肥胖相关脂肪因子与结直肠癌的关联：一项病例对照研究与荟萃分析
Association between obesity-related adipokines and colorectal cancer: a case-control study and meta-analysis.
作者信息
Joshi Rakhi Kumari, Kim Woo Jin, Lee Sang-Ah
机构信息
Rakhi Kumari Joshi, Sang-Ah Lee, Department of Preventive Medicine, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do 200-701, South Korea.
出版信息
World J Gastroenterol. 2014 Jun 28;20(24):7941-9. doi: 10.3748/wjg.v20.i24.7941.
AIM
To examine the association between obesity-related adipokines (adiponectin, leptin, resistin, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) and colorectal cancer (CRC) risk.
METHODS
Serum levels of adipokines were measured in 100 CRC patients and age- and sex-matched controls for the data analysis. Unconditional logistic regression models were used for estimating ORs and 95%CIs related to each adipokine. For the meta-analysis, studies published before July 2013 available on Medline/PubMed and EMBASE were retrieved. The analysis included a total of 17 relevant studies (including the present case-control study): nine studies on adiponectin and eight on leptin. The effect sizes of ORs and 95%CIs were estimated using RevMan 5.1. Heterogeneity was evaluated using Cochran's Q-test and I (2) statistics.
RESULTS
Among the five adipokines, only resistin levels were significantly higher in cases than in controls (P < 0.001). The case-control study results showed no association between adiponectin and CRC and a negative association between leptin and CRC. However, the results of the meta-analysis showed a significant inverse association between adiponectin and CRC (OR = 0.91, 95%CI: 0.83-1.00, P = 0.04) and no association between CRC and leptin. After stratification by study design, an inverse association between adiponectin and CRC was observed in prospective studies only (OR = 0.90, 95%CI: 0.82-0.99, P = 0.03), whereas the association between leptin and CRC was inconsistent (prospective studies: OR = 1.14, 95%CI: 1.02-1.27, P = 0.02 and retrospective studies: OR = 0.47, 95%CI: 0.29-0.74, P = 0.001). The associations of resistin and TNF-α with CRC risk were positive, but no association was observed for IL-6.
CONCLUSION
Our results suggest a negative association of leptin, positive associations of resistin and TNF-α, and null associations of adiponectin and IL-6 with CRC. However, further studies with larger number of prospective approaches are needed.
目的
研究肥胖相关脂肪因子（脂联素、瘦素、抵抗素、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α））与结直肠癌（CRC）风险之间的关联。
方法
对100例CRC患者及年龄和性别匹配的对照组进行血清脂肪因子水平检测以进行数据分析。采用无条件逻辑回归模型估计各脂肪因子的比值比（OR）和95%可信区间（CI）。对于荟萃分析，检索了2013年7月之前发表在Medline/PubMed和EMBASE上的研究。该分析共纳入17项相关研究（包括本病例对照研究）：9项关于脂联素的研究和8项关于瘦素的研究。使用RevMan 5.1估计OR和95%CI的效应大小。采用Cochran's Q检验和I²统计量评估异质性。
结果
在这五种脂肪因子中，仅病例组的抵抗素水平显著高于对照组（P < 0.001）。病例对照研究结果显示脂联素与CRC之间无关联，瘦素与CRC之间呈负相关。然而，荟萃分析结果显示脂联素与CRC之间存在显著负相关（OR = 0.91，95%CI：0.83 - 1.00，P = 0.04），CRC与瘦素之间无关联。按研究设计分层后，仅在前瞻性研究中观察到脂联素与CRC之间呈负相关（OR = 0.90，95%CI：0.82 - 0.99，P = 0.03），而瘦素与CRC之间的关联不一致（前瞻性研究：OR = 1.14，95%CI：1.02 - 1.27，P = 0.02；回顾性研究：OR = 0.47，95%CI：0.29 - 0.74，P = 0.001）。抵抗素和TNF-α与CRC风险的关联为正，但未观察到IL-6与CRC的关联。
结论
我们的结果表明，瘦素与CRC呈负相关，抵抗素和TNF-α与CRC呈正相关，脂联素和IL-6与CRC无关联。然而，需要更多前瞻性研究方法进行进一步研究。
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