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題名:血脂異常、糖尿病、代謝症候群 對發生大腸直腸癌的影響與分析
作者:許書華
校院名稱:輔仁大學
系所名稱:商學研究所博士班
指導教授:陳銘芷
劉志光
學位類別:博士
出版日期:2022
主題關鍵詞:代謝症候群糖尿病血脂異常大腸直腸癌metabolic syndromediabetes mellitusdyslipidemiacolorectal cancer
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(1) 背景:大腸直腸癌為全球第三大最常見的惡性腫瘤,也是癌症死亡的第二大原因。2013-2016年為台灣男性常見癌症第一位,女性常見癌症第二位。經常在晚期才被診斷出來,並且在年輕世代的發病率不斷上升,已經成為今日經濟的沉重負擔和巨大的公共衛生挑戰。糖尿病的致癌機制非常複雜,包括過量活性含氧物的形成、慢性發炎和康復現象受損,共同導致糖尿病狀態下的癌症發生。脂蛋白和血脂可能會藉由產生氧化壓力、炎症和胰島素抵抗而影響到癌症的生成,血脂異常在大腸直腸癌的風險中有其潛在作用。本研究的目的是利用具有全國代表性的樣本判定台灣人口中大腸直腸癌的流行病學特徵,評估糖尿病、代謝症候群對大腸直腸癌的影響,並針對血脂的基線水平及其對於大腸直腸癌風險的影響之間的關聯性進行全面定量評估。在初級和次級預防中控制血脂異常可減輕大腸直腸癌的疾病負擔。
(2)方法:這是一項以社區為基礎的長期前瞻性世代研究。資料來源為以全國人口為基礎的台灣三高調查,變量如糖尿病、代謝症候群由 Cox 比例風險模型進行推估,再根據年齡做進一步的調整。我們計算了大腸直腸癌在血清膽固醇、三酸甘油脂、低密度脂蛋白膽固醇和高密度脂蛋白膽固醇含量之聯合類別中的相對比率,並檢查它們的組合效應和統計交互作用。
(3)結果:男性、年齡、腰圍、糖尿病、高三酸甘油脂、高膽固醇、吸煙史和新陳代謝症候群被證明具有增加罹患大腸直腸癌的風險。此外, 三酸甘油脂含量 ≥150 mg/dL 和膽固醇含量 ≥180 mg/dL 的糖尿病患者與三酸甘油脂含量 <150 mg/dl 和膽固醇含量 <180 mg/dL 的糖尿病患者相比,罹患大腸直腸癌的風險高了 4.118 倍,具顯著差異(95% CI,1.061-15.975;p = 0.0407)。
(4)結論:糖尿病患者可透過飲食調整、運動或增進藥物順從性的方式積極控制三酸甘油脂和膽固醇含量,不僅是為了預防心血管疾病,也是作為預防大腸直腸癌的第一步。對於臨床醫師和政策制定者在實施更精準的血脂異常管理目標時,本研究極具價值。
(1) Background: Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer deaths worldwide. In Taiwan, 2013-2016, it is the first leading cancer for males and second in females. It often diagnosed at advanced stages, and with increasing incidence at younger generation. CRC poses a heavy financial burden and a huge public health challenge nowadays. The cancer-causing mechanisms in diabetes are complex, including excessive reactive oxygen species (ROS) formation, chronic inflammation, and impaired healing phenomena, collectively leading to carcinogenesis under diabetic conditions. Lipoproteins and serum lipids may have an influence on carcinogenesis by making oxidative stress, inflammation, and insulin resistance. Dyslipidemia plays a potential role in the risk of CRC. The purpose of this study is to use nationally representative samples to determine epidemiologic characteristics of CRC in the Taiwanese population, and to evaluate the associations between baseline levels of lipid profile and their effect on risk of colorectal cancer (CRC) comprehensively and quantitatively. The control of dyslipidemia in primary and secondary prevention may reduce the disease burden of CRC.
(2) Methods: This is a nationwide long-term community-based prospective cohort study. Data were retrieved from the nationwide population-based Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia (TwSHHH). Variables like diabetes and metabolic syndrome were estimated by the Cox proportional hazards model which was then further adjusted for age. We also calculated the relative ratios (RRs) of CRC for joint categories of serum cholesterol, triglyceride (TG), low-density lipoproteins cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) level, and to examine their combined effect and statistical interactions.
(3) Results: Male, age, waist circumference, diabetes mellitus (DM), high TG, high cholesterol level, smoking history, and metabolic syndrome were proved to increase the risk of CRC. In addition, DM patients with a TG level ≥ 150 mg/dL and cholesterol ≥ 180 mg/dL had a 4.118-fold higher risk of CRC as compared with a TG level < 150 mg/dL and cholesterol level < 180 mg/dL, which was a significant difference (95% CI, 1.061–15.975; p = 0.0407).
(4) Conclusions: Patients with DM should control TG and cholesterol level through diet, exercise, or taking medi-cations more aggressively, not only for preventing cardiovascular disease, but also for first pre-vention of CRC. The study can be valuable for the clinicians and policy makers to implement more precisely goals about dyslipidemia management.
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