2型糖尿病患者血清癌胚抗原水平变化及其影响因素分析

Change of serum CEA level and related metabolic factors in patients with type 2 diabetes mellitus

关键词:  2型糖尿病  癌胚抗原  糖化血红蛋白  空腹血糖  餐后2h血糖

Key words:  type 2 diabetes mellitus  carcinoembryonic antigen  glycated hemoglobin A1c  fasting glucose  2h postprandial glucose

摘要:

目的观察2型糖尿病患者血清癌胚抗原(carcinoembryonic antigen, CEA)水平变化及其影响因素。方法选取2018年1月—2020年12月在上海交通大学医学院附属新华医院内分泌科住院的40~70岁2型糖尿病(type 2 diabetes mellitus, T2DM)患者共952例作为研究对象，将来自新华医院体检中心的年龄与性别匹配的471例非糖尿病人群(non-type 2 diabetes mellitus, Non-T2DM)作为对照组，比较两组人群血清CEA水平的差异性，分析年龄、血压（blood pressure, BP）、糖化血红蛋白(glycated hemoglobin A1c, HbA1c)、空腹血糖(fasting blood glucose, FBG)、餐后2h血糖(2h postprandial blood glucose, 2h-PG)、空腹C肽(fasting C-peptide, FC-p)、餐后2h C 肽(2h postprandial C-peptide, 2h C-p)、胰岛素抵抗指数(homeostasis model assessment, HOMA-IR)、高密度脂蛋白胆固醇（high density lipoprotein-cholesterol, HDL-C）、低密度脂蛋白胆固醇（low density lipoprotein-cholesterol, LDL-C）、总胆固醇（total cholesterol, TC）、三酰甘油（triglyceride, TG）、体质量指数(body mass index, BMI)及糖尿病病程与血清CEA的相关性，探讨无恶性肿瘤的T2DM患者血清CEA水平的影响因素。结果T2DM患者血清CEA异常者约占11%，Non-T2DM组血清CEA异常者约占4%，T2DM患者组血清CEA水平明显高于Non-T2DM组[2.62(1.82,3.83) vs 2.14(1.51,2.96)ng/mL，P<0.001]，逐步回归分析显示血清CEA与年龄、HbA1c、FBG、2h-PG独立正相关，二元logistic回归分析显示校正多种混杂因素后，HbA1c、FBG、2h-PG是血清CEA升高的独立危险因素，校正后的OR值和95%CI分别为HbA1c： OR=1.338,95%CI(1.198~1.495), FBG： OR=1.102, 95%CI(1.016~1.195), 2h-PG： OR=1.065, 95%CI(1.009~1.123)。二元Logistic回归显示将HbA1c≤7%时血清CEA水平作为参考，当8%≤HbA1c＜9%时，血清CEA升高的风险是参考的3.459倍（95%CI： 1.373~8.713）。当HbA1c≥9%时，其OR值是5.084（95%CI： 2.230~11.589）。结论2型糖尿病患者血清CEA水平明显升高，年龄、HbA1c、FBG、2h-PG是其独立危险因素，HbA1c对CEA的影响最大，提示血糖控制越差，血清CEA水平越高，当HbA1c≥8%时，T2DM患者血清CEA升高的风险明显增加。

Abstract:

ObjectiveTo investigate the change of serum carcinoembryonic antigen(CEA) levels in type 2 diabetes mellitus(T2DM) and its association with related metabolic factors. MethodsA total 952 T2DM patients(malignant tumor were excluded) aged 40-70 years who were hospitalized in the Department of Endocrinology， Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2020 were enrolled，and 471 non-diabetic subjects matched by sex and age who underwent health check-up in the Medical Center of Xinhua Hospital were recruited as controls. The serum CEA levels were compared between the two groups. The association of serum CEA level with age, blood pressure(BP), glycated hemoglobin A1c(HbA1c), fasting blood glucose(FBG), 2h-postprandial blood glucose(2h-PG), fasting C-peptide(FC-p), 2h-postprandial C-peptide(2h C-p), homeostasis model assessment index(HOMA-IR), high density lipoprotein-cholesterol(HDL-C), low density lipoprotein-cholesterol(LDL-C), total cholesterol(TC), triglyceride(TG), body mass index(BMI) and duration of diabetes were analyzed. ResultsSerum CEA above the upper limit of normal were detected in 11% of T2DM patients, which was significantly higher than in controls(4%); and the average serum CEA level in T2DM patients was significantly higher than that in controls[2.62(1.82,3.83) vs 2.14(1.51,2.96)ng/ml, P<0.001]. Stepwise regression analysis showed that serum CEA was positively and independently correlated with age, HbA1c, FBG and 2h-PG(β=0.020, P<0.05, β=0.207, P<0.05, β=0.091, P<0.05, β=0.070, P<0.05; respectively). Binary logistic regression analysis showed that HbA1c, FBG, and 2h-PG were the independent risk factors for the increase of serum CEA after adjusting for multiple confounding factors[AORS = 1.338, 95%CI(1.198-1.495), AORS=1.102, 95%CI(1.016-1.195), AORS=1.065, 95%CI(1.009-1.123), respectively]. Binary logistic regression showed that compared with HbA1c≤7%, the risk of increased CEA in patients with HbA1c 8%-9% and >9% were significantly increased(OR=3.459, 95%CI： 1.373-8.713; and OR=5.084, 95%CI： 2.230-11.589). ConclusionThe serum CEA level of type 2 diabetic patients is significantly elevated. Age, HbA1c, FBG, and 2h-PG are independent risk factors of increased CEA level; when HbA1c is higher than 8% the risk of abnormal serum CEA increases in T2DM patients.