2型糖尿病患者抗糖尿病治疗后CA19-9水平的变化及相关影响因素-动脉网

Changes of CA19-9 levels and related influencing factors in patients with type 2 diabetes mellitus after antidiabetic therapy

Nature 等信源发布 2025-01-08 18:54



可切换为仅中文







Abstract

摘要

Abnormalities of carbohydrate antigen 19 − 9 (CA19-9) are common in patients with type 2 diabetes mellitus (T2DM), and in some patients, CA19-9 returns to normal level after glycemic control. The aim of this study was to investigate the factors associated with CA19-9 levels in patients with T2DM and the associated influences on the degree of reduction of CA19-9 levels after antidiabetic therapy (AT).

碳水化合物抗原19-9（CA19-9）异常在2型糖尿病（T2DM）患者中很常见，在一些患者中，血糖控制后CA19-9恢复正常水平。本研究的目的是调查与T2DM患者CA19-9水平相关的因素以及抗糖尿病治疗（AT）后CA19-9水平降低程度的相关影响。

This study was an observational cross-sectional study. A total of 213 patients with T2DM were enrolled in this study, of whom 105 with abnormal CA19-9 and 108 with normal CA19-9. Socio-demographic information, complete blood counts, biochemical indicators, thyroid function indicators, and CA19-9 level were collected separately for each subject.

这项研究是一项观察性横断面研究。本研究共纳入213例T2DM患者，其中105例CA19-9异常，108例CA19-9正常。分别收集每个受试者的社会人口统计学信息，全血细胞计数，生化指标，甲状腺功能指标和CA19-9水平。

Levels of glycosylated hemoglobin, type A1C (.

糖化血红蛋白水平，A1C型（。

HbA1c

糖化血红蛋白

), fasting blood glucose (FBG) were significantly higher in T2DM patients with abnormal CA19-9 compared to patients with normal CA19-9 (both FDR < 0.001). CA19-9 level was significantly and positively correlated with neutrophil/lymphocyte ratio (NLR) (

)，CA19-9异常的T2DM患者的空腹血糖（FBG）显着高于CA19-9正常的患者（FDR均<0.001）。CA19-9水平与中性粒细胞/淋巴细胞比率（NLR）显着正相关(

= 0.16,

=0.16,

= 0.02), monocyte/lymphocyte ratio (MLR) (

=0.02），单核细胞/淋巴细胞比率（MLR）(

= 0.16,

=0.16,

= 0.02), and FBG (

=0.02），和FBG(

= 0.38,

=0.38,

< 0.001), while significantly and negatively correlated with free triiodothyronine (FT3) (

<0.001），而与游离三碘甲状腺原氨酸（FT3）呈显著负相关(

=-0.22,

= 0.002) and albumin count (

=0.002）和白蛋白计数(

=-0.18,

= 0.007). After AT, the degree of decrease in CA19-9 level in T2DM patients with abnormal CA19-9 was significantly positively correlated with degree of decrease in FBG (

=0.007）。AT后，CA19-9异常的T2DM患者的CA19-9水平下降程度与FBG下降程度显着正相关(

= 0.33,

=0.33,

< 0.001), as well as CA19-9 level before AT (

<0.001），以及AT之前的CA19-9水平(

= 0.73,

== 0.73,

< 0.001), NLR (

<0.001），NLR(

= 0.20,

== 0.20,

= 0.04), and MLR (

==0.04）和MLR(

= 0.25,

=0.25,

= 0.01). In this study, we investigated the influencing factors associated with CA19-9 level and the factors influencing degree of CA19-9 reduction after AT in T2DM patients with abnormal CA19-9.

= 0.01）。本研究调查了CA19-9异常的T2DM患者AT后CA19-9水平的影响因素以及影响CA19-9降低程度的因素。

Introduction

简介

Diabetes mellitus is a common disease worldwide, with a global prevalence of about 10%, and is on the rise

糖尿病是世界范围内的常见疾病，全球患病率约为10%，并且呈上升趋势

. Diabetes is a metabolic disease characterized by hyperglycemia due to insufficient insulin secretion or inadequate insulin function, and type 2 diabetes mellitus (T2DM) is the most common type of diabetes, accounting for more than 90% of all diabetes

糖尿病是一种代谢性疾病，其特征是由于胰岛素分泌不足或胰岛素功能不足而导致高血糖，而2型糖尿病（T2DM）是最常见的糖尿病类型，占所有糖尿病的90%以上

. The health hazards caused by diabetes are not limited to diabetes itself, but are also related to its complications, such as various cardiovascular diseases, diabetic neuropathy, nephropathy, and retinopathy

糖尿病对健康的危害不仅限于糖尿病本身，还与其并发症有关，如各种心血管疾病、糖尿病神经病变、肾病和视网膜病变

. Diabetes mellitus and its complications seriously affect the lives of patients and impose a heavy economic burden on both patients and society. According to statistics, the global medical cost of diabetes and its related complications is currently close to 1 trillion dollars

糖尿病及其并发症严重影响患者的生活，给患者和社会带来沉重的经济负担。据统计，目前全球糖尿病及其相关并发症的医疗费用接近1万亿美元

The results of many previous studies suggest a possible correlation between T2DM and the risk of malignant tumors, with patients with T2DM having a significantly higher risk of developing malignant tumors than the healthy population

先前许多研究的结果表明，T2DM与恶性肿瘤的风险之间可能存在相关性，T2DM患者患恶性肿瘤的风险明显高于健康人群

. For example, the findings of Kort et al. revealed that diabetes is an independent risk factor for colorectal cancer (CRC), and that the risk of CRC in patients with T2DM is approximately 1.30 times higher than that of the healthy population

例如，Kort等人的研究结果表明，糖尿病是结直肠癌（CRC）的独立危险因素，T2DM患者患CRC的风险约为健康人群的1.30倍

. In addition, a meta-analysis by Pisani found that chronic hyperglycemic status was associated with a high incidence of colorectal and pancreatic cancer

此外，Pisani的一项荟萃分析发现，慢性高血糖状态与结直肠癌和胰腺癌的高发病率有关

. However, the argument that diabetes is a risk factor for malignant tumors has not been strongly substantiated, and in fact, many malignant tumors may, in turn, lead to insulin secretion or insufficient function, which can lead to diabetes

然而，糖尿病是恶性肿瘤的危险因素的论点尚未得到有力证实，事实上，许多恶性肿瘤可能反过来导致胰岛素分泌或功能不足，从而导致糖尿病

. The unreliability of this correlation between diabetes and malignancy has likewise been exposed by the results of some studies, such as the meta-analysis by Tsilidis et al. which showed that only a few associations between diabetes and malignancy were unbiased

一些研究的结果同样暴露了糖尿病与恶性肿瘤之间这种相关性的不可靠性，例如Tsilidis等人的荟萃分析。该研究表明，糖尿病与恶性肿瘤之间只有少数关联是无偏见的

. The correlation and causation between diabetes and malignancy remains inconclusive.

糖尿病与恶性肿瘤之间的相关性和因果关系尚无定论。

Although we cannot establish a specific link between diabetes and malignancy, it is an indisputable fact that abnormally elevated levels of tumor markers are common in patients with T2DM in clinical practice. Carbohydrate antigens are commonly used clinical tumor markers, and although they cannot be used as a diagnostic criterion for malignant tumors, they have been used as a widely used screening indicator for malignant tumors because of their relatively high specificity, low price, and simplicity.

尽管我们无法在糖尿病和恶性肿瘤之间建立特定的联系，但不争的事实是，在临床实践中，T2DM患者的肿瘤标志物水平异常升高很常见。碳水化合物抗原是常用的临床肿瘤标志物，尽管它们不能用作恶性肿瘤的诊断标准，但由于其相对较高的特异性，较低的价格和简单性，它们已被广泛用作恶性肿瘤的筛查指标。

. Carbohydrate antigen 19 − 9 (CA19-9) is used to screen for a variety of malignancies, and abnormally elevated CA19-9 levels are more common in tumor-free T2DM patients than in tumor-free healthy populations, and in many patients with T2DM, CA19-9 levels decrease significantly with decreasing blood glucose.

碳水化合物抗原19-9（CA19-9）用于筛查多种恶性肿瘤，无肿瘤T2DM患者的CA19-9水平异常升高比无肿瘤健康人群更常见，在许多T2DM患者中，CA19-9水平随着血糖降低而显着降低。

However, more studies are needed to investigate the extent of reduction in CA-199 levels after antidiabetic therapy (AT) in patients with T2DM and its associated factors. The aim of this study was to investigate the risk factors associated with abnormally elevated CA-199 levels in patients with T2DM, the proportion of patients whose CA-199 levels decreased to normal levels after AT, and the factors influencing the degree of decrease in CA-199 levels..

然而，需要更多的研究来调查T2DM患者抗糖尿病治疗（AT）后CA-199水平降低的程度及其相关因素。本研究的目的是调查与T2DM患者CA-199水平异常升高相关的危险因素，AT后CA-199水平降至正常水平的患者比例，以及影响CA-199水平下降程度的因素。。

Methods

方法

Study design and participants

研究设计和参与者

The authors affirmed that all operations and reports involving human participants in this study were consistent with the declaration of Helsinki, as amended by the World Medical Association in 2013.

作者确认，本研究中涉及人类参与者的所有操作和报告均符合2013年世界医学协会修订的《赫尔辛基宣言》。

This study was a retrospective cross-sectional study. From all inpatients with T2DM hospitalized in Zhejiang Xiaoshan Hospital from January 2014 to December 2023, those with abnormal CA19-9 levels at the time of admission were screened and included in this study as the experimental group (EG). And those with normal CA19-9 levels on admission were randomly screened from hospitalized patients with T2DM in the last 1 year as control group (CG)..

这项研究是一项回顾性横断面研究。从2014年1月至2023年12月在浙江萧山医院住院的所有T2DM住院患者中，筛选入院时CA19-9水平异常的患者作为实验组（EG）。从过去1年住院的T2DM患者中随机筛选入院时CA19-9水平正常的患者作为对照组（CG）。。

The inclusion criteria for EG in this study were: (1) diagnosis of T2DM; (2) fasting blood glucose (FBG) > 6.1 mmol/L at admission; and (3) CA19-9 > 37.0 U/mL at admission. The inclusion criteria for CG were the same as EG, except that the third inclusion criterion was changed to: CA19-9 ≤ 37 U/mL at admission.

本研究中EG的纳入标准为：（1）T2DM的诊断；（2）入院时空腹血糖（FBG）＞6.1 mmol/L；（3）入院时CA19-9＞37.0 U/mL。CG的纳入标准与EG相同，只是第三个纳入标准改为：入院时CA19-9≤37 U/mL。

Exclusion criteria for EG and CG were: (1) diagnosis of malignant or benign tumors or abnormal elevation of any of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), or recombinant cytokeratin fragment antigen 21 − 1 (CYFRA21-1); (2) history of acute infection or administration of antimicrobial drugs in the month prior to admission and during hospitalization; (3) diagnosed with autoimmune diseases or had taken immunomodulatory drugs one month before or during hospitalization; and (4) diagnosed with any organ dysfunction..

EG和CG的排除标准是：（1）诊断恶性或良性肿瘤或甲胎蛋白（AFP），癌胚抗原（CEA）或重组细胞角蛋白片段抗原21-1（CYFRA21-1）异常升高；（2）入院前一个月和住院期间有急性感染史或服用抗菌药物史；（3）在住院前或住院期间一个月被诊断患有自身免疫性疾病或服用过免疫调节药物；（4）被诊断患有任何器官功能障碍。。

Collection of socio-demographic information and detection of clinical biochemical indicators and tumor markers

收集社会人口统计学信息并检测临床生化指标和肿瘤标志物

Information on gender, age, body mass index (BMI), education level, duration of T2DM, comorbidities, history of hypertension, history of smoking, and history of alcohol consumption was collected from each subject. In addition, each subject’s complete blood counts, biochemical indicators, thyroid function indicators, and CA19-9 at the time of admission and after AT were collected, respectively, including counts of white blood cell, neutrophil, lymphocyte, monocytes, eosinophil, basophil, red blood cell, hemoglobin, platelet, albumin, and levels of triiodothyronine (T3), tetraiodothyronine (T4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), anti-thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb), serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), FBG, and CA19-9.

从每个受试者中收集有关性别，年龄，体重指数（BMI），教育程度，T2DM持续时间，合并症，高血压病史，吸烟史和饮酒史的信息。此外，分别收集每个受试者入院时和at后的全血细胞计数，生化指标，甲状腺功能指标和CA19-9，包括白细胞，中性粒细胞，淋巴细胞，单核细胞，嗜酸性粒细胞，嗜碱性粒细胞，红细胞，血红蛋白，血小板，白蛋白以及三碘甲状腺原氨酸（T3），四碘甲状腺原氨酸（T4），游离三碘甲状腺原氨酸（FT3），游离甲状腺素（FT4），促甲状腺激素（TSH），抗甲状腺球蛋白抗体（TGAb）和甲状腺过氧化物酶抗体（TPOAb），血清总胆固醇（TC），甘油三酯（TG），低水平密度脂蛋白胆固醇（LDL-C），高密度脂蛋白胆固醇（HDL-C），FBG和CA19-9。

As for glycosylated hemoglobin, type A1C (HbA1c), since the interval between pre- and post-treatment was only about one week, we only collected HbA1c levels at the time of admission for each subject. Furthermore, since neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) are commonly used inflammatory markers and are used as biomarkers for a variety of diseases.

至于糖化血红蛋白A1C（HbA1c），由于治疗前后的间隔仅为一周左右，因此我们仅在每个受试者入院时收集HbA1c水平。此外，由于中性粒细胞/淋巴细胞比率（NLR），血小板/淋巴细胞比率（PLR）和单核细胞/淋巴细胞比率（MLR）是常用的炎症标志物，并被用作多种疾病的生物标志物。

, we also calculated NLR, PLR, and MLR separately for each subject. Blood samples were collected from fasting inter-elbow blood before 7 am. In this study, the critical value for CA19-9 abnormality was 37.0 U/mL

，我们还分别计算了每个主题的NLR，PLR和MLR。早上7点之前从空腹肘间血液中采集血样。在这项研究中，CA19-9异常的临界值为37.0 U/mL

Statistical analysis

统计分析

Multiple Imputation was used to impute missing values (imputations:20; imputation method: fully conditional specification (MCMC); maximum iterations:50; model type for scale variables: predictive mean matching (PMM)). Kolmogorov-Smirnov was used to test normality of continuous variables. Paired-Samples T Test or Independent-Samples T Test was used for continuous variables conforming to normal distribution, and Mann-Whitney U Test or Wilcoxon Test was used for continuous variables not conforming to normal distribution or rank variables.

多重插补用于插补缺失值（插补：20；插补方法：完全条件规范（MCMC）；最大迭代次数：50次；尺度变量的模型类型：预测平均匹配（PMM））。Kolmogorov-Smirnov用于测试连续变量的正态性。配对样本T检验或独立样本T检验用于符合正态分布的连续变量，Mann-Whitney U检验或Wilcoxon检验用于不符合正态分布或秩变量的连续变量。

Pearson and Spearman correlation analyses were used for exploring correlations between continuous variables and between continuous variables and categorical variables, respectively. To further explore the correlation, multiple linear regression analysis was performed on top of the correlation analysis.

Pearson和Spearman相关分析分别用于探索连续变量之间以及连续变量和分类变量之间的相关性。为了进一步探索相关性，在相关性分析的基础上进行了多元线性回归分析。

To control for false positive rates, P values from difference analysis were corrected by False Discovery Rate (FDR) correction. All statistical analyses for this study were completed on SPSS 25.0..

为了控制假阳性率，通过错误发现率（FDR）校正来校正差异分析的P值。本研究的所有统计分析均在SPSS 25.0上完成。。

Results

结果

The differences of social demographic information, blood routine indexes and biochemical indexes between EG and CG

EG和CG的社会人口统计学信息，血常规指标和生化指标的差异

In this study, the percentage of missing values in data used for statistical analysis was 2.9% in EG and no missing values in CG. As shown in Table

在这项研究中，用于统计分析的数据中缺失值的百分比在EG中为2.9%，在CG中没有缺失值。如表所示

, a total of 213 eligible subjects were recruited in this study, including 105 subjects in EG and 108 subjects in CG. There were 72 males and 33 females in EG and 81 males and 27 females in CG. The prevalence of hypertension was 41.9% (44/105) and 36.1% (39/108), rate of cigarette smoking was 42.9% (45/105) and 40.7% (44/108), rate of alcohol drinking was 24.8% (26/105) and 25.0% (27/108), in EG and CG, respectively.

，本研究共招募了213名符合条件的受试者，包括EG中的105名受试者和CG中的108名受试者。EG中有72名男性和33名女性，CG中有81名男性和27名女性。EG和CG的高血压患病率分别为41.9%（44/105）和36.1%（39/108），吸烟率分别为42.9%（45/105）和40.7%（44/108），饮酒率分别为24.8%（26/105）和25.0%（27/108）。

The average age of EG and CG was 50.2 ± 15.5 years and 49.3 ± 13.5 years, average duration of T2DM was 3.6 ± 5.2 years and 4.8 ± 5.7 years, and average BMI was 24.1 ± 5.1 and 24.8 ± 3.9, respectively. The number of complications of T2DM was 1.8 ± 0.9 and 1.7 ± 0.9, respectively..

EG和CG的平均年龄分别为50.2±15.5岁和49.3±13.5岁，T2DM的平均病程分别为3.6±5.2岁和4.8±5.7岁，平均BMI分别为24.1±5.1和24.8±3.9，分别。T2DM并发症的数量分别为1.8±0.9和1.7±0.9，分别。。

Table 1 Social demographic information, blood routine indexes and biochemical indexes between EG and CG.

表1 EG和CG之间的社会人口统计学信息，血常规指标和生化指标。

Full size table

全尺寸表

There were no significant differences between subjects in the EG and CG groups in terms of gender, age, education, BMI, smoking, alcohol consumption, prevalence of hypertension, duration of T2DM and number of complications (all

EG组和CG组的受试者在性别、年龄、教育程度、BMI、吸烟、饮酒、高血压患病率、T2DM持续时间和并发症数量方面无显著差异（均为

> 0.05), while the counts of white blood cells, neutrophils, levels of FT4, HbA1C, and FBG in EG were significantly higher than those in CG, FT3 level in EG was significantly lower than that in CG (all

>0.05），EG的白细胞，中性粒细胞计数，FT4，HbA1C和FBG水平显着高于CG，而EG的FT3水平显着低于CG（所有

< 0.05). However, after FDR correction for P values, only HbA1C and FBG level remained significantly different between EG and CG (both FDR < 0.001).

<0.05）。然而，在FDR校正P值后，EG和CG之间只有HbA1C和FBG水平保持显着差异（FDR均为 < 0.001).

Analysis of related factors of CA19-9 levels

CA19-9水平的相关因素分析

In order to explore the related factors of CA19-9 levels in patients with T2DM, correlation analysis was conducted between CA19-9 levels and other variables. The results showed that, CA19-9 levels were positively correlated with NLR (

为了探讨2型糖尿病患者CA19-9水平的相关因素，对CA19-9水平与其他变量进行相关性分析。结果表明，CA19-9水平与NLR呈正相关(

= 0.16,

=0.16,

= 0.02), MLR (

==0.02），毫升(

= 0.16,

=0.16,

= 0.02) and FBG levels (

==0.02）和FBG水平(

= 0.38,

=0.38,

< 0.001), and were negatively correlated with FT3 levels (

<0.001），与FT3水平呈负相关(

=-0.22,

= 0.002) and albumins counts (

==0.002）和白蛋白计数(

=-0.18,

= 0.007).

== 0.007).

As shown in Table

如表所示

, further multiple linear regression analysis showed that FT3 levels had a significant negative effect on CA19-9 levels (B=-7.52, t=-2.01,

，进一步的多元线性回归分析表明，FT3水平对CA19-9水平有显着的负面影响（B=-7.52，t=-2.01，

= 0.046, VIF = 1.33), while FBG levels had a significant positive effect on CA19-9 levels (B = 1.55, t = 5.77,

=0.046，VIF=1.33），虽然FBG水平对CA19-9水平有显着的积极影响（B=1.55，t=5.77，

< 0.001, VIF = 1.51).

<0.001，VIF>1.51）。

Table 2 Related influencing factors of CA19-9 levels.

表2 CA19-9水平的相关影响因素。

Full size table

全尺寸表

Analysis of variables with significant differences before and after AT

AT前后有显著差异的变量分析

In EG, 62.9% (66/105) of subjects had normalized CA19-9 levels after AT. The results of Paired-Samples T Test showed that levels of FBG, TG, TC, LDL-C and CA19-9 in EG were significantly decreased after AT (all FDR < 0.001).

在EG中，62.9%（66/105）的受试者在AT后将CA19-9水平标准化。配对样本T检验的结果显示，AT后EG中FBG，TG，TC，LDL-C和CA19-9的水平显着降低（所有FDR < 0.001).

Analysis of related factors for the reduction of CA19-9 level after AT

AT后CA19-9水平降低的相关因素分析

To explore the factors related to degree of reduction in CA19-9 levels after AT, we performed a correlation analysis of the decrease values of CA19-9 after AT in subjects of EG. In order to investigate the factors associated with the degree of decrease in CA19-9 levels after AT, we performed a correlation analysis of the decrease values of CA19-9 levels after AT in the subjects of EG.

为了探索与AT后CA19-9水平降低程度相关的因素，我们对EG受试者AT后CA19-9的降低值进行了相关分析。为了研究与AT后CA19-9水平降低程度相关的因素，我们对EG受试者AT后CA19-9水平的降低值进行了相关分析。

The results showed that, reduction of CA19-9 levels was correlated with reduction of FBG levels (.

结果表明，CA19-9水平的降低与FBG水平的降低相关（。

= 0.33,

=0.33,

< 0.001) after AT, and CA19-9 levels (

0.001）和CA19-9水平(

= 0.73,

== 0.73,

< 0.001), NLR (

<0.001），NLR(

= 0.20,

== 0.20,

= 0.04) and MLR (

==0.04）和MLR(

= 0.25,

=0.25,

= 0.01) before AT.

=0.01）。

As shown in Table

如表所示

, results of multiple linear regression analysis showed that levels of CA19-9 before AT had a significant positive effect on decline degree of CA19-9 levels (B = 0.53, t = 9.91,

多元线性回归分析结果表明，AT前CA19-9水平对CA19-9水平下降程度有显著的正向影响（B = 0.53, t=9.91，

< 0.001, VIF = 1.09). The degree of FBG decline also had a positive effect on degree of CA19-9 decline, although the effect was not significant (B = 0.24, t = 1.74,

<0.001，VIF=1.09）。FBG下降程度对CA19-9下降程度也有积极影响，尽管效果不显着（B = 0.24, t=1.74，

= 0.09, VIF = 1.90).

＝＝0.09，VIF＝＝1.90）。

Table 3 Factors associated with the degree of decline in CA19-9 levels after antidiabetic therapy.

表3与抗糖尿病治疗后CA19-9水平下降程度相关的因素。

Full size table

全尺寸表

Discussion

讨论

In this study, a cross-sectional study was conducted to explore patients with T2DM with abnormal/normal CA199 levels. The main findings of this study were as follows: (1) patients with T2DM with abnormal CA19-9 levels had significantly higher levels of HbA1c and FBG compared to those with normal CA19-9 levels; (2) CA19-9 levels were significantly positively correlated with NLR, MLR, FBG levels and negatively correlated with FT3 levels and albumins counts; (3) among patients with T2DM with abnormal CA19-9 levels, the degree of reduction in CA19-9 levels was significantly positively correlated with the degree of reduction in FBG after AT, and CA19-9 levels, NLR, MLR before AT..

在这项研究中，进行了一项横断面研究，以探索CA199水平异常/正常的T2DM患者。这项研究的主要发现如下：（1）CA19-9水平异常的T2DM患者的HbA1c和FBG水平显着高于CA19-9水平正常的患者；（2） CA19-9水平与NLR，MLR，FBG水平显着正相关，与FT3水平和白蛋白计数呈负相关；（3）在CA19-9水平异常的T2DM患者中，CA19-9水平的降低程度与AT后FBG的降低程度以及AT前CA19-9水平，NLR，MLR显着正相关。。

Tumor markers such as carbohydrate antigens for early screening of malignant tumors have limited reference value in the general population due to their low threshold of positivity and the influence of multiple factors

肿瘤标志物，如用于早期筛查恶性肿瘤的碳水化合物抗原，由于其阳性阈值低和多种因素的影响，在一般人群中的参考价值有限

. However, because they are relatively inexpensive and easy to perform, they still have high value for use in screening for people with symptoms of malignant tumors or at high risk for malignant tumors. Although some studies have reported that diabetes increases risk of pancreatic cancer, colon cancer and other malignant tumors, a large proportion of these studies have obvious bias, so the causal relationship between diabetes and malignant tumors still needs to be further studied.

然而，由于它们相对便宜且易于操作，因此在筛查有恶性肿瘤症状或有恶性肿瘤高风险的人群方面仍具有很高的价值。虽然一些研究报道糖尿病会增加胰腺癌，结肠癌和其他恶性肿瘤的风险，但这些研究中有很大一部分存在明显的偏倚，因此糖尿病与恶性肿瘤之间的因果关系仍需要进一步研究。

. It is a fact, however, that the proportion of diabetic patients with abnormally elevated CA19-9 levels is much higher than in healthy population, even though these patients do not have malignant tumors.

然而，事实上，CA19-9水平异常升高的糖尿病患者比例远高于健康人群，即使这些患者没有恶性肿瘤。

Among the patients with T2DM recruited in this study, FBG levels were significantly higher in those with abnormal CA19-9 levels, which is also consistent with the results of some previous studies

在这项研究中招募的T2DM患者中，CA19-9水平异常的患者的FBG水平明显较高，这也与之前的一些研究结果一致

. In addition, the degree of decrease in CA19-9 levels after AT was also significantly and positively correlated with the degree of decrease in FBG levels, and all these results suggest that CA19-9 levels in patients with T2DM are closely related to FBG levels. The exact mechanism by which CA19-9 levels are elevated in patients with T2DM is currently unknown.

此外，AT后CA19-9水平的下降程度也与FBG水平的下降程度显着正相关，所有这些结果表明T2DM患者的CA19-9水平与FBG水平密切相关。目前尚不清楚T2DM患者CA19-9水平升高的确切机制。

CA19-9 is expressed in the exocrine region of the pancreas, and T2DM is associated with inflammation in the exocrine region of the pancreas, and hyperglycemia-induced pancreatic islet inflammation may be one of the reasons for elevated CA19-9 levels in patients with T2DM.

CA19-9在胰腺外分泌区表达，T2DM与胰腺外分泌区炎症有关，高血糖诱导的胰岛炎症可能是T2DM患者CA19-9水平升高的原因之一。

. In addition, decreased pancreatic β-cell function in patients with T2DM may also lead to elevated CA19-9 levels. It has been reported that hyperglycemia-induced glucotoxicity can lead to decreased pancreatic β-cell function, and the degree of elevation of serum CA19-9 levels in patients with T2DM is negatively correlated with pancreatic β-cell function.

此外，T2DM患者胰腺β细胞功能降低也可能导致CA19-9水平升高。据报道，高血糖引起的糖毒性可导致胰腺β细胞功能下降，T2DM患者血清CA19-9水平升高程度与胰腺β细胞功能呈负相关。

. Our study also found that patients with T2DM with abnormal CA19-9 levels had relatively higher counts of white blood cells and neutrophils, although this difference was no longer statistically significant after correction. Meanwhile, our results showed that CA19-9 levels were significantly and positively correlated with NLR and MLR in T2DM patients, but we believe that larger samples and more studies are needed to confirm whether this correlation between CA19-9 levels and inflammatory markers is statistically and clinically significant..

我们的研究还发现，CA19-9水平异常的T2DM患者的白细胞和中性粒细胞计数相对较高，尽管校正后这种差异不再具有统计学意义。同时，我们的研究结果显示，CA19-9水平与T2DM患者的NLR和MLR显着正相关，但我们认为需要更大的样本和更多的研究来证实CA19-9水平与炎症标志物之间的这种相关性是否具有统计学和临床意义。。

Previous studies have shown that certain antihyperglycemic agents such as metformin and certain insulins, are associated with lower CA19-9 levels and survival benefit in patients with malignancy, yet some may increase the risk of malignancy in patients with T2DM

先前的研究表明，某些抗高血糖药物（例如二甲双胍和某些胰岛素）与恶性肿瘤患者的CA19-9水平降低和生存获益相关，但有些可能会增加T2DM患者的恶性肿瘤风险

. In order to verify whether different types of antihyperglycemic agents have different effects on the degree of reduction of CA19-9 levels in patients with T2DM, we investigated the antihyperglycemic agents used in this study. Of the 105 subjects, 2 were not treated with insulin and the other 103 were all treated with insulin; in addition, depending on the needs of the condition, one or more of metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-dependent glucose transporters 2 (SGLT-2) inhibitors, alpha-glucosidase inhibitors, or thiazolidinediones (TZD) may also be included in the antihyperglycemic agents used by the subjects.

为了验证不同类型的抗高血糖药物是否对T2DM患者CA19-9水平的降低程度有不同的影响，我们研究了本研究中使用的抗高血糖药物。在105名受试者中，2名未接受胰岛素治疗，另外103名均接受胰岛素治疗；此外，根据病情的需要，一种或多种二甲双胍，二肽基肽酶-4（DPP-4）抑制剂，胰高血糖素样肽-1（GLP-1）受体激动剂，钠依赖性葡萄糖转运蛋白2（SGLT-2）抑制剂，α-葡萄糖苷酶抑制剂或噻唑烷二酮类（TZD）也可以包括在受试者使用的抗高血糖药中。

Unfortunately, we did not find a significant correlation between whether CA19-9 levels returned to normal after AT and the variety and number of types of antihyperglycemic agents, and similarly, we did not find significant differences in the contribution of different antihyperglycemic agents to the degree of reduction in CA19-9 levels.

不幸的是，我们没有发现AT后CA19-9水平是否恢复正常与抗高血糖药物类型和数量之间存在显着相关性，同样，我们也没有发现不同抗高血糖药物对CA19-9水平降低程度的贡献存在显着差异。

Our findings seem to suggest that the degree of decrease in CA19-9 levels in patients with T2DM is only related to the degree of glycemic decrease and not to the antihyperglycemic agents used. However, most of the subjects in this study were taking two or more antihyperglycemic agents concurrently, making it difficult to explore the effects of specific antihyperglycemic agents on CA19-9 levels.

我们的研究结果似乎表明，T2DM患者CA19-9水平的降低程度仅与血糖降低程度有关，而与使用的抗高血糖药物无关。然而，本研究中的大多数受试者同时服用两种或两种以上的抗高血糖药物，因此很难探索特定抗高血糖药物对CA19-9水平的影响。

We believe this still warrants further study..

我们认为这仍然值得进一步研究。。

Some studies have also reported significant correlations between high BMI, lipid levels and positive serum tumor markers

一些研究还报道了高BMI、血脂水平与血清肿瘤标志物阳性之间的显著相关性

. For example, the results of a study by Guo et al. showed that BMI and TG were independent predictors of tumor marker positivity in CRC

例如，郭等人的一项研究结果表明，BMI和TG是CRC肿瘤标志物阳性的独立预测因子

. However, this study did not find significant correlations between BMI, lipid levels and CA19-9 levels in patients with T2DM. We believe that BMI or obesity is a strong confounder associated with many factors. Obese people have a higher incidence of metabolic disorders such as hyperglycemia, hypertension, hyperlipidemia, and cardiovascular disease, which are risk factors for malignant tumors.

然而，这项研究没有发现T2DM患者的BMI，血脂水平和CA19-9水平之间存在显着相关性。我们认为BMI或肥胖是与许多因素相关的强烈混杂因素。肥胖人群代谢紊乱的发生率较高，如高血糖、高血压、高脂血症和心血管疾病，这些都是恶性肿瘤的危险因素。

. In addition, another reason may be that this study focused on CA19-9 levels, whereas the correlation between BMI or lipid levels and other tumor markers may be more pronounced, which needs to be verified by more studies.

此外，另一个原因可能是这项研究集中在CA19-9水平，而BMI或血脂水平与其他肿瘤标志物之间的相关性可能更为明显，这需要更多的研究来验证。

Interestingly, this study found a negative correlation between FT3 levels and CA19-9 levels. And those with abnormal CA19-9 levels had lower FT3 and higher FT4 compared to T2DM patients with normal CA19-9 levels. Previous studies have made less mention of the relationship between thyroid function and tumor markers.

有趣的是，这项研究发现FT3水平与CA19-9水平呈负相关。与CA19-9水平正常的T2DM患者相比，CA19-9水平异常的患者FT3较低，FT4较高。以前的研究很少提到甲状腺功能与肿瘤标志物之间的关系。

Studies have shown that thyroid hormones promote tumor growth and metastasis, while hypothyroidism has the opposite effect.

研究表明，甲状腺激素促进肿瘤生长和转移，而甲状腺功能减退症则相反。

. Whether the correlation between thyroid hormone levels and CA19-9 levels found in this study is simply due to sample heterogeneity needs to be verified by further expansion of the sample size.

。本研究中发现的甲状腺激素水平与CA19-9水平之间的相关性是否仅仅是由于样本异质性，需要通过进一步扩大样本量来验证。

This is despite the fact that studies have uncovered that patients with T2DM are associated with higher CA19-9 levels, suggesting the importance of routine testing for tumor markers in populations with poor glycemic control

尽管研究发现T2DM患者的CA19-9水平较高，这表明在血糖控制不佳的人群中常规检测肿瘤标志物的重要性

. However, there have been few studies on the extent of decrease in CA19-9 levels and related influencing factors in T2DM patients with abnormal CA19-9 levels after AT. In this study, we found that poor glycemic control was an independent risk factor for abnormally elevated CA19-9 levels in patients with T2DM, and furthermore, the degree of decrease in CA19-9 levels was significantly associated with the degree of decrease in FBG.

然而，关于AT后CA19-9水平异常的T2DM患者CA19-9水平下降的程度及其相关影响因素的研究很少。在本研究中，我们发现血糖控制不佳是T2DM患者CA19-9水平异常升高的独立危险因素，此外，CA19-9水平下降的程度与FBG下降的程度显着相关。

These results reinforce the importance of controlling blood glucose levels in daily life for patients with T2DM..

这些结果强化了控制T2DM患者日常生活中血糖水平的重要性。。

There are some limitations in our study. First, the small sample size and single-center study limit the generalizability of our findings. Second, although we expected to exclude patients with malignant tumors by screening each subject for tumor indicators, nevertheless, subjects may still have underlying tumors, such as early stage lymphomas or some occult nonfunctioning tumors, which are often difficult to detect and may affect the results of this study.

我们的研究存在一些局限性。首先，小样本量和单中心研究限制了我们研究结果的普遍性。其次，尽管我们预计通过筛查每个受试者的肿瘤指标来排除恶性肿瘤患者，但受试者仍可能有潜在的肿瘤，如早期淋巴瘤或一些隐匿性无功能肿瘤，这些肿瘤通常难以检测，并可能影响本研究的结果。

Third, the duration of AT received by the subjects was not uniform, and the duration of therapy may also have had an impact on the change in CA19-9 levels. Fourth, healthy controls were not included in this study, making it impossible to investigate whether the FBG levels of those with abnormally elevated CA19-9 in the healthy population were also relatively high, although their FBG levels did not yet meet the criteria for T2DM..

第三，受试者接受AT的持续时间并不一致，治疗的持续时间也可能对CA19-9水平的变化产生影响。第四，本研究未包括健康对照组，因此无法调查健康人群中CA19-9异常升高者的FBG水平是否也相对较高，尽管他们的FBG水平尚未达到T2DM的标准。。

In summary, our study investigated the differences in the indicators between patients with T2DM with abnormal/normal CA19-9 levels and analyzed the factors associated with CA19-9 levels. In addition, factors related to the influence of degree of decrease in CA19-9 levels were further analyzed.

总之，我们的研究调查了CA19-9水平异常/正常的T2DM患者之间指标的差异，并分析了与CA19-9水平相关的因素。此外，还进一步分析了与CA19-9水平下降程度影响相关的因素。

Data availability

数据可用性

All raw data for this study can be provided by the corresponding author under reasonable and legal conditions.

通讯作者可以在合理和合法的条件下提供本研究的所有原始数据。

References

参考文献

Saeedi, P. et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition.

Saeedi，P.等人，《2019年全球和区域糖尿病患病率估计以及2030年和2045年预测：国际糖尿病联合会糖尿病图谱第9版的结果》。

Diabetes Res Clin Pract

糖尿病临床实践

157

, 107843. (2019).

Ma, R. C. W. Epidemiology of diabetes and diabetic complications in China.

Ma，R.C.W。中国糖尿病和糖尿病并发症的流行病学。

Diabetologia

糖尿病学

(6), 1249–1260 (2018).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Tripathi, B. K. & Srivastava, A. K. Diabetes mellitus: complications and therapeutics.

Tripathi，B.K。和Srivastava，A.K。糖尿病：并发症和治疗。

Med. Sci. Monit.

医学科学。莫尼特。

(7), RA130–RA147 (2006).

（7），RA130–RA147（2006）。

PubMed

Google Scholar

谷歌学者

Zhao, Y., Jiang, Z. & Guo, C. New hope for type 2 diabetics: targeting insulin resistance through the immune modulation of stem cells.

Zhao，Y.，Jiang，Z。＆Guo，C。2型糖尿病的新希望：通过干细胞的免疫调节靶向胰岛素抵抗。

Autoimmun. rev.

自身免疫。rev。

(2), 137–142 (2011).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Sun, H. et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045.

Sun，H.等人，《IDF糖尿病地图集：2021年全球、区域和国家级糖尿病患病率估计和2045年预测》。

Diabetes Res. Clin. Pract.

糖尿病研究临床。实践。

183

, 109119 (2022).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Zhang, P-H. et al. Zhu Y-M: increased risk of cancer in patients with type 2 diabetes mellitus: a retrospective cohort study in China.

Zhang，P-H。等。Zhu Y-M：中国2型糖尿病患者癌症风险增加的回顾性队列研究。

BMC Public Health

BMC公共卫生

, 567 (2012).

Article

文章

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

de Kort, S. et al. Higher risk of colorectal cancer in patients with newly diagnosed diabetes mellitus before the age of colorectal cancer screening initiation.

de Kort，S.等人。在结直肠癌筛查开始之前，新诊断糖尿病患者患结直肠癌的风险较高。

Sci. Rep.

科学。代表。

, 46527 (2017).

Article

文章

ADS

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Pisani, P. Hyper-insulinaemia and cancer, meta-analyses of epidemiological studies.

Pisani，P。高胰岛素血症和癌症，流行病学研究的荟萃分析。

Arch. Physiol. Biochem.

拱门。生理学。生物化学。

114

(1), 63–70 (2008).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Andersen, D. K. et al. Diabetes, pancreatogenic diabetes, and pancreatic Cancer.

Andersen，D.K.等人，《糖尿病、胰源性糖尿病和胰腺癌》。

Diabetes

糖尿病

(5), 1103–1110 (2017).

Article

文章

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

Pannala, R. et al. Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus.

Pannala，R。等人。胰腺癌相关糖尿病的患病率和临床特征。

Gastroenterology

胃肠病学

134

(4), 981–987 (2008).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Tsilidis, K. K., Kasimis, J. C., Lopez, D. S., Ntzani, E. E. & Ioannidis, J. P. A. Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies.

Tsilidis，K.K.，Kasimis，J.C.，Lopez，D.S.，Ntzani，E.E.＆Ioannidis，J.P.A。2型糖尿病和癌症：观察性研究荟萃分析的综述。

BMJ

350

, g7607 (2015).

，g7607（2015）。

Article

文章

PubMed

Google Scholar

谷歌学者

Sturgeon, C. M. et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers.

Sturgeon，C.M.等人。国家临床生物化学研究院实验医学实践指南，用于睾丸癌、前列腺癌、结直肠癌、乳腺癌和卵巢癌的肿瘤标志物。

Clin. Chem.

克林顿。化学。

(12), e11–e79 (2008).

（12），e11–e79（2008）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Locker, G. Y. et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer.

Locker，G.Y.等人，ASCO 2006年胃肠道癌症中肿瘤标志物使用建议的更新。

J. Clin. Oncol.

J、克林。肿瘤。

(33), 5313–5327 (2006).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Starzer, A. M. et al. Systemic inflammation scores correlate with survival prognosis in patients with newly diagnosed brain metastases.

Starzer，A.M.等人。全身炎症评分与新诊断脑转移瘤患者的生存预后相关。

Br. J. Cancer

Br.J.癌症

124

(7), 1294–1300 (2021).

Article

文章

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

Özdin, S. & Böke, Ö. Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in different stages of schizophrenia.

Özdin，S。和Böke，Ö。精神分裂症不同阶段的中性粒细胞/淋巴细胞，血小板/淋巴细胞和单核细胞/淋巴细胞比率。

Psychiatry Res.

精神病学研究。

271

, 131–135 (2019).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Cheng, X. et al. Associations of essential trace elements with epigenetic aging indicators and the potential mediating role of inflammation.

Cheng，X。等人。必需微量元素与表观遗传衰老指标的关联以及炎症的潜在介导作用。

Redox Biol.

氧化还原生物。

, 102910 (2023).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Boyd, L. N. C. et al. Prediction model for early-stage pancreatic Cancer using routinely measured blood biomarkers.

Boyd，L.N.C.等人。使用常规测量的血液生物标志物预测早期胰腺癌的模型。

JAMA Netw. Open.

JAMA网络。打开。

(8), e2331197 (2023).

（8），e2331197（2023）。

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Zhu, X. et al. Pancreatic Cancer: an exocrine tumor with endocrine characteristics.

Zhu，X。等。胰腺癌：一种具有内分泌特征的外分泌肿瘤。

Ann. Surg.

安·瑟格。

(2023).

Tempero, M. A. et al. Pancreatic adenocarcinoma.

Tempero，M.A。等人。胰腺癌。

J. Natl. Compr. Canc Netw.

J.纳特尔。我买。坎昆网络。

(9). (2010).

Kang, D-W., Barnes, O., Vander Heiden, M. G. & Dieli-Conwright, C. M. Effect of exercise on tumor markers - is exercise anti-tumorigenic in humans? A scoping review of preliminary clinical investigations.

Kang，D-W.，Barnes，O.，Vander Heiden，M.G。和Dieli Conwright，C.M。运动对肿瘤标志物的影响-运动对人类有抗肿瘤作用吗？初步临床研究的范围界定审查。

Crit. Rev. Oncol. Hematol.

Crit。肿瘤学博士。血液。

178

, 103779 (2022).

Article

文章

PubMed

Google Scholar

谷歌学者

Lega, I. C. & Lipscombe, L. L. Review: diabetes, obesity, and Cancer-Pathophysiology and Clinical implications.

Lega，I.C.＆Lipscombe，L.L.评论：糖尿病，肥胖和癌症的病理生理学和临床意义。

Endocr. Rev.

(1). (2020).

Fang, T-Z. et al. Influence of blood glucose fluctuations on chemotherapy efficacy and safety in type 2 diabetes mellitus patients complicated with lung carcinoma.

方，T-Z。等。血糖波动对2型糖尿病合并肺癌患者化疗疗效和安全性的影响。

World J. Diabetes

世界J.糖尿病

(4), 645–653 (2024).

Article

文章

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

Lin, Y. et al. Age-related disparities in Pan-cancer Mortality and causes of death: analysis of Surveillance, Epidemiology, and end results (SEER) data.

Lin，Y.等人，《泛癌死亡率和死亡原因的年龄相关差异：监测、流行病学和最终结果（SEER）数据分析》。

J. Cancer

J、癌症

(6), 1613–1623 (2024).

Article

文章

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

Shang, X. et al. The serum levels of tumor marker CA19-9, CEA, CA72-4, and NSE in type 2 diabetes without malignancy and the relations to the metabolic control.

Shang，X。等。无恶性肿瘤的2型糖尿病患者血清肿瘤标志物CA19-9，CEA，CA72-4和NSE水平及其与代谢控制的关系。

Saudi Med. J.

沙特医学杂志。

(2), 204–208 (2017).

Article

文章

MathSciNet

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

Zhang, P. et al. Hyperglycemia is associated with adverse prognosis in patients with pancreatic neuroendocrine neoplasms.

Zhang，P。等。高血糖与胰腺神经内分泌肿瘤患者的不良预后相关。

Endocrine

内分泌

(2), 262–271 (2022).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Donath, M. Y. et al. Islet inflammation in type 2 diabetes: from metabolic stress to therapy.

Donath，M.Y.等人，《2型糖尿病的胰岛炎症：从代谢应激到治疗》。

Diabetes Care

糖尿病护理

(2), S161–S164 (2008).

（2），S161–S164（2008）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Yu, H. et al. Serum CA19-9 level associated with metabolic control and pancreatic beta cell function in diabetic patients.

Yu，H.等人。糖尿病患者血清CA19-9水平与代谢控制和胰岛β细胞功能相关。

Exp. Diabetes Res.

实验糖尿病研究。

2012

, 745189 (2012).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Weir, G. C. Glucolipotoxicity, β-Cells, and diabetes: the Emperor has no clothes.

Weir，G.C。糖脂毒性，β细胞和糖尿病：皇帝没有衣服。

Diabetes

糖尿病

(3), 273–278 (2020).

Article

文章

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

Lytrivi, M., Castell, A-L., Poitout, V. & Cnop, M. Recent insights into mechanisms of β-Cell lipo- and glucolipotoxicity in type 2 diabetes.

Lytrivi，M.，Castell，A-L.，Poitout，V。＆Cnop，M。最近对2型糖尿病中β细胞脂毒性和糖脂毒性机制的见解。

J. Mol. Biol.

J.分子生物学。

432

(5), 1514–1534 (2020).

Article

文章

PubMed

Google Scholar

谷歌学者

Lee, S. H. et al. Can metformin change the prognosis of pancreatic cancer? Retrospective study for pancreatic cancer patients with pre-existing diabetes mellitus type 2.

Lee，S.H.等人，二甲双胍能改变胰腺癌的预后吗？已有2型糖尿病的胰腺癌患者的回顾性研究。

Dig. Liver Dis.

挖掘。肝脏疾病。

(4), 435–440 (2016).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Pretta, A. et al. Retrospective survival analysis in patients with metastatic pancreatic ductal adenocarcinoma with insulin-treated type 2 diabetes mellitus.

Pretta，A。等人。胰岛素治疗的2型糖尿病转移性胰腺导管腺癌患者的回顾性生存分析。

Tumori

肿瘤

107

(6), 550–555 (2021).

Article

文章

PubMed

Google Scholar

谷歌学者

Wu, S., Wang, J., Jing, L. & Chen, L. A Diabetic Patient Complicated with Pancreatic Cancer after using Liraglutide: a Case Report.

Wu，S.，Wang，J.，Jing，L。＆Chen，L。一名使用利拉鲁肽后并发胰腺癌的糖尿病患者：病例报告。

Front. Endocrinol.

正面。内分泌。

, 608966 (2020).

Article

文章

Google Scholar

谷歌学者

Xu, R. et al. Exploration of the application potential of serum multi-biomarker model in colorectal cancer screening.

Xu，R。等。探索血清多生物标志物模型在结直肠癌筛查中的应用潜力。

Sci. Rep.

科学。代表。

(1), 10127 (2024).

Article

文章

ADS

PubMed

PubMed Central

公共医学中心

MATH

数学

Google Scholar

谷歌学者

Wang, X., Gao, Y., Wang, H., Gong, X. & Bao, P. Tumor markers for lipid metabolism-related genes: based on small cell lung cancer and bronchial asthma dual analysis.

Wang，X.，Gao，Y.，Wang，H.，Gong，X。＆Bao，P。脂质代谢相关基因的肿瘤标志物：基于小细胞肺癌和支气管哮喘双重分析。

Environ. Toxicol.

环境。有毒。

(5), 2855–2868 (2024).

Article

文章

ADS

PubMed

MATH

数学

Google Scholar

谷歌学者

Guo, J., Wang, B., Hou, W. & Ma, K. Risk factors for elevated serum colorectal cancer markers in patients with type 2 diabetes mellitus.

Guo，J.，Wang，B.，Hou，W。＆Ma，K。2型糖尿病患者血清结直肠癌标志物升高的危险因素。

Open. Life Sci.

打开。生命科学。

(1), 267–273 (2020).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Martínez-Reyes, I. & Chandel, N. S. Cancer metabolism: looking forward.

Martínez-Reyes，I。＆Chandel，N.S。癌症代谢：展望。

Nat. Rev. Cancer

Nat.Rev.癌症

(10), 669–680 (2021).

Article

文章

PubMed

Google Scholar

谷歌学者

Yang, S. et al. Cholesterol metabolism and urinary system tumors.

Yang，S.等。胆固醇代谢与泌尿系统肿瘤。

Biomedicines

生物医学

(8). (2024).

Moeller, L. C. & Führer, D. Thyroid hormone, thyroid hormone receptors, and cancer: a clinical perspective.

Moeller，L.C。＆Führer，D。甲状腺激素，甲状腺激素受体和癌症：临床观点。

Endocr. Relat. Cancer

内分泌。相关。癌症

(2), R19–R29 (2013).

（2），R19–R29（2013）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学者

Meng, M. & Shi, L-L. Serum tumor markers expression (CA199, CA242, and CEA) and its clinical implications in type 2 diabetes mellitus.

Meng，M。＆Shi，L-L。血清肿瘤标志物表达（CA199，CA242和CEA）及其在2型糖尿病中的临床意义。

World J. Diabetes

世界J.糖尿病

(2), 232–239 (2024).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Download references

下载参考资料

Acknowledgements

致谢

We thank all the staff and subjects who participated in this study, and all the reviewers and journal editors who reviewed and processed this manuscript.

我们感谢所有参与本研究的工作人员和受试者，以及所有审阅和处理本手稿的审稿人和期刊编辑。

Author information

作者信息

Author notes

作者笔记

Xiafei Zhao and Yan Wang contributed equally to this work.

赵夏飞和王燕对这项工作做出了同样的贡献。

Authors and Affiliations

作者和隶属关系

Affiliated Xiaoshan Hospital, Hangzhou Normal University/Zhejiang Xiaoshan Hospital, 728 Yucai North Road, Hangzhou, 311200, China

杭州师范大学附属萧山医院/浙江萧山医院，杭州育才北路728号，311200

Xiafei Zhao, Yan Wang, Ling Zhou, Aili Ye & Quanfeng Zhu

赵晓飞、王燕、周玲、叶爱丽和朱全峰

Authors

作者

Xiafei Zhao

赵霞飞

View author publications

查看作者出版物

You can also search for this author in

您也可以在中搜索此作者

PubMed

Google Scholar

谷歌学者

Yan Wang

王燕（音）

View author publications

查看作者出版物

You can also search for this author in

您也可以在中搜索此作者

PubMed

Google Scholar

谷歌学者

Ling Zhou

凌州

View author publications

查看作者出版物

You can also search for this author in

您也可以在中搜索此作者

PubMed

Google Scholar

谷歌学者

Aili Ye

家庭Yes

View author publications

查看作者出版物

You can also search for this author in

您也可以在中搜索此作者

PubMed

Google Scholar

谷歌学者

Quanfeng Zhu

朱全峰（音）

View author publications

查看作者出版物

You can also search for this author in

您也可以在中搜索此作者

PubMed

Google Scholar

谷歌学者

Contributions

捐款

Quanfeng Zhu: Project design and management. Aili Ye: Project management and manuscript revision. Xiafei Zhao: Data collection and first draft writing. Yan Wang: Data collection and manuscript revision. Ling Zhou: Statistical Analysis. All authors reviewed the manuscript.

朱全峰：项目设计与管理。叶爱丽：项目管理和稿件修订。赵夏飞：数据收集和初稿撰写。王燕：数据收集和手稿修订。凌舟：统计分析。所有作者都审阅了手稿。

Corresponding authors

通讯作者

Correspondence to

通信对象

Aili Ye

家庭Yes

或

Quanfeng Zhu

朱全峰（音）

Ethics declarations

道德宣言

Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

Ethics statement

道德声明

Written informed consent was drawn up prior to the start of this study, and all subjects participating in this study signed a written informed consent form to indicate their agreement to the publication of all images, clinical data, and other data contained in the article. This study was approved by the Medical Ethics Committee of Zhejiang Xiaoshan Hospital on January 25, 2024 (NO.

书面知情同意书是在本研究开始之前起草的，所有参与本研究的受试者都签署了书面知情同意书，以表明他们同意发表文章中包含的所有图像，临床数据和其他数据。本研究于2024年1月25日获得浙江省萧山医院医学伦理委员会批准（NO。

2024005)..

Additional information

其他信息

Publisher’s note

出版商注释

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Springer Nature在已发布的地图和机构隶属关系中的管辖权主张方面保持中立。

Rights and permissions

权限和权限

Open Access

开放存取

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

本文是根据知识共享署名非商业性NoDerivatives 4.0国际许可证授权的，该许可证允许以任何媒介或格式进行任何非商业性使用，共享，分发和复制，只要您对原始作者和来源给予适当的信任，提供知识共享许可证的链接，并指出您是否修改了许可材料。

You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit .

要查看此许可证的副本，请访问。

http://creativecommons.org/licenses/by-nc-nd/4.0/

Reprints and permissions

重印和许可

About this article

关于本文

Cite this article

引用本文

Zhao, X., Wang, Y., Zhou, L.

赵，X，王，Y，周，L。

et al.