代謝症候群比胰島素阻抗性、糖化血色素對於結腸腫瘤發生率更有預測性

Metabolic syndrome is a stronger predictor of colorectal neoplasm than insulin resistance and glycocylated hemoglobin

林忠成(Chung-Cheng Lin)

指導教授 ： 吳登強

高雄醫學大學/醫學院/醫學研究所/碩士(2013年)

https://doi.org/10.6832/KMU.2013.00042

摘要

目前結腸惡性腫瘤在台灣地區自2010年以來已經竄升為發生率第一名的惡性腫瘤，且發生率逐年升高。現今已知的危險因子包括年紀越大、男性、不健康的飲食及生活型態、高油脂及低纖維飲食、菸草的使用、之前罹患過結腸腫瘤或惡性腫瘤病史、有一等親罹患結腸惡性腫瘤之家族史、家族性遺傳結腸瘜肉症候群以及罹患發炎性結腸炎。近年來國內外有許多流行病學報告指出罹患代謝症候群、胰島素阻抗性以及罹患糖尿病可能和結腸腫瘤發生有所相關性。本篇收集了在高雄醫學大學附設醫院1318位胃腸內科門診患者，分析結腸腫瘤與代謝症候群、糖化血色素高低以及多項血清生化指標之間的關聯性，經多因子校正後發現年紀越大、男性、符合代謝症候群診斷標準、以及有結腸惡性腫瘤一等親家族史等，都是增加結腸腫瘤特別是侵襲性結腸腫瘤發生率的獨立因子，其中符合越多項危險因子，罹患結腸腫瘤的危險度越高。我們能針對符合上述四項危險因子發展出罹患結腸腫瘤危險度預測公式，在臨床上若針對風險性高的患者安排結腸內視鏡檢查，以便早期發現結腸腫瘤進而進行切除，達到次級預防結腸惡性腫瘤的發生或是早期診斷出結腸惡性腫瘤。

關鍵字

結腸腫瘤 ； 代謝症候群 ； 胰島素阻抗性 ； 糖化血色素

並列摘要

There is increasing incidence of colorectal cancer in the world andTaiwan. Factors that have been correlated with an increased risk for colorectal neoplasm include old age, male, excess dietary fat, obesity, cigarette smoking, previous colorectal polyp history and familial history of colorectal cancer. Colorectal adenoma and advanced colorectal neoplasm increase the risk for colorectal adenocarcinoma. In recently, metabolic syndrome, insulin resistance and diabetes mellitus are also investigated to be associated with an increased incidence of colorectal neoplasm. We collected 1318 patients who had visited gastroenterology clinics one medical center. The result of this study showed older men who had family history of colorectal cancer and met the criteria for metabolic syndrome had a highest incidence of colorectal neoplasm than none of them. By the way, metabolic syndrome may be another stronger predictor for colorectal neoplasm than HbA1c, insulin resistance and other biochemical elements. Through these four risk factors, we can develop a risk score for the colorectal neoplasm incidence to finding out the population who are at highest risk of colorectal neoplasm and arrange colonoscopy for explicit survey.

並列關鍵字

colorectal neoplasm ； metabolic syndrome ； insulin resistance ； glycocylated hemoglobin

參考文獻

考文獻

[1] Department of Health EY, R.O.C. (Taiwan). Cancer Registry Annual Report, 2009 Taiwan. In; 2011.

[2] Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.

[3] Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975;36:2251-70.

[4] Yeoh KG, Ho KY, Chiu HM, Zhu F, Ching JY, Wu DC, et al. The Asia-Pacific Colorectal Screening score: a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects. Gut 2011;60:1236-41.