糖尿病患者胃肠道恶性肿瘤风险增加及其与抗糖尿病药物的相关性：台湾一项基于全国人口的研究

Increased risk of gastrointestinal malignancy in patients with diabetes mellitus and correlations with anti-diabetes drugs: a nationwide population-based study in Taiwan.

作者信息

Chiu Chun-Chih, Huang Chin-Chou, Chen Yu-Chun, Chen Tzeng-Ji, Liang Ying, Lin Shing-Jong, Chen Jaw-Wen, Leu Hsin-Bang, Chan Wan-Leong

机构信息

Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan.

出版信息

Intern Med. 2013;52(9):939-46. doi: 10.2169/internalmedicine.52.8276. Epub 2012 Mar 1.

DOI:10.2169/internalmedicine.52.8276

PMID:23648711

Abstract

OBJECTIVE

Although the major cause of morbidity and mortality in patients with diabetes mellitus (DM) is cardiovascular disease, DM is also associated with certain site-specific cancers. However, whether DM is associated with an increased risk of cancer of the digestive tract remains undetermined. A nationwide, population-based database in Taiwan was analyzed to explore the relationship between DM and cancer of the digestive organs.

METHODS

From 2000 to 2007, a study cohort consisting of 39,515 patients with newly diagnosed diabetes without a previous diagnosis of gastrointestinal (GI) cancer was identified from the National Health Insurance Research Database in Taiwan. A control cohort of 79,030 age- and sex-matched non-diabetic subjects was selected to compare the occurrence of GI malignancies between the two groups. The association between the incidence of GI cancers and the use of glucose-lowering therapies was also investigated.

RESULTS

During the 7-year follow-up period, GI cancers developed in 929 diabetic patients (2.35%) and 1,126 subjects (1.42%) in the comparison cohort. DM was associated with a 2.75-fold (95% confidence interval (CI), 2.51-3.02) higher risk of developing GI malignancy. Among GI cancers, the incidences of stomach (adjusted hazard ratio (HR), 1.49; 95% CI, 1.16-1.92), liver (adjusted HR, 2.65; 95% CI, 2.29-3.07), colon (adjusted HR, 1.58; 95% CI, 1.28-1.94) and pancreatic cancers (adjusted HR, 4.35; 95% CI, 2.93-6.47) were significantly increased in the patients with DM. An analysis of the effects of various glucose-lowering therapies in the diabetic patients revealed the use of α-glucosidase inhibitors to be associated with a lower risk of hepatic cancer (adjusted HR, 0.62; 95% CI, 0.4-0.94). Thiazolidinedione (TZD) treatment was associated with lower stomach (adjusted HR, 0.11; 95% CI, 0.02-0.82) and hepatic cancer risks (adjusted HR, 0.46; 95% CI, 0.29-0.73), while sulfonylurea use was associated with a lower colon cancer risk (adjusted HR, 0.74; 95% CI, 0.51-1.09) and a higher pancreatic cancer risk (adjusted HR, 2.36; 95% CI, 1.21-4.61).

CONCLUSION

Patients with DM have an increased risk of GI malignancy that may be affected by the use of different categories of glucose-lowering therapies.

摘要

目的

虽然糖尿病（DM）患者发病和死亡的主要原因是心血管疾病，但DM也与某些特定部位的癌症有关。然而，DM是否与消化道癌症风险增加相关仍未确定。本研究分析了台湾一个全国性的基于人群的数据库，以探讨DM与消化器官癌症之间的关系。

方法

2000年至2007年期间，从台湾国民健康保险研究数据库中确定了一个由39515例新诊断糖尿病且既往无胃肠道（GI）癌诊断的患者组成的研究队列。选取79030例年龄和性别匹配的非糖尿病受试者作为对照队列，比较两组间GI恶性肿瘤的发生情况。还研究了GI癌症发病率与降糖治疗使用之间的关联。

结果

在7年的随访期内，929例糖尿病患者（2.35%）和对照队列中的1126例受试者（1.42%）发生了GI癌症。DM与发生GI恶性肿瘤的风险高2.75倍（95%置信区间（CI），2.51 - 3.02）相关。在GI癌症中，糖尿病患者的胃癌（调整后风险比（HR），1.49；95% CI，1.16 - 1.92）、肝癌（调整后HR，2.65；95% CI，2.29 - 3.07）、结肠癌（调整后HR，1.58；95% CI，1.28 - 1.94）和胰腺癌（调整后HR，4.35；95% CI，2.93 - 6.47）发病率显著增加。对糖尿病患者各种降糖治疗效果的分析显示，使用α - 葡萄糖苷酶抑制剂与肝癌风险较低相关（调整后HR，0.62；95% CI，0.4 - 0.94）。噻唑烷二酮（TZD）治疗与较低的胃癌（调整后HR，0.11；95% CI，0.02 - 0.82）和肝癌风险相关（调整后HR，0.46；95% CI，0.29 - 0.73），而使用磺脲类药物与较低的结肠癌风险（调整后HR，0.74；95% CI，0.51 - 1.09）和较高的胰腺癌风险相关（调整后HR，2.36；95% CI，1.21 - 4.61）。