本文選題：二甲雙胍 + 胰腺癌��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:在我國,胰腺癌排名癌癥死因第6位。流行病學(xué)資料顯示,胰腺癌的1年總生存率只有24%,5年總生存率僅為5%。目前中晚期胰腺癌仍缺乏有效的治療手段。胰腺癌患者往往合并糖尿病并且接受降糖治療。多項基礎(chǔ)研究及回顧性研究表明了二甲雙胍可降低包括胰腺癌在內(nèi)的多種腫瘤發(fā)病率及改善預(yù)后,但缺乏基于人群的大型隨機對照試驗,還需要進一步的證據(jù)來確定臨床實踐中二甲雙胍的使用對胰腺癌患者的生存期是否存在影響。目的:探討二甲雙胍及其他臨床特征因素對合并糖尿病的胰腺癌患者生存的影響。方法:回顧性收集2013-08-01至2016-07-31期間浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院住院同時確診為胰腺癌和糖尿病的87位患者的臨床特征,統(tǒng)計分析胰腺癌患者的臨床預(yù)后因素,如性別、年齡、CA199水平、BMI、吸煙史、飲酒史、腫瘤部位、腫瘤大小、腫瘤治療方案、糖尿病治療方案,比較這些臨床特征在是否接受二甲雙胍治療上的差異,使用Kaplan-Meier評估及繪制生存曲線,使用單因素及多因素Cox比例風(fēng)險模型評估各因素對生存期的影響。結(jié)果:患者確診胰腺癌時的平均年齡為64.48±7.33歲(48-82歲),其中男性患者占59.77%。研究對象總體的6個月,1年和3年生存率分別為58.62%,34.48%和6.90%。多因素Cox比例風(fēng)險回歸分析顯示胰腺癌早期對生存的危險比為0.211(95%CI:0.109-0.448),未進行化療對生存的危險比為 1.913(95%CI:1.004-3.643)。在降糖治療方案中選擇使用胰島素和二甲雙胍分別為40.23%和20.69%,是否使用二甲雙胍與胰腺癌死亡風(fēng)險無關(guān)(Exp(B):0.837;95%CI:0.242-2.891)。結(jié)論:本研究提示合并糖尿病的胰腺癌患者的預(yù)后與腫瘤分期、是否進行手術(shù)治療、是否化療干預(yù)相關(guān)。二甲雙胍的使用不能改善合并糖尿病的胰腺癌患者的預(yù)后。其原因可能與研究樣本量過少、二甲雙胍未達到有效血藥濃度及隨訪時間較短相關(guān),后續(xù)可通過擴充樣本量或多中心研究,統(tǒng)計二甲雙胍使用劑量和時間及延長隨訪時間等手段來進一步明確二甲雙胍的使用對合并糖尿病的胰腺癌患者的預(yù)后影響。
[Abstract]:Background: pancreatic cancer is the sixth leading cause of cancer death in China.Epidemiological data showed that the 1-year overall survival rate of pancreatic cancer was only 24%, and the 5-year overall survival rate was only 5%.At present, there is still a lack of effective treatment for advanced pancreatic cancer.Pancreatic cancer patients often have diabetes and receive hypoglycemic treatment.A number of basic and retrospective studies have shown that metformin can reduce the incidence and improve the prognosis of a variety of tumors, including pancreatic cancer, but lacks a population-based large randomized controlled trial.Further evidence is needed to determine whether the use of metformin in clinical practice has an impact on survival in patients with pancreatic cancer.Objective: to investigate the effect of metformin and other clinical characteristics on the survival of pancreatic cancer patients with diabetes mellitus.Methods: the clinical features of 87 patients with pancreatic cancer and diabetes were collected retrospectively from January 2013-08-01 to 2016-07-31. The clinical prognostic factors, such as sex, were statistically analyzed in 87 patients with pancreatic cancer and diabetes mellitus who were hospitalized in run run run Shaw Hospital of Zhejiang University Medical College.Age CA199 levels, smoking history, drinking history, tumor site, tumor size, tumor treatment regimen, diabetes treatment protocol, compared these clinical characteristics in whether to receive metformin treatment or not, using Kaplan-Meier to evaluate and draw survival curve.Univariate and multivariate Cox proportional risk models were used to evaluate the effects of each factor on survival.Results: the mean age of diagnosis of pancreatic cancer was 64.48 鹵7.33 years old and 48-82 years old, of which 59.77 were male.The 6-month, 1-year and 3-year survival rates of the subjects were 58.62% and 6.90%, respectively.Multivariate Cox proportional risk regression analysis showed that the survival risk ratio in early stage of pancreatic cancer was 0.21195 CI: 0.109-0.448, and that without chemotherapy was 1.91395 CI: 1.004-3.643.The rates of insulin and metformin were 40.23% and 20.69%, respectively. Whether or not to use metformin had nothing to do with the risk of death of pancreatic cancer.Conclusion: this study suggests that the prognosis of pancreatic cancer patients with diabetes is related to tumor staging, surgical treatment and chemotherapy intervention.The use of metformin does not improve the prognosis of pancreatic cancer patients with diabetes.The reasons may be related to the small sample size of the study, the failure of metformin to reach the effective blood concentration and the shorter follow-up time, and may be followed up by expanding the sample size or polycentric study.To further determine the prognostic effect of metformin on pancreatic cancer patients with diabetes mellitus, the dosage and time of metformin use and the prolongation of follow-up time were calculated to further determine the prognostic effect of metformin use on pancreatic cancer patients with diabetes mellitus.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1;R735.1
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本文編號：1766780