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目的探讨抗糖尿病药物与乳腺癌发病的关系,为乳腺癌的预防提供科学依据。方法于2013年1月~2015年10月,在北京垂杨柳医院及哈尔滨医科大学附属第三医院首次就诊并实施手术治疗的417例新发乳腺癌合并2型糖尿病(T2DM)的患者(糖尿病诊断5年内的)作为病例组,选取同时期在北京垂杨柳医院健康体检中心参加体检的年龄≥30岁有T2DM病史(诊断5年内)的女性438人作为对照组。病例组经病理学诊断为原发性乳腺癌且无其他肿瘤病史,年龄≥30岁,病例间无任何血缘关系。收集研究对象的基本信息,乳腺癌其他危险因素及二甲双胍、磺脲类药物及胰岛素使用情况。单因素分析使用χ2检验,混杂因素的调整使用多元logistic分析,以P<0.05为差异有统计学意义。结果两组年龄、文化程度、月收入及婚姻状况在病例组与对照组间差异均无统计学意义。被动吸烟、流产史、工作或家庭压力及无体育锻炼与糖尿病者患乳腺癌有统计学关联,OR(95%CI)分别为:4.986(3.330~7.465)、2.357(1.780~3.122)、3.036(2.221~4.149)及1.687(1.199~2.374),其他因素,如吸烟史、饮酒史、月经初潮、绝经、母乳喂养、体质指数、产第一胎年龄均在病例组与对照组间差异无统计学意义。经调整年龄、文化程度、工作强度、月收入、被动吸烟、体育锻炼、流产史、工作或家庭压力及体质指数后,二甲双胍药物与乳腺癌发病有统计学关联(OR=0.170,95%CI:0.125~0.259),磺脲类药物与乳腺癌发病有统计学关联(OR=2.357,95%CI:1.460~4.025),胰岛素与乳腺癌发病无统计学关联(OR=1.236,95%CI:0.969~2.857)。结论降糖药物二甲双胍为乳腺癌发病的保护因素,而磺脲类药物为乳腺癌发病的危险因素,胰岛素与乳腺癌没有关联。
Objective To investigate the relationship between antidiabetic drugs and the incidence of breast cancer and provide a scientific basis for the prevention of breast cancer. Methods From January 2013 to October 2015, 417 newly diagnosed breast cancer patients with type 2 diabetes mellitus (T2DM) who were treated and treated surgically at Chu Yang Yang Liu Hospital of Beijing and the Third Affiliated Hospital of Harbin Medical University (diagnosis of diabetes 5 years) as the case group, 438 women with the history of T2DM (diagnosis of 5 years) who were ≥30 years of age who participated in the physical examination during the same period in the Chaoyangliu Hospital of Health Examination Center of Beijing were selected as the control group. Cases of pathological diagnosis of primary breast cancer and no other tumor history, age ≥ 30 years old, no blood relationship between cases. Collect the basic information of subjects, other risk factors of breast cancer and the use of metformin, sulfonylureas and insulin. Univariate analysis using χ2 test, the adjustment of confounding factors using multivariate logistic analysis to P <0.05 was considered statistically significant. Results There was no significant difference in age, education level, monthly income and marital status between the case group and the control group. OR (95% CI) were 4.986 (3.330 ~ 7.465), 2.357 (1.780 ~ 3.122), 3.036 (1.780 ~ 3.122) respectively, while there was a significant correlation between passive smoking, history of abortion, work or family stress and no physical exercise and diabetes. 2.221 ~ 4.149) and 1.687 (1.199 ~ 2.374). Other factors, such as smoking history, drinking history, menarche, menopause, breastfeeding, body mass index, and the age at first birth, were no significant differences between the case group and the control group significance. Metformin drug was significantly associated with the incidence of breast cancer (OR = 0.170, 95% CI: 1). After adjusting for age, education level, work intensity, monthly income, passive smoking, physical exercise, abortion history, work or family stress and body mass index, (OR = 2.357, 95% CI: 1.460 ~ 4.025). There was no significant correlation between insulin and breast cancer incidence (OR = 1.236, 95% CI: 0.969 ~ 2.857). Conclusions Metformin, a hypoglycemic agent, is a protective factor in the pathogenesis of breast cancer, while sulfonylureas are risk factors for breast cancer. Insulin is not associated with breast cancer.