内科理论与实践 ›› 2022, Vol. 17 ›› Issue (06): 435-440.doi: 10.16138/j.1673-6087.2022.06.003
缪雅1, 刘丽丽2, 侯田志超1, 严青华2, 庞怡2, 吴春晓2, 程旻娜2, 施燕2, 黎衍云2(), 田景琰1()
收稿日期:
2022-11-14
出版日期:
2022-12-30
发布日期:
2023-02-27
通讯作者:
黎衍云 E-mail: 基金资助:
MIAO Ya1, LIU Lili2, HOU Tianzhichao1, YAN Qinghua2, PANG Yi2, WU Chunxiao2, CHENG Minna2, SHI Yan2, LI Yanyun2(), TIAN Jingyan1()
Received:
2022-11-14
Online:
2022-12-30
Published:
2023-02-27
摘要:
目的:探讨糖尿病前期患者全因肿瘤及特定部位肿瘤发病风险。方法:对2011年至2018年期间新诊断且纳入上海市社区糖尿病管理信息系统(Shanghai Standardized Diabetes Management System,SSDMS)31 568例20岁及以上的糖尿病前期患者,采用身份证号码作为唯一标识符,与上海市恶性肿瘤登记系统进行数据链接。获取其恶性肿瘤发病情况,计算不同性别、年龄的糖尿病前期患者全因及前10位恶性肿瘤发病率、标准化发病率及标准化发病率比(standard incidence ratio,SIR)。结果:糖尿病前期人群全因肿瘤发病率为868.1/10万人年,男性、女性分别为1 099.48/10万人年和729.19/10万人年;标化发病率为567.49/10万人年,男性、女性分别为512.15/10万人年和597.91/10万人年。全因肿瘤SIR为0.97,男性、女性均为0.99。糖尿病前期患者全因肿瘤相对发病风险随年龄上升呈逐渐下降趋势,20~49、50~59、60~69、70~79以及≥80岁组糖尿病前期人群SIR分别为3.04、1.21、1.00、0.92和 0.66。其中20~49岁和50~59岁组糖尿病前期人群甲状腺癌的发病风险分别是同年龄总人群的4.85和1.86倍,女性20~49岁和50~59岁组糖尿病前期人群分别是同性别、年龄总人群的4.46和1.53倍。50岁以下组男性糖尿病前期人群膀胱癌和肾癌风险分别是同性别、年龄总人群的36.34和 13.49倍。60~69岁组男性糖尿病前期前列腺癌的风险是同性别、年龄总人群的2.66倍。结论:糖尿病前期人群全因肿瘤发病风险与全人群相比未见明显升高,全因肿瘤及特定部位肿瘤相对发病风险随年龄上升呈逐渐下降趋势。应加强对特定性别和特定年龄人群特定癌种的筛查。对于80岁以上新发糖尿病前期者,建议重新评估疾病诊断及预后的风险。
中图分类号:
缪雅, 刘丽丽, 侯田志超, 严青华, 庞怡, 吴春晓, 程旻娜, 施燕, 黎衍云, 田景琰. 上海糖尿病前期人群恶性肿瘤发病风险分析[J]. 内科理论与实践, 2022, 17(06): 435-440.
MIAO Ya, LIU Lili, HOU Tianzhichao, YAN Qinghua, PANG Yi, WU Chunxiao, CHENG Minna, SHI Yan, LI Yanyun, TIAN Jingyan. Risk analysis of malignant tumor incidence in pre-diabetes patients in Shanghai[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(06): 435-440.
表1
不同年度纳入队列的糖尿病前期患者基本情况[$\bar{x}±s$/n(%)]
年度 | 随访时间(年) | 年龄(岁) | 男性[n(%)] | 女性[n(%)] | 合计[n(%)] |
---|---|---|---|---|---|
2011 | 7.27±1.22 | 65.15±10.56 | 1 309(36.95) | 2 234(63.05) | 3 543(11.22) |
2012 | 6.31±1.03 | 65.94±10.10 | 2 226(38.34) | 3 580(61.66) | 5 806(18.39) |
2013 | 5.41±0.79 | 65.65±9.56 | 1 865(36.37) | 3 263(63.63) | 5 128(16.24) |
2014 | 4.40±0.65 | 65.98±9.60 | 1 854(38.54) | 2 956(61.46) | 4 810(15.24) |
2015 | 3.51±0.46 | 66.68±9.63 | 1 502(38.76) | 2 373(61.24) | 3 875(12.28) |
2016 | 2.36±0.28 | 64.28±9.74 | 1 587(40.08) | 2 373(59.92) | 3 960(12.54) |
2017 | 1.51±0.27 | 65.76±9.65 | 954(41.37) | 1 352(58.63) | 2 306(7.30) |
2018 | 0.54±0.16 | 67.18±9.35 | 911(42.57) | 1 229(57.43) | 2 140(6.78) |
合计 | 4.39±2.22 | 65.76±9.83 | 12 208(38.67) | 19 360(61.33) | 31 568(100.00) |
F/χ2 | 31 554.2 | 26.86 | 40.31 | ||
P | <0.000 1 | <0.000 1 | <0.000 1 |
表2
糖尿病前期人群全因肿瘤及前10位肿瘤发病率、ASR及SIR
瘤别 | 发病例数(n) | 发病率(/10万人年) | ASR(/10万人年) | SIR(95%CI) |
---|---|---|---|---|
合计 | ||||
全因肿瘤 | 1 206 | 868.10 | 567.49 | 0.97(0.91~1.02) |
肺癌 | 213 | 151.27 | 53.71 | 0.81(0.70~0.92) |
结直肠癌 | 155 | 110.06 | 51.74 | 0.85(0.72~0.98) |
胃癌 | 121 | 85.84 | 44.70 | 0.97(0.80~1.15) |
乳腺癌 | 105 | 74.54 | 63.78 | 1.30(1.05~1.55) |
甲状腺癌 | 78 | 55.34 | 180.49 | 1.42(1.10~1.74) |
肝癌 | 68 | 48.21 | 13.68 | 0.89(0.68~1.10) |
胰腺癌 | 55 | 38.98 | 11.50 | 0.97(0.72~1.23) |
膀胱癌 | 30 | 21.26 | 24.01 | 0.88(0.57~1.20) |
中枢神经系统肿瘤 | 16 | 11.34 | 3.40 | 0.52(0.27~0.78) |
肾癌 | 25 | 17.72 | 24.34 | 0.89(0.54~1.24) |
男性 | ||||
全因肿瘤 | 573 | 1 099.48 | 512.15 | 0.99(0.91~1.07) |
肺癌 | 110 | 207.72 | 57.32 | 0.76(0.62~0.90) |
结直肠癌 | 83 | 156.79 | 50.19 | 0.98(0.77~1.19) |
前列腺癌 | 84 | 158.73 | 38.95 | 1.53(1.20~1.86) |
胃癌 | 73 | 137.70 | 44.25 | 1.06(0.82~1.31) |
肝癌 | 42 | 79.17 | 22.11 | 1.00(0.70~1.30) |
胰腺癌 | 26 | 48.96 | 14.26 | 1.03(0.63~1.42) |
膀胱癌 | 24 | 45.22 | 60.79 | 1.07(0.64~1.49) |
甲状腺癌 | 11 | 20.72 | 81.86 | 1.17(0.48~1.86) |
肾癌 | 14 | 26.37 | 57.93 | 0.96(0.46~1.46) |
淋巴癌 | 17 | 32.02 | 8.62 | 1.41(0.74~2.08) |
女性 | ||||
全因肿瘤 | 633 | 729.19 | 597.91 | 0.99(0.91~1.06) |
乳腺癌 | 105 | 119.65 | 101.03 | 1.07(0.87~1.28) |
肺癌 | 103 | 117.24 | 51.09 | 1.00(0.81~1.20) |
结直肠癌 | 72 | 81.92 | 53.79 | 0.78(0.60~0.96) |
甲状腺癌 | 67 | 76.26 | 239.11 | 1.25(0.95~1.55) |
胃癌 | 48 | 54.57 | 45.88 | 1.01(0.73~1.30) |
胰腺癌 | 29 | 32.95 | 9.93 | 0.98(0.62~1.34) |
肝癌 | 26 | 29.54 | 8.65 | 0.94(0.58~1.30) |
中枢神经系统肿瘤 | 12 | 13.64 | 4.42 | 0.56(0.25~0.88) |
胆囊癌 | 25 | 28.41 | 7.85 | 1.21(0.73~1.68) |
子宫体癌 | 13 | 14.57 | 19.87 | 0.89(0.41~1.38) |
表3
糖尿病前期患者不同诊断年龄全因及前10位肿瘤SIR(95%CI)
瘤别 | 20~49 岁 | 50~59 岁 | 60~69 岁 | 70~79 岁 | ≥80 岁 |
---|---|---|---|---|---|
合计 | |||||
全因肿瘤 | 3.04(1.99~4.09) | 1.21(1.04~1.38) | 1.00(0.91~1.09) | 0.92(0.83~1.00) | 0.66(0.54~0.78) |
肺癌 | 1.29(0.04~7.17) | 0.82(0.49~1.16) | 1.03(0.83~1.23) | 0.68(0.52~0.84) | 0.59(0.35~0.83) |
结直肠癌 | 3.38(0.41~12.19) | 1.26(0.75~1.78) | 0.78(0.56~0.99) | 0.98(0.74~1.21) | 0.39(0.16~0.62) |
胃癌 | 4.45(0.53~16.05) | 1.42(0.76~2.07) | 1.08(0.77~1.39) | 0.91(0.64~1.18) | 0.54(0.22~0.86) |
乳腺癌 | 2.83(0.06~5.59) | 1.56(1.00~2.12) | 1.04(0.70~1.38) | 1.31(0.80~1.81) | 1.56(0.54~2.57) |
甲状腺癌 | 4.85(2.55~7.16) | 1.86(1.25~2.46) | 0.68(0.36~1.00) | 1.14(0.29~1.98) | 1.17(0.04~6.54) |
肝癌 | 0.65(0.17~1.13) | 0.86(0.51~1.21) | 0.92(0.55~1.29) | 1.12(0.53~1.71) | |
胰腺癌 | 1.54(0.40~2.68) | 1.07(0.59~1.55) | 1.06(0.63~1.48) | 0.44(0.05~0.82) | |
膀胱癌 | 22.02(2.64~79.48) | 0.66(0.08~2.40) | 0.95(0.36~1.54) | 0.96(0.44~1.48) | 0.44(0.09~1.28) |
中枢神经系统肿瘤 | 0.41(0.05~1.47) | 0.57(0.15~1.00) | 0.43(0.01~0.84) | 0.79(0.16~2.31) | |
肾癌 | 7.00(0.84~25.26) | 1.29(0.26~2.32) | 0.55(0.14~0.96) | 1.00(0.31~1.69) | 0.80(0.10~2.88) |
男性 | |||||
全因肿瘤 | 2.87(0.88~4.86) | 1.18(0.87~1.48) | 1.13(0.98~1.28) | 0.95(0.82~1.08) | 0.64(0.48~0.80) |
肺癌 | 0.75(0.23~1.26) | 0.99(0.71~1.27) | 0.67(0.46~0.88) | 0.53(0.24~0.82) | |
结直肠癌 | 2.00(0.91~3.09) | 0.95(0.61~1.30) | 1.07(0.71~1.42) | 0.36(0.04~0.67) | |
前列腺癌 | 2.16(0.26~7.79) | 2.66(1.79~3.53) | 1.23(0.82~1.64) | 0.92(0.38~1.47) | |
胃癌 | 2.08(0.85~3.32) | 1.28(0.83~1.73) | 0.84(0.50~1.19) | 0.69(0.21~1.16) | |
肝癌 | 0.74(0.01~1.46) | 0.84(0.38~1.29) | 1.42(0.80~2.04) | 0.74(0.09~1.39) | |
胰腺癌 | 1.67(0.35~4.89) | 0.95(0.29~1.60) | 1.17(0.51~1.84) | 0.62(0.13~1.82) | |
膀胱癌 | 36.34(4.36~131.18) | 1.35(0.16~4.86) | 1.05(0.27~1.82) | 1.19(0.49~1.90) | 0.40(0.05~1.43) |
甲状腺癌 | 3.99(0.82~11.67) | 1.49(0.03~2.95) | 0.45(0.05~1.61) | 1.55(0.19~5.59) | |
肾癌 | 13.49(1.62~48.69) | 1.52(0.31~4.46) | 0.75(0.09~1.41) | 0.67(0.14~1.96) | 0.71(0.02~3.98) |
淋巴癌 | 0.92(0.03~5.14) | 1.83(0.56~3.09) | 1.48(0.38~2.58) | 0.56(0.02~3.14) | |
女性 | |||||
全因肿瘤 | 2.81(1.69~3.94) | 1.21(1.01~1.41) | 0.95(0.83~1.08) | 0.95(0.81~1.08) | 0.68(0.51~0.86) |
乳腺癌 | 2.26(0.05~4.47) | 1.13(0.72~1.53) | 0.86(0.58~1.14) | 1.18(0.73~1.63) | 1.61(0.56~2.67) |
肺癌 | 1.84(0.06~10.24) | 1.03(0.51~1.56) | 1.26(0.91~1.61) | 0.82(0.52~1.12) | 0.69(0.26~1.11) |
结直肠癌 | 6.10(0.73~22.02) | 0.95(0.36~1.54) | 0.67(0.39~0.96) | 0.94(0.61~1.26) | 0.42(0.08~0.75) |
甲状腺癌 | 4.46(2.13~6.80) | 1.53(1.00~2.06) | 0.64(0.31~0.96) | 0.95(0.12~1.79) | 1.58(0.05~8.82) |
胃癌 | 6.79(0.81~24.52) | 1.24(0.32~ 2.17) | 1.06(0.54~1.59) | 1.14(0.64~1.63) | 0.34(0.07~0.99) |
胰腺癌 | 1.80(0.04~3.56) | 1.30(0.53~2.08) | 0.98(0.43~1.54) | 0.30(0.04~1.09) | |
肝癌 | 1.13(0.23~3.32) | 1.22(0.46~1.97) | 0.37(0.01~0.72) | 1.56(0.54~2.57) | |
中枢神经系统肿瘤 | 0.49(0.06~1.77) | 0.80(0.21~1.39) | 1.28(0.26~3.75) | ||
胆囊癌 | 1.33(0.16~4.82) | 1.36(0.42~2.31) | 1.29(0.53~2.05) | 0.84(0.02~1.66) | |
子宫体癌 | 5.57(0.17~31.00) | 0.88(0.02~1.75) | 0.64(0.01~1.27) | 1.00(0.21~2.92) | 1.54(0.05~8.60) |
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