Diabetes mellitus: a risk factor for pancreatic cancer?
Diabetes mellitus: a risk factor for pancreatic cancer?
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DOI：
10.1007/s00423-004-0469-8
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发表时间：
2005-02-01
影响因子：
2.3
通讯作者：
Pour, PM
中科院分区：
文献类型：
--
作者：
Yalniz, M;Pour, PM
胰腺癌（PC）和糖尿病之间的关系存在争议。虽然一些研究人员认为11型糖尿病是PC的易感因素，但最近的数据表明，糖尿病和葡萄糖代谢改变是PC的结果，然而，这些患者葡萄糖代谢改变的临床表现差异很大。约70%的PC患者有糖耐量受损（IGT）或明显的糖尿病。其中，近60%的IGT或糖尿病患者在手术后得到改善，而其余患者仅表现出轻微或无改善。从生物学上看，PC有三种类型：（1）与IGT或糖尿病无关的PC;（2）与IGT或糖尿病相关的PC，术后异常改善;（3）与IGT或糖尿病相关的PC，术后异常未改善。根据我们自己的研究，我们认为大多数患者糖代谢受损的原因是致癌物直接或癌细胞释放的致糖尿病物质改变了胰岛细胞。胰岛改变的程度（即局灶性或弥漫性）可以决定单独切除肿瘤是否可以改善代谢改变。阐明该机制对于提供早期肿瘤标志物和开发预防或治疗方式具有极其重要的意义。
The relationship between pancreatic cancer (PC) and diabetes is controversial. While some investigators assume that type 11 diabetes is a predisposition to PC, recent data argue that diabetes and altered glucose metabolism are a consequence of PC, and yet, the clinical presentation of the altered glucose metabolism in these patients varies considerably. Around 70% of patients with PC have impaired glucose tolerance (IGT) or frank diabetes. Of these, nearly 60% show an improvement of IGT or diabetes after surgery, whereas the rest show only mild or no improvement. It appears that biologically there are three types of PC: (1) PC not associated with IGT or diabetes; (2) PC associated with IGT or diabetes in which the abnormality improves postoperatively; (3) PC associated with IGT or diabetes in which the abnormality does not improve postoperatively. Based on our own studies, we suggest that the reason for impaired glucose metabolism in most patients is the alteration of islet cells either by the carcinogen directly, or by diabetogenic substances released by cancer cells. The extent of the islet alteration (i.e. focal or diffuse) may determine whether the removal of tumor alone can improve the metabolic alteration. The elucidation of the mechanism is of immense importance for providing an early tumor marker and for developing preventative or therapeutic modalities.