糖尿病和高敏C反应蛋白水平影响消化系统恶性肿瘤发生风险的前瞻性队列研究  

The influence of diabetes mellitus and high-sensitivity C-reactive protein on the risk of diges-tive system malignancy:a prospective cohort study

作　　者：刘款 李佳兴 马超 王万超 田园 董智刚 韦稳强 陈朔华 吴寿岭 刘四清 Liu Kuan;Li Jiaxing;Ma Chao;Wang Wanchao;Tian Yuan;Dong Zhigang;Wei Wenqiang;Chen Shuohua;Wu Shouling;Liu Siqing(Department of Hepatobiliary and Pancreatic Surgery,The Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China;Health Examination Center,Kailuan General Hos-pital Affiliated to North China University of Science and Technology,Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院肝胆胰外科,唐山063000 [2]华北理工大学附属开滦总医院健康体检中心,唐山063000

出　　处：《中华消化外科杂志》2025年第1期93-102,共10页Chinese Journal of Digestive Surgery

基　　金：四大慢病重大专项(2023ZD0508700)。

摘　　要：目的探讨糖尿病(DM)和高敏C反应蛋白(Hs-CRP)水平对消化系统恶性肿瘤发生风险的影响。方法采用前瞻性队列研究方法。选取2006年华北理工大学附属开滦总医院等唐山市9家医院参加健康体检的93928例受试者的临床资料。根据受试者是否合并DM和Hs-CRP水平进行分组。无DM且Hs-CRP≤3 mg/L受试者设为DM(-)CRP(-)组,无DM且Hs-CRP>3 mg/L受试者设为DM(-)CRP(+)组,有DM且Hs-CRP≤3 mg/L受试者设为DM(+)CRP(-)组,有DM且Hs-CRP>3 mg/L受试者设为DM(+)CRP(+)组。由固定医师团队收集受试者资料。以2006年首次健康体检时间为随访起点,随访终点事件为发生消化系统恶性肿瘤或死亡,随访时间截至2021年12月31日。观察指标:(1)4组受试者临床资料比较。(2)受试者消化系统恶性肿瘤的发病情况及累积发病率。(3)DM和Hs-CRP水平分别对消化系统恶性肿瘤发生风险的影响。(4)DM和Hs-CRP水平共同对消化系统恶性肿瘤发生风险的影响。(5)敏感性分析。正态分布的计量资料多组间比较采用单因素方差分析;两两比较,方差齐采用最小显著性差异法检验,方差不齐采用Dunnett′s T3检验。偏态分布的计量资料多组间比较采用Kruskal-Wallis秩和检验,两两比较采用Dunn-Bonferroni检验。计数资料多组间比较采用χ^(2)检验,多重比较采用Bonferroni检验。采用Kaplan-Meier法绘制累积发病曲线,Log-rank检验进行累积发病率分析。采用Cox比例风险模型进行多因素分析。所有模型校正相关混杂因素。结果(1)4组受试者临床资料比较。93928例受试者中,DM(-)CRP(-)组70743例,DM(-)CRP(+)组14644例,DM(+)CRP(-)组6425例,DM(+)CRP(+)组2116例。4组受试者性别、年龄、空腹血糖、Hs-CRP水平、三酰甘油、丙氨酸氨基转移酶、体质量指数、已婚、吸烟、饮酒、高中及以上学历、体育锻炼、高盐饮食、高脂饮食、乙型肝炎病毒表面抗原阳性、脂肪肝、肝硬化、胆囊结石、服Objective To investigate the influence of diabetes mellitus(DM)and high-sen-sitivity C-reactive protein(Hs-CRP)on the risk of digestive system malignancy.Methods The pro-spective cohort study was conducted.The clinical data of 93928 participants who participated health examination in 9 hospitals at Tangshan,including Kailuan General Hospital Affiliated to North China University of Science and Technology et al,in 2006 were selected.According to the presence or absence of DM and the level of Hs-CRP,all participants were divided into 4 groups,including the DM(-)CRP(-)group defined as absence of DM and Hs-CRP≤3 mg/L,the DM(-)CRP(+)group defined as absence of DM and Hs-CRP>3 mg/L,the DM(+)CRP(-)group defined as presence of DM and Hs-CRP≤3 mg/L,and the DM(+)CRP(+)group defined as presence of DM and Hs-CRP>3 mg/L.The data of participants were collected by a fixed team of physicians.The first physical examination in 2006 was taken as the starting point for follow-up.The end event of follow-up was defined as the occurrence of digestive system malignancy or death,and the follow-up was up to December 31,2021.Observation indicators:(1)comparison of clinical data among the 4 groups of participants;(2)the incidence and cumulative incidence rate of digestive system malignancy in participants;(3)influence of DM and Hs-CRP level on the risk of digestive system malignancy;(4)the combined influence of DM and Hs-CRP level on the risk of digestive system malignancy;(5)sensitivity analysis.Comparison of measurement data with normal distribution among multiple groups was conducted using the one-way analysis of variance.For pairwise comparison,least significant difference test was used for homogeneity of variance,and Dunnett′s T3 test was used for heterogeneity of variance.Comparison of measurement data with skewed distribution among multiple groups was conducted using the Kruskal-Wallis rank sum test,and Dunn-Bonferroni test was used for pairwise comparison.Comparison of count data among multiple groups was conducted using the ch

关 键 词：恶性肿瘤 消化系统 C反应蛋白 糖尿病 危险因素 队列研究 

分 类 号：R587.1[医药卫生—内分泌] R735[医药卫生—内科学]