胰島素、脂肪與癌症：藥理學觀點

Insulin, Fat and Cancer: Pharmacological Aspects

唐正乾(Chang-Chen Tang) ； 陳滄山(Tsang-Shan Chen) ； 徐維信(Wei-Sin Hsu) ； 許世元(Shih-Yuan Hsu)

《內科學誌》 17卷4期 (2006/08) Pp. 169-176

https://doi.org/10.6314/JIMT.2006.17(4).04

摘要

癌症是一種惡質化、長期且階段性發展的疾病，流行病學研究發現，胰島素、脂肪與癌症三者問有著關聯性存在。胰島素及脂肪藉由分泌生長因子、性賀爾蒙與脂肪細胞素等，對生物體的新陳代謝與生理作用產生顯著的影響，因而增加致癌風險。脂肪細胞不僅能儲存多餘的能量，且會分泌脂肪細胞素(adipocytokine)，如瘦素(leptin)、脂聯素(adrponectin)、阻抗素(resistin)、腫瘤壞死因子－α(tumor necrosis factor-α, TNF-α)與第1型胞漿素原活化體抑制劑(plasminogen activator inhibitor-1, PAI-1)等，進入全身血液循環。脂肪細胞素主要的生理角色，包括新陳代謝、胰島素敏感性、血壓、免疫、血管新生與生理平衡等，同時也是細胞癌化病原學上重要角色的扮演者。第1型類胰島素生長因子(insulin-like growth factor-1, IGF-1)，表現出強而有力的有絲分裂作用，進而增加致癌風險。有研究指出，第2型糖尿病患者服用胰島素促泌劑，如磺醯尿素類(sulfonylureas)及給予外源性胰島素，可能增加致癌風險；而服用胰島素增敏劑，如thiazolidinediones(TZDs)及雙胍類（如metformin），卻可能減少致癌風險，唯仍需有更多的支持證據；但無論如何，多瞭解胰島素、脂肪與癌症之間細胞生理及新陳代謝作用的關聯性，對於癌症的預防與治療，是有正面的意義。

關鍵字

胰島素 ； 胰島素阻抗 ； 高胰島素血症 ； 脂肪 ； 癌症

並列摘要

Cancer is a degenerative disease that develops over a long period of time and different stages. Epidemiological studies revealed that there was correlation among insulin, fat and cancer. Through the secretion of growth factors, sex hormones and adipocytokines, insulin and fat showed a significant effect on the physiological and metabolic function, thereby increase the risk of carcinogenesis. Adipose tissue not only serves as storage of excess energy, but also secretes adipocytokines (e.g., leptin, adiponectin, resistine, TNF-α and PAI-1) into circulating blood. These adipocytokines not only have physiological function in metabolism, insulin sensitivity, blood pressure, immunity, angiogenesis and haemostasis, but also play an important role in the etiology of cancer. Insulin-like growth factor-1 (IGF-1) showed powerful mitogenic effects, and thus may increase risk of cancer. Recently, studies have shown that the use of insulin-secretors (i.e., sulfonylureas) and exogenous insulin may increase risk of cancer in type 2 diabetic patients, while insulin-sensitizers (i.e., thiazolidinediones) and metformin may reduce risk of cancer although more evidences are needed. A better understanding of diverse range of physiological and metabolic processes and the relationship among insulin, fat and malignancy may be helpful in elucidating more preventive avenues to manage cancer.

並列關鍵字

Insulin ； Insulin resistance ； Hyperinsulinemia ； Fat ； Cancer