肝切除术后1年内伴或不伴2型糖尿病的BCLC B - C期肝细胞癌患者血糖变异性的外科护理视角分析：一项2016年至2020年的回顾性队列研究

A surgical nursing perspective analysis of glucose variability in BCLC stage B-C hepatocellular carcinoma patients with and without T2D within 1 year of hepatectomy: a retrospective cohort study from 2016 to 2020.

作者信息

Wang Li-Ping, Zhu Jia-Sha, Zhan Feng-Di, Fang Tian, Zhao Li

机构信息

Department of Breast Surgery/Plastic Surgery, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

J Gastrointest Oncol. 2023 Apr 29;14(2):943-951. doi: 10.21037/jgo-23-163.

DOI:10.21037/jgo-23-163

PMID:37201059

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10186515/

Abstract

BACKGROUND

Previous research has reported that variability in glucose levels is associated with a variety of patient characteristics in colon cancer. However, relevant research is still lacking in relation to hepatocellular carcinoma (HCC).

METHODS

A total of 95 HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage B-C who underwent liver resection at the Eastern Hepatobiliary Surgery Hospital and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included in this study. The patients were divided into 2 groups with type 2 diabetes (T2D) and without T2D. The primary outcome variable was blood glucose variability at 1 month and within 1 year of HCC surgery.

RESULTS

In this study, the age of patients with T2D was greater than that of patients without T2D (mean age: 70.3±8.45 60.4±11.27 years, P=0.031). Compared to the patients without T2D, those with T2D had higher blood glucose measurements within 1 month (33 7) and 1 year (46.5 22.5, P<0.001) of surgery. The T2D patients and non-T2D patients did not differ in terms of chemotherapy medication or other characteristics. Among the 95 patients with BCLC stage B-C HCC, those with T2D had higher variability in glucose levels (P<0.001) than those without T2D within 1 month of surgery [standard deviation (SD) =46.43 mg/dL, coefficient of variation (CV) =23.5% SD =21.56 mg/dL, CV =13.21%], and within 1 year of surgery (SD =42.49 mg/dL, CV =26.14% SD =20.45 mg/dL, CV =17.36%). A correlation was found between a lower body mass index and higher variability in glucose levels within 1 month of surgery among patients with T2D [SD (r=-0.431, P<0.05) and CV (r=-0.464, P<0.01)]. A higher preoperative blood glucose level in T2D patients was correlated with a higher blood glucose variability within 1 year of surgery (r=0.435, P<0.01). Variability in glucose levels was weakly correlated with the demographic and clinical characteristics of patients who do not have T2D.

CONCLUSIONS

HCC patients with T2D in BCLC stage B-C showed greater variability in glucose levels within 1 month and 1 year of surgery. Preoperative hyperglycemia, insulin use, and a lower cumulative dose of steroids were clinical features correlated with a higher variability in glucose levels in T2D patients.

摘要

背景

先前的研究报道，血糖水平的变异性与结肠癌患者的多种特征相关。然而，关于肝细胞癌（HCC）的相关研究仍然缺乏。

方法

本研究纳入了95例在东方肝胆外科医院和上海交通大学医学院附属新华医院接受肝切除术的巴塞罗那临床肝癌（BCLC）B - C期HCC患者。将患者分为有2型糖尿病（T2D）和无T2D两组。主要结局变量为HCC手术后1个月及1年内的血糖变异性。

结果

在本研究中，T2D患者的年龄大于无T2D的患者（平均年龄：70.3±8.45岁对60.4±11.27岁，P = 0.031）。与无T2D的患者相比，T2D患者在手术后1个月（33±7）和1年（46.5±22.5，P < 0.001）的血糖测量值更高。T2D患者和非T2D患者在化疗药物或其他特征方面没有差异。在95例BCLC B - C期HCC患者中，T2D患者在手术后1个月内的血糖水平变异性高于无T2D的患者（P < 0.001）[标准差（SD）= 46.43mg/dL，变异系数（CV）= 23.5%对SD = 21.56mg/dL，CV = 13.21%]，在手术后1年内也是如此（SD = 42.49mg/dL，CV = 26.14%对SD = 20.45mg/dL，CV = 17.36%）。在T2D患者中，发现较低的体重指数与手术后1个月内较高的血糖水平变异性之间存在相关性[SD（r = -0.431，P < 0.05）和CV（r = -0.464，P < 0.01）]。T2D患者术前较高的血糖水平与手术后1年内较高的血糖变异性相关（r = 0.435，P < 0.01）。血糖水平变异性与无T2D患者的人口统计学和临床特征弱相关。