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血清甘油三酯水平升高可能是胆囊结石病患者胆囊癌风险的一个关键独立预测因素:一项病例对照研究。

Elevated serum triglyceride levels may be a key independent predicting factor for gallbladder cancer risk in gallbladder stone disease patients: a case-control study.

机构信息

Department of Geriatric Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No 277 West Yanta Road, Xi'an, China.

Shaanxi Nutrition Society, Medical School, of Xi'an Jiaotong University Xi'an, Shaanxi, China.

出版信息

BMC Endocr Disord. 2022 Nov 8;22(1):270. doi: 10.1186/s12902-022-01189-y.

Abstract

BACKGROUND

Gallbladder stone diseases (GSD) is a main risk factor of gallbladder cancer (GBC). This study aimed to reveal their bridge to metabolic syndrome.

MATERIAL/METHOD: The clinical and experimental data of 2210 GBC patients, from 3524 Chinese patients, in our hospital from Jan. 2009 to Dec. 2020 were summarized. The metabolic syndrome indexes, influencing factors for both GBC and GSD, were analyzed by unconditional logistic regression in this case-control study.

RESULT

There were significantly higher morbidity of GBC in the overall, GSD and non-GSD with hypertriglyceridemia patients versus non-hypertriglyceridemia ones (P < 0.001, all). In GSD patients, univariate regression showed a significantly positive correlation between serum triglyceride (TG), low density lipoprotein cholesterol (LDL-c), fasting insulin (FINS) levels, Homeostasis model assessment-insulin resistance (HOMA-IR), female being, body mass index, hypertriglyceridemia and hazard of GBC with GSD (P < 0.001, all), and a significantly negative correlation to systolic pressure (SBP), diastolic pressure (DBP), hypertension and high-density lipoprotein cholesterol (HDL-c), fasting blood glucose (FBG) (P < 0.05, all); multivariate regression showed that serum triglyceride was the most significantly positive factor associated to GBC (P < 0.001, all) among the hazard factors including serum TG, LDL-c levels, HOMA-IR. In non-GSD ones, multivariate regression showed that HOMA-IR was the most significantly positive factor associated to GBC among the hazard factors including serum TG, LDL-c levels, HOMA-IR, female being, while DM had a significantly inversion negative association (P < 0.001).

CONCLUSION

We found initially that elevated serum TG levels could be the most remarkable independent predicting factor for GBC risk with GSD, while insulin resistance might act as the first one in non-GSD. More importantly, we advocated initially the sharp rise of serum TG levels as the potential of a candidate diagnostic or prognostic biomarker of GBC with GSD.

TRIAL REGISTRATION

The study may be performed in accordance with the ethical standards provided by the responsible committee of our institution (First Affiliated Hospital of Xi'an Jiaotong University. XJTU1AF2020LSK-160) at which the work was carried out an in accordance with the Declaration of Helsinki. The ethics committee of our institution strictly comply with the requirements of ICH-GCP、GCP and relevant regulations to construct, operate and implement operating procedures.

摘要

背景

胆囊结石病(GSD)是胆囊癌(GBC)的主要危险因素。本研究旨在揭示其与代谢综合征的关系。

材料/方法:总结了我院 2009 年 1 月至 2020 年 12 月收治的 3524 例中国患者中 2210 例 GBC 患者的临床和实验资料。在这项病例对照研究中,通过非条件 logistic 回归分析了 GBC 和 GSD 的代谢综合征指标及影响因素。

结果

总体而言,与非高甘油三酯血症患者相比,高甘油三酯血症患者的 GBC 发病率明显更高(P<0.001,均)。在 GSD 患者中,单因素回归显示,血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-c)、空腹胰岛素(FINS)水平、稳态模型评估胰岛素抵抗(HOMA-IR)、女性、体重指数、高甘油三酯血症与 GBC 合并 GSD 的危险呈显著正相关(P<0.001,均),与收缩压(SBP)、舒张压(DBP)、高血压和高密度脂蛋白胆固醇(HDL-c)、空腹血糖(FBG)呈显著负相关(P<0.05,均);多因素回归显示,血清甘油三酯是与 GBC 最显著相关的危险因素(P<0.001,均),包括血清 TG、LDL-c 水平、HOMA-IR。在非 GSD 患者中,多因素回归显示,HOMA-IR 是与 GBC 最显著相关的危险因素,包括血清 TG、LDL-c 水平、HOMA-IR、女性,而糖尿病则呈显著负相关(P<0.001)。

结论

我们初步发现,血清 TG 水平升高可能是 GSD 合并 GBC 的最显著独立危险因素,而胰岛素抵抗可能是 GSD 合并 GBC 的首要因素。更重要的是,我们最初提倡将血清 TG 水平的急剧升高作为 GSD 合并 GBC 的潜在诊断或预后生物标志物。

试验注册

本研究可符合西安交通大学第一附属医院伦理委员会(西安交通大学第一附属医院,XJTU1AF2020LSK-160)的伦理标准,并严格按照赫尔辛基宣言的要求进行。本机构的伦理委员会严格按照 ICH-GCP、GCP 和相关法规的要求构建、操作和实施操作规程。

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