Saydah Sharon H, Platz Elizabeth A, Rifai Nader, Pollak Michael N, Brancati Frederick L, Helzlsouer Kathy J
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
Cancer Epidemiol Biomarkers Prev. 2003 May;12(5):412-8.
We evaluated the association of plasma insulin and other markers of insulin and glucose control with subsequent colorectal cancer. Incident colon (n = 132) and rectal (n = 41) cancer cases and matched controls (n = 346) were identified between baseline in 1989 and 2000 among participants in a community-based cohort in Washington County, Maryland. Circulating markers of insulin and glucose control were measured in baseline blood samples. Body mass index (BMI) and use of medications to treat diabetes mellitus were self-reported at baseline. Conditional logistic regression was used to estimate matched odds ratios (ORs). Compared with the lowest fourth, participants with insulin concentrations in the highest fourth were not at an increased risk of colorectal cancer [OR, 0.78; 95% confidence interval (CI), 0.45-1.35; P(trend) = 0.24]. Similarly, no associations were observed for the ratio of total cholesterol:HDL-cholesterol, triglycerides, and insulin-like growth factor binding protein 1. However, those in the highest fourth of glycosylated hemoglobin (HbA(1c)) level had a slightly increased risk of colorectal cancer (OR, 1.57; 95% CI, 0.94-2.60; P(trend) = 0.02). The OR of colorectal cancer was 1.70 (95% CI, 1.01-2.86; P(trend) = 0.08) comparing BMI >/=30 kg/m(2) to <25 kg/m(2). The OR of colorectal cancer was 2.43 (95% CI, 1.10-5.38) for the use of medications to treat diabetes. The associations of higher HbA(1c), higher BMI, and the use of medications to treat diabetes, with colorectal cancer lend support to the hypothesis that perturbations in insulin and glucose control may influence colorectal carcinogenesis. It is possible that HbA(1c), BMI, and the use of medications to treat diabetes, as a surrogate for protracted or severe type 2 diabetes mellitus, may have been better time-averaged indicators of hyperinsulinemia and hyperglycemia than the plasma markers that were measured once prediagnostically in a nonfasting population.
我们评估了血浆胰岛素及其他胰岛素和血糖控制指标与后续结直肠癌之间的关联。在马里兰州华盛顿县一个基于社区的队列研究参与者中，于1989年基线期至2000年间确定了132例结肠癌和41例直肠癌发病病例以及匹配的346例对照。在基线血样中检测胰岛素和血糖控制的循环指标。体重指数（BMI）和糖尿病治疗药物的使用情况在基线期通过自我报告获得。采用条件逻辑回归来估计匹配比值比（OR）。与最低四分位数相比，胰岛素浓度处于最高四分位数的参与者患结直肠癌的风险并未增加[OR，0.78；95%置信区间（CI），0.45 - 1.35；P（趋势）= 0.24]。同样，未观察到总胆固醇与高密度脂蛋白胆固醇比值、甘油三酯及胰岛素样生长因子结合蛋白1有任何关联。然而，糖化血红蛋白（HbA1c）水平处于最高四分位数的人群患结直肠癌的风险略有增加（OR，1.57；95% CI，0.94 - 2.60；P（趋势）= 0.02）。将BMI≥30 kg/m²与＜25 kg/m²相比，结直肠癌的OR为1.70（95% CI，1.01 - 2.86；P（趋势）= 0.08）。使用糖尿病治疗药物的人群患结直肠癌的OR为2.43（95% CI，1.10 - 5.38）。较高的HbA1c、较高的BMI以及使用糖尿病治疗药物与结直肠癌之间的关联支持了这样一种假说，即胰岛素和血糖控制的紊乱可能影响结直肠癌的发生。有可能HbA1c、BMI以及使用糖尿病治疗药物作为持续性或重度2型糖尿病的替代指标，相比于在非空腹人群中诊断前仅测量一次的血浆标志物，可能是更好的高胰岛素血症和高血糖的时间平均指标。
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