血液肿瘤化疗后继发糖尿病的影响因素探究  

Influencing factors of secondary diabetes mellitus after chemotherapy for hematologic tumors

作　　者：胡姗姗 黄黎[1] 高新芳[1] 俞方泉 叶虹位 HU Shanshan;HUANG Li;GAO Xinfang;YU Fangquan;YE Hongwei(Department of Hematology,Jinhua People’s Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]金华市人民医院血液内科,浙江金华321000

出　　处：《中国现代医生》2024年第34期10-14,33,共6页China Modern Doctor

基　　金：浙江省金华市科技计划重点项目(2021-3-111)。

摘　　要：目的探讨血液肿瘤化疗后继发糖尿病的影响因素。方法回顾性分析2018年1月至2024年1月金华市人民医院收治的396例血液肿瘤患者的病历资料,依据患者化疗期间是否发生继发性糖尿病将其分为继发糖尿病组(n=127)和非糖尿病组(n=269)。采用转录组测序探究两组患者的差异信号通路。采用多因素Logistic回归分析筛选化疗后继发糖尿病的影响因素,并构建血液肿瘤化疗后继发糖尿病的预测模型。结果两组患者的骨髓样本共同差异基因主要富集于血管内皮功能调控和血管稳态通路。两组患者的年龄、体质量指数(body mass index,BMI)、糖尿病家族史、高血压病史、高脂血症病史、地塞米松月换算累计量、血清内皮素-1(endothelin-1,ET-1)、血管细胞黏附分子1(vascular cell adhesion molecule 1,VCAM-1)、内皮型一氧化氮合酶(endothelial nitric oxide synthase,eNOS)水平比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、BMI、高脂血症病史、地塞米松月换算累计量、ET-1、VCAM-1和eNOS均为血液肿瘤患者化疗后继发糖尿病的独立影响因素(P<0.05)。构建的预测模型预测化疗后继发糖尿病的曲线下面积为0.844(95%CI:0.806~0.883,P<0.001),预测效能较好。结论年龄、BMI、合并高脂血症、地塞米松月换算累计量、ET-1、VCAM-1和eNOS均是血液肿瘤患者化疗后继发糖尿病的独立影响因素,构建的预测模型可作为临床早期筛查的工具。Objective To investigate the influencing factors of secondary diabetes mellitus after chemotherapy for hematologic tumors.Methods The medical records of 396 patients with hematologic tumors admitted to Jinhua People’s Hospital from January 2018 to January 2024 were retrospectively analyzed.According to whether patients developed secondary diabetes mellitus during chemotherapy,they were divided into secondary diabetes mellitus group(n=127)and non-diabetes mellitus group(n=269).Transcriptome sequencing was used to explore the different signaling pathways between two groups.Multivariate Logistic regression analysis was used to screen the influencing factors of secondary diabetes mellitus after chemotherapy,and the prediction model of secondary diabetes mellitus after hematologic tumor chemotherapy was constructed.Results The common differential genes in bone marrow samples of two groups were mainly concentrated in vascular endothelial function regulation and vascular homeostasis pathway.There were significant differences in age,body mass index(BMI)and family history of diabetes mellitus,hypertension and hyperlipidemia,dexamethasone on conversion cumulative quantity,endothelin-1(ET-1),vascular cell adhesion molecule 1(VCAM-1),endothelial nitric oxide synthase(eNOS)between two groups(P<0.05).Multivariate Logistic regression analysis showed that age,BMI,history of hyperlipidemia,dexamethasone on conversion cumulative quantity,ET-1,VCAM-1 and eNOS were independent influencing factors for secondary diabetes mellitus in patients with hematologic tumors after chemotherapy(P<0.05).The area under the curve of predictive model was 0.844(95%CI:0.806-0.883,P<0.001),indicating that the predictive ability of the model was good.Conclusion Age,BMI,combined hyperlipidemia,dexamethasone on conversion cumulative quantity,ET-1,VCAM-1 and eNOS are all independent influencing factors for secondary diabetes mellitus in patients with hematologic tumors after chemotherapy,and the prediction model can be used as a tool for early clinical s

关 键 词：血液肿瘤 化疗 继发性糖尿病 影响因素 预测模型 

分 类 号：R733[医药卫生—肿瘤]