李 勇 潘绵顺 邱书珺 王 鹏 邵显军 张 丽
【摘要】 目的 探讨胰腺癌合并糖尿病患者放疗后血糖变化情况及相关因素。 方法 回顾性分析了I~III期胰腺癌合并糖尿病患者69例，根据糖尿病病程长短分为四组，分析各组的临床特征及经过立体定向放疗以后各组患者血糖变化的情况，并探讨血糖与肿瘤标志物变化的相关性。 结果 各组患者临床特点无统计学差异。糖尿病程在12个月以内的胰腺癌患者所占比例达39.1%，远高于其它组；且糖尿病病程越长，胰腺癌比例越低。胰腺癌经有效治疗后，糖尿病病程在12个月以内与12~24个月的患者相比，血糖的改善无统计学意义（P=0.519），而与病程在24~36个月及36个月以上的患者相比，血糖的改善差异有统计学意义（P值分别为0.021和0.001）。对于糖尿病病程在24个月以内的胰腺癌患者，经有效治疗后随着肿瘤标志物的降低，血糖亦有相应的改善；而对糖尿病病程在24个月以上的患者，肿瘤经有效治疗后血糖改善率远低于肿瘤标志物的降低率，差异有统计学意义（P<0.05）。 结论 糖尿病病程在24个月以内的胰腺癌患者的高血糖可能是继发于胰腺癌的一种临床表现，因此，对于新发糖尿病患者需要密切随访以早期发现胰腺癌。
Analysis of blood glucose change after radiotherapy in pancreatic cancer patients with diabetes mellitus and related factors LI Yong，PAN Mian-shun，QIU Shu-jun，WANG Peng，SHAO Xian-jun，ZHANG Li. Shanghai center of Radiation Oncology，Chinese People’s armed police Forces，Shanghai, 201103,China
Corresponding author: PAN Mian-shun
【Abstract】 Objective To investigate the changes of blood glucose in pancreatic cancer patients with diabetes mellitus(DM) after radiotherapy and analyse the related factors. Methods Retrospectively analysis on 69 cases of I～III stage of pancreatic carcinoma with DM. All patients were divided into four groups according to the history of DM, each groups’ clinical characters and the blood glucose changes after stereotactic radiotherapy were analyzed. The correlation between blood glucose and serum tumor markers were analyzed at last. Result No significant differences were found in clinical characteristics of each groups. The history of DM within 12 months accounted for 39.1% in all pancreatic cancer patients, more higher than other groups, and the incidence of pancreatic cancer reduced with prolonged history of DM. After radiotherapy, the blood glucose changes were no significant differences between groups of DM history within 12 months and DM history at 12～24 months（P=0.519）. But there were significant differences when patients of DM history within 12 months compared with DM history at 24～36 months and more than 36 months（ P= 0.021 and 0.001 respectively）. The value of blood glucose as well as tumor markers decreased for pancreatic cancer patients with history of DM within 24 months after effective treatment. In pancreatic cancer patients with DM history for more than 24 months, after radiotherapy, the rate of blood glucose improvement is far lower than the tumor markers and the difference was statistically significant（P<0.05）. Conclusion Hyperglycemia associated with pancreatic cancer is a kind of secondary diabetes and may be one clinical manifestation of pancreatic cancer. It is always be found within 24 months before the diagnose of pancreatic cancer. Therefore, for patients with new onset diabetes need close follow-up to the early detection of pancreatic cancer.