Yoshida Isao, Suzuki Ayako, Vallée Marc, Matano Yutaka, Masunaga Takaharu, Zenda Takahiro, Shinozaki Kimihide, Okada Toshihide
Second Department of Internal Medicine, Kanazawa University [corrected] and Hokuriku Hospital, Kanazawa, Ishikawa, Japan.
Clin Gastroenterol Hepatol. 2006 Oct;4(10):1225-31. doi: 10.1016/j.cgh.2006.07.002. Epub 2006 Sep 18.
BACKGROUND & AIMS: Obesity and diabetes mellitus are associated with an increased incidence of proximal colon cancer. Colonic adenoma that has been reported to be associated with elevated serum insulin levels and subsets of hyperplastic polyps might serve as a precursor of colon cancer. In this study, we sought to determine segment-specific associations between serum insulin levels and the prevalence of adenoma and hyperplastic polyps in the proximal and distal colon.
We studied 343 consecutive patients who underwent colonoscopy in our hospital. All medical information, including fasting serum insulin, was obtained at colonoscopy. We performed multinomial logistic regression models by using the outcome categories of none (reference), proximal-only, distal-only, and both-segment lesions for the presence of adenoma/hyperplastic polyp with serum insulin, age, gender, lifestyle characteristics, and the presence of other types of lesions as predictors. Odds ratios (ORs) and 95% confidence intervals (CIs) are provided for a 5-muU/mL increase in serum insulin.
Overall, serum insulin levels were significantly associated with adenoma (OR, 1.5; 95% CI, 1.1-2.0; P = .005) and borderline associated with hyperplastic polyps (OR, 1.3; 95% CI, 1.0-1.7; P = .075). In multinomial logistic regression models, elevated serum insulin levels were significantly associated with proximal-only adenoma (OR, 1.8; 95% CI, 1.2-2.5; P = .002), both-side hyperplastic polyp (OR, 1.7; 95% CI, 1.1-2.5; P = .015), and proximal-only hyperplastic polyp (OR, 1.5; 95% CI, 1.0-2.1; P = .048) and borderline associated with distal-only adenoma (OR, 1.5; 95% CI, 1.0-2.1; P =.059) but not with distal-only hyperplastic polyp.
Serum insulin levels directly correlate with the presence of adenoma and hyperplastic polyps in the proximal colon and might also less strongly correlate with the presence of distal adenoma.
肥胖和糖尿病与近端结肠癌发病率增加相关。据报道，结肠腺瘤与血清胰岛素水平升高有关，增生性息肉的某些亚型可能是结肠癌的前体。在本研究中，我们试图确定血清胰岛素水平与近端和远端结肠腺瘤及增生性息肉患病率之间的节段特异性关联。
我们研究了在我院连续接受结肠镜检查的343例患者。在结肠镜检查时获取所有医学信息，包括空腹血清胰岛素。我们使用无（参照）、仅近端、仅远端以及两段均有病变作为腺瘤/增生性息肉存在情况的结局类别，以血清胰岛素、年龄、性别、生活方式特征以及其他类型病变的存在情况作为预测因素，进行多项逻辑回归模型分析。给出血清胰岛素每增加5 μU/mL时的比值比（OR）和95%置信区间（CI）。
总体而言，血清胰岛素水平与腺瘤显著相关（OR，1.5；95% CI，1.1 - 2.0；P = 0.005），与增生性息肉存在临界相关性（OR，1.3；95% CI，1.0 - 1.7；P = 0.075）。在多项逻辑回归模型中，血清胰岛素水平升高与仅近端腺瘤显著相关（OR，1.8；95% CI，1.2 - 2.5；P = 0.002）、双侧增生性息肉（OR，1.7；95% CI，1.1 - 2.5；P = 0.015）以及仅近端增生性息肉（OR，1.5；95% CI，1.0 - 2.1；P = 0.048）存在临界相关性，与仅远端腺瘤相关（OR，1.5；95% CI，1.0 - 2.1；P = 0.059），但与仅远端增生性息肉无关。
血清胰岛素水平与近端结肠腺瘤和增生性息肉的存在直接相关，与远端腺瘤的存在可能也有较弱的相关性。
