摘要
目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者恶性肿瘤的发病风险及空腹血糖对其的影响。方法采用回顾性队列研究的方法对2004—2020年间上海市恶性肿瘤登记信息与闵行区居民电子健康档案(electronic health record,EHR)系统中信息进行整合。空腹血糖分类采用4分位数表示,<7.0 mmol/L为Q1组,7.0~7.9 mmol/L为Q2组,8.0~9.7 mmol/L为Q3组,≥9.8 mmol/L为Q4组。采用Cox回归模型和限制性立方样条(restricted cubic splines,RCS)函数进行分析。结果共纳入70361名研究对象,男性占49.03%,女性占50.97%,建卡平均年龄(63.15±10.56)岁,人均随访时间(9.25±4.38)年,恶性肿瘤发病率为868.14/10万人年,男性939.87/10万人年,女性801.85/10万人年,随着病程延长恶性肿瘤发病风险降低(P<0.05)。多因素分析显示,与Q1组相比,Q3组空腹血糖对恶性肿瘤的发病率影响最明显(OR=1.44,95%CI:1.33~1.56)。RCS结果显示,校正了年龄因素后,全人群以及不同性别、病程分组随着空腹血糖均数升高,恶性肿瘤发病均呈先上升后减缓或下降的非线性趋势,差异有统计学意义(P_(非线性)<0.05)。结论T2DM患者恶性肿瘤发病风险较高,空腹血糖对恶性肿瘤发病率的影响并非单纯取决于浓度的高低。
Objective To investigate the incidence of malignant tumors in type 2 diabetes mellitus(T2DM)patients and the effect of fasting blood glucose(FBG)on the incidence.Methods A record linkage was carried out between Cancer Registry System in Shanghai and the electronic health record(EHR)of residents in Minhang District during 2004-2020,then a retrospective cohort study was conducted for analysis.Fasting blood glucose classification was conducted with Q1 group(<7.0 mmol/L),Q2 group(7.0-7.9 mmol/L),Q3 group(8.0-9.7 mmol/L),and Q4 group(≥9.8 mmol/L).To quantify the hazard and effect on the risk of cancer incidence in diabetic patients,the Cox regression model and restricted cubic splines(RCS)were used.Results The study included 70361 subjects in total,with a male to female ratio of 49.03%to 50.97%,an average age of(63.15±10.56)years,and an average follow-up time of(9.25±4.38)years.Malignant tumor incidence rate was 868.14/100000 person years,while male 939.87/100000 person years,female 801.85/100000 person years,respectively.And the incidence of malignant tumor decreased with the duration of the disease(P<0.05).With an OR of 1.44(95%CI:1.33-1.56),Q3 group had the highest influence on the incidence of malignant tumors in multivariate analysis when compared to Q1 group.After adjusted the impact of age,the RCS graphs revealed a nonlinear trend in which the incidence of malignant tumors increased initially,then slowed down or decreased with an increase in mean glucose fasting,and the difference was statistically significant(P_(nonlinear)<0.05).Conclusion With high incidence of malignant tumors in T2DM patients,the impact of glucose fasting on the incidence of malignant tumors does not depend entirely on the concentration.
作者
刘蒲
李俊
许慧琳
LIU Pu;LI Jun;XU Hui-lin(Community Health Service Center of Zhuanqiao District,Shanghai 201108,China;Center for Disease Control and Prevention of Minhang District,Shanghai 201101,China)
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2024年第3期338-343,共6页
Fudan University Journal of Medical Sciences
基金
上海市卫健委卫生行业临床研究基金青年项目(20214Y0453)。
