaluate the expression and clinical significance of serum insulin（Insulin）levels in patients with non-diabetic glioma.Methods 286 patients with glioma were selected and only 216 patients with non-diabetic glioma as observation,As a control group,432 healthy matched in a 12 ratio for age,blood lipid levels,and body mass index.The clinical data and blood glucose parameters were compared between the two groups.Receiver-operating characteristic（ROC）curve analysis was applied to determine the best cutoff values for insulin and according to the best value of the node is divided into insulin≥10.3 mU/L and AGR10.3 mU/L level;The progression-free survival（PFS）of two groups of non-diabetic glioma was analyzed by KaplanMeier.Univariable and Multivariable COX proportional hazards models were used to analyze the prognostic factors of progressionfree survival.Results The glioma group and the control group were matched by 12,the two groups had no significant difference in age,body mass index and blood lipid（P〈0.05）and fasting blood glucose and insulin were statistically significant（P〈0.05）,glycosylated hemoglobin（HbA1 C）was not statistically significant（P〈0.05）;The operating characteristic curve（ROC）was used to determine the optimal cut-off point of insulin=10.3 mU/L for the prognosis of patients with glioma and there were significant differences in tumor stage and progression.Kaplan-Meier analysis of two groups of progression free survival time were statistically significant（P〈0.05）and the group of serum insulin≥10.3 mU/L had poor prognosis.COX analyzed of univariable factors associated progression-free survival（PFS）（P〈0.05）with tumor stage（HR=1.36,95% CI：1.15-1.62）,fasting insulin（HR=2.11,95% CI：1.19-3.77）;COX analyzed of Multivariable factors associated progression-free survival（PFS）（P〈0.05）with tumor stage（HR=1.42,95% CI：1.09-1.86）,fasting,insulin（HR=1.98,95% CI：1.06-3.69）.Conclusion Preoperative insulin levels ha

关 键 词：胰岛素 胶质细胞瘤 无进展生存时间 胰岛素抵抗指数 预后 

分 类 号：R730.264[医药卫生—肿瘤]