Wang Jiun-Ling, Chang Chia-Hsuin, Lin Jou-Wei, Wu Li-Chiu, Chuang Lee-Ming, Lai Mei-Shu
Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Int J Cancer. 2014 Aug 15;135(4):956-67. doi: 10.1002/ijc.28738. Epub 2014 Mar 21.
Patients with Type 2 diabetes mellitus are at a higher risk of colorectal cancer (CRC). The objective of our study was to examine the inter-relationship among infection sites, systemic antibiotic use and risk of CRC among patients with Type 2 diabetes mellitus. From a diabetic cohort from the Taiwan's National Health Insurance claims database, we identified 3,593 incident colon cancer cases, 1,979 rectal cancer cases and 22,288 controls and conducted a nested case-control study to examine the association between antibiotic use and CRC incidence. Logistic regression models were applied to estimate the odds ratio (OR) and the 95% confidence interval (95% CI) between infection sites, antibiotic use and CRC incidence. Patients with intra-abdominal infection were significantly associated with increased risk for colon cancer (OR = 2.01, 95% CI = 1.73-2.35) and rectal cancer (OR = 1.59, 95% CI = 1.26-2.00). Any antianaerobic antibiotic use was associated with a higher risk of colon cancer (OR = 2.31, 95% CI = 2.12-2.52) and rectal cancer (OR = 1.69, 95% CI = 1.50-1.90) but without an obvious dose-response relationship for cumulative use. Antianaerobic antibiotics also increased the risks for those with nonintra-abdominal infection. No association was found between antiaerobic agent use and the CRC risk. The results suggest intra-abdominal infections and antianaerobic antibiotic use may be a marker for precancerous lesions or early CRC, although the possibility of antianaerobic antibiotics playing an additional role cannot be excluded. Further research examining the relationship between intra-abdominal infection, antianaerobic antibiotics use and possible change of microbiota leading to colorectal carcinogenesis is warranted.
2型糖尿病患者患结直肠癌（CRC）的风险更高。我们研究的目的是探讨2型糖尿病患者感染部位、全身性抗生素使用与CRC风险之间的相互关系。从台湾国民健康保险理赔数据库的糖尿病队列中，我们确定了3593例结肠癌新发病例、1979例直肠癌新发病例和22288例对照，并进行了一项巢式病例对照研究，以检验抗生素使用与CRC发病率之间的关联。应用逻辑回归模型估计感染部位、抗生素使用与CRC发病率之间的比值比（OR）和95%置信区间（95%CI）。腹腔内感染患者与结肠癌风险增加显著相关（OR = 2.01，95%CI = 1.73 - 2.35）和直肠癌风险增加显著相关（OR = 1.59，95%CI = 1.26 - 2.00）。任何抗厌氧菌抗生素的使用与结肠癌风险较高相关（OR = 2.31，95%CI = 2.12 - 2.52）和直肠癌风险较高相关（OR = 1.69，95%CI = 1.50 - 1.90），但累积使用无明显剂量反应关系。抗厌氧菌抗生素也增加了非腹腔内感染患者的风险。未发现使用抗需氧菌药物与CRC风险之间存在关联。结果表明，腹腔内感染和抗厌氧菌抗生素的使用可能是癌前病变或早期CRC的一个标志物，尽管不能排除抗厌氧菌抗生素发挥额外作用的可能性。有必要进一步研究腹腔内感染、抗厌氧菌抗生素的使用与可能导致结直肠癌发生的微生物群变化之间的关系。
