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目的探讨细胞角蛋白19片段抗原21-1(CYFRA21-1)在糖尿病伴乳腺癌患者中的变化及临床意义。方法选取糖尿病伴乳腺癌患者(DM+乳腺癌组)103例、单纯糖尿病患者(DM组)98例、单纯乳腺癌患者(乳腺癌组)90例及体检健康女性(NC组)82名。另对DM+乳腺癌组随访2年,根据乳腺癌转移和复发情况分为复发亚组30例和非复发亚组68例。收集各组临床资料,ELISA测定血清CYFRA21-1的表达水平。采用多元逐步回归分析糖尿病伴乳腺癌患者CYFRA21-1水平的影响因素。结果(1)DM+乳腺癌组和DM组FPG、2hPG、FIns、HbA_1c及HOMA-IR高于单纯乳腺癌组和NC组,且DM+乳腺癌组2hPG、FIns、HbA_1c及HOMA-IR高于DM组(P<0.05);(2)DM+乳腺癌组、DM组及单纯乳腺癌组CYFRA21-1[(8.82±3.83)vs(5.16±2.77)vs(6.38±3.11)vs(1.02±0.33)ng/ml]、游离PSA(FPSA)[(0.06±0.01)vs(0.02±0.01)vs(0.04±0.01)vs(0.01±0.01)ng/ml]、总PSA(TPSA)[(0.69±0.22)vs(0.25±0.11)vs(0.39±0.27)vs(0.13±0.08)ng/ml]、CA153[(64.51±9.11)vs(19.30±2.32)vs(39.77±5.10)vs(7.40±2.59)U/ml]及CEA[(12.79±3.61)vs(2.23±0.50)vs(6.22±1.38)vs(1.57±0.48)ng/ml]水平均高于NC组(P<0.05或P<0.01)。DM+乳腺癌组各指标均高于DM组和单纯乳腺癌组,而DM组CYFRA21-1、游离前列腺特异性抗原(FPSA)、CA153及CEA低于单纯乳腺癌组(P<0.05或P<0.01);(3)复发亚组年龄、糖尿病病程、FPG、2hPG、FIns、HbA_1c、HOMA-IR及CYFRA21-1水平均高于非复发亚组(P<0.05);(4)多元逐步回归分析显示,年龄、糖尿病病程、HbA_1c是糖尿病伴乳腺癌患者CYFRA21-1水平的影响因素(P=0.000、0.000、0.012)。结论 CYFRA21-1在糖尿病伴乳腺癌患者血清中水平升高,可能是糖尿病伴乳腺癌患者乳腺癌复发的预测指标之一。年龄、糖尿病病程、HbA_1c是糖尿病伴乳腺癌患者CYFRA21-1水平的影响因素。
Objective To investigate the changes and clinical significance of cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) in patients with diabetes mellitus and breast cancer. Methods 103 patients with diabetes mellitus and breast cancer (DM + breast cancer), 98 patients with DM (DM group), 90 patients with simple breast cancer (breast cancer) and 82 healthy women (NC) were enrolled. Another DM + breast cancer group were followed up for 2 years, according to breast cancer recurrence and recurrence was divided into 30 cases of recurrence subgroup and 68 cases of non-recurrence subgroup. The clinical data of each group were collected and the expression level of serum CYFRA21-1 was determined by ELISA. Factors influencing the level of CYFRA21-1 in diabetic patients with breast cancer were analyzed by multivariate stepwise regression analysis. Results (1) FPG, 2hPG, FIns, HbA_1c and HOMA-IR in DM + breast cancer group and DM group were higher than those in simple breast cancer group and NC group, and the levels of 2hPG, FIns, HbA 1c and HOMA-IR in DM + breast cancer group were higher than those in DM group (P <0.05); (2) The expression of CYFRA21-1 [(8.82 ± 3.83) vs (5.16 ± 2.77) vs (6.38 ± 3.11) vs (1.02 ± 0.33) ng / (P <0.01), total PSA (TPSA) [(0.69 ± 0.22) vs (P <0.01) 0.25 ± 0.11 vs 0.39 ± 0.27 vs 0.13 ± 0.08 ng / ml], CA153 [(64.51 ± 9.11) vs (19.30 ± 2.32 vs (39.77 ± 5.10) vs (7.40 ± 2.59) U / ml] (12.79 ± 3.61 vs 2.23 ± 0.50 vs 6.22 ± 1.38 vs 1.57 ± 0.48 ng / ml, respectively) were significantly higher than those in NC group (P <0.05 or P <0.01). The indexes of DM + breast cancer group were higher than that of DM group and simple breast cancer group, while CYFRA21-1, FPSA, CA153 and CEA in DM group were lower than those in simple breast cancer group (P <0.05 or P <0.01) ); (3) The age, duration of diabetes, FPG, 2hPG, FIns, HbA_1c, HOMA-IR and CYFRA21-1 levels in recurrence subgroup were higher than those in non-recurrence subgroup (P <0.05) , Age, duration of diabetes and HbA_1c were the influencing factors of CYFRA21-1 level in diabetic patients with breast cancer (P = 0.000,0.000,0.012). Conclusions CYFRA21-1 levels in serum of patients with diabetes mellitus and breast cancer may be one of the predictors of breast cancer recurrence in patients with diabetes mellitus and breast cancer. Age, duration of diabetes, and HbA_1c are the influencing factors of CYFRA21-1 in patients with diabetes mellitus and breast cancer.