糖尿病与胰腺癌关系的探讨

糖尿病与胰腺癌关系的探讨

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作者：李军辉，沙焕臣，马清涌，王连才，郭坤，刘晗，黎韡

【摘要】目的探讨糖尿病与胰腺癌的关系，高血糖对胰腺癌组织内神经的影响。方法采用病例对照研究对我院1999年1月至2008年3月诊治的胰腺癌患者513例进行回顾性研究，分为血糖升高组和正常血糖组，进行各项指标比较;并对手术切除组织标本进行神经相关指标免疫组化染色，观察其表达差异。结果各项指标中，高血糖组更容易出现精神差(P0.05);有糖尿病史的患者中，血糖得到控制的手术切除率和疼痛出现率明显增高(P0.05);免疫组化表现，两组亦有差异。结论明确有糖尿病史的胰腺癌患者，积极控制血糖有利于提高根治性手术率，高血糖可使胰腺癌神经发生改变，可能参与了神经浸润的发生。

【关键词】胰腺癌;糖尿病;神经浸润

ABSTRACT: Objective To explore the relationship between diabetes and pancreatic cancer and the role of hyperglycemia in the nerves distributed in pancreatic cancer. Methods We made

a retrospective case control study of 513 pancreatic cancer patients in our hospital between January 1999 and March 2008. They were divided into euglycemia group and hyperglycaemia group, and various indexes were compared between them. Expressions of protein gene product 9.5 (PGP9.5) and myelin P0 protein (MPP) were analyzed by immunohistochemistry in formalin fixed radical cured pancreatic cancer specimens from 81 pancreatic cancer cases and 10 normal pancreas tissue cases as controls. Results More cases had the symptom of weariness in hyperglycaemia group compared with euglycemia group (P0.05). The frequency of radical operation and pain was higher when the level of blood glucose was controlled within the normal range in the cases with the history of diabetes mellitus (DM) (P0.05). The frequency of strong PGP9.5 staining was significantly higher in hyperglycaemia group than in euglycemia group and normal control group (P0.05) whereas the expression of MPP was the opposite among the three groups (P0.05). Conclusion Controlling blood glucose within the normal level can help increase the rate of radical operation in pancreatic cancer cases with hyperglycaemia. Hyperglycemia can alter the nerve fibers in pancreatic cancer, which may effect the perineural infiltration in pancreatic cancer.

KEY WORDS: pancreatic cancer; diabetes mellitus; perineural infiltration

胰腺癌是一种恶性程度高、病情进展快、预后极差的消化系统肿瘤。近年来其发病率明显增高，其发病率可排在第9到10位，死亡率可排在第4～5位，5年生存率即使行根治性切除术，也只有10%～25%[1]。其预后主要与局部复发，淋巴结转移，肝转移，腹膜后浸润和周围神经浸润有关[2]。后者是胰腺癌特殊的生物学行为，且被认为是胰腺癌独立的预后指标。据报道，仅有淋巴结转移而无神经浸润的胰腺癌患者5年生存率可达75%，既有淋巴结转移又有神经浸润的患者5年生存率仅29%[3]。研究显示，胰腺癌的周围神经浸润是根治性手术后复发率较高的主要原因之一，但其神经浸润的具体发生机制至今尚未完全明了。

随着人们生活水平的提高及生活方式和饮食结构的变化,糖尿病的发病率也逐年上升。因此，人们越来越关注二者之间的相关性。目前，关于糖尿病与胰腺癌的关系尚存在两种观点[4]。一种观点认为,糖尿病患者胰腺癌的发病率较无糖尿病患者明显增加,糖尿病可能是胰腺癌的危险因素之一[5]。另一种观点认为,糖尿病可能是胰腺癌的首发症状,是胰腺癌所引起的后果之一[6]。在胰腺癌患者同时存在血糖升高时，高血糖可对胰腺神经产生怎样的影响，这种影响是否可影响患者临床表现的变化，以及治疗的情况，国内外尚未见报道。为进一步明确糖尿病与胰腺癌的关系，本文对胰腺癌患者进行病例对照研究，分析二者之间流行病学关系,探讨糖尿病是否对胰腺癌神经产生