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上海交通大學(xué)醫(yī)學(xué)院附屬上海市第六人民醫(yī)院賈偉平教授等開展的一項(xiàng)隊(duì)列研究提示，接受人胰島素治療的2型糖尿病患者罹患癌癥的整體風(fēng)險(xiǎn)雖未額外增加，但肝癌風(fēng)險(xiǎn)明顯升高，其全因死亡和癌癥死亡風(fēng)險(xiǎn)也增加。

研究者從上海糖尿病登記研究中納入8774例從未接受胰島素治療的糖尿病患者，分入胰島素治療組和非胰島素治療組，接受隨訪至首次確診癌癥或死亡或至2011年7月31日。結(jié)果顯示，胰島素治療組和非胰島素治療組分別確診98例和170例癌癥，發(fā)生率分別為78.6/萬病人年和74.3/萬病人年，兩組的癌癥發(fā)生風(fēng)險(xiǎn)無顯著差異（經(jīng)校正RR=1.20，P=0.228）。與非胰島素治療組相比，胰島素治療組的肝癌風(fēng)險(xiǎn)顯著升高（經(jīng)校正RR=2.84，P=0.028），全因死亡（經(jīng)校正RR=1.89，P<0.0001）和癌癥死亡（經(jīng)校正RR=2.16，P=0.001）風(fēng)險(xiǎn)亦升高。

研究者表示，盡管胰島素治療組糖尿病患者的全因死亡和癌癥死亡風(fēng)險(xiǎn)均較高，但其病情相對(duì)嚴(yán)重，故應(yīng)謹(jǐn)慎解讀該研究結(jié)果。

The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes.

We recruited 8,774 insulin-naive diabetes patients from the Shanghai Diabetes Registry (SDR). The follow-up rate was 85.4%. All subjects were divided into the insulin use cohort (n =3,639) and the non-insulin use cohort (n = 5,135). The primary outcome was the first diagnosis of any cancer. The secondary outcome was all-cause mortality. Cox proportional hazards model was used to estimate the relative risk (RR) of cancer and mortality.

We observed 98 cancer events in the insulin use cohort and 170 in the non-insulin use cohort. Cancer incidence rates were 78.6 and 74.3 per 10,000 patients per year in the insulin users and the non-insulin users, respectively. No significant difference in cancer risk was observed between the two cohorts (adjusted RR=1.20, 95% CI 0.89-1.62, P=0.228). Regarding site-specific cancers, only the risk of liver cancer was significantly higher in the insulin users compared to that in the non-insulin users (adjusted RR = 2.84, 95% CI 1.12-7.17, P=0.028). The risks of overall mortality (adjusted RR = 1.89, 95% CI 1.47-2.43, P<0.0001) and death from cancer (adjusted RR = 2.16, 95% CI 1.39-3.35, P = 0.001) were all significantly higher in the insulin users than in the non-insulin users.

There was no excess risk of overall cancer in patients with type 2 diabetes who were treated with human insulin. However, a significantly higher risk of liver cancer was found in these patients. Moreover, insulin users showed higher risks of overall and cancer mortality. Considering that individuals treated with insulin were more likely to be advanced diabetic patients, caution should be used in interpreting these results.