血糖對於子宮頸上皮細胞病變的影響

Effect of Blood Glucose on Cervical Epithelial Pathogenesis

10.3966/168232812020063002003

蘇家龍(Jia-Lung Su)；王俊堯(Jiun-Yao Wang)；蔡濬莉(Jun-Li Tsai)；林彥廷(Yen-Ting Lin)；蔡崇煌(Chung-Huang Tsai)；李孟智(Meng-Chih Lee)；翁瑞宏(Ruey-Hong Wong)

子宮頸上皮細胞 ； 子宮頸癌 ； 血糖 ； 抹片 ； 切片檢查 ； cervical biopsy ； cervical cancer ； cervical epithelial cells ； pap smear ； serum glucose level

台灣家庭醫學雜誌

30卷2期（2020 / 06 / 01）

78 - 91

繁體中文

目的：正常的子宮頸上皮細胞變化為子宮頸癌之前，會經過一連串的細胞分化。已知第二型糖尿病與子宮頸癌的發生率和死亡率的增加有關；然而，高血糖是否相關於子宮頸上皮細胞之病變則是不清楚的。本研究目的為釐清高血糖是否會促進正常子宮頸上皮細胞病變。方法：本研究是一項以醫院為基礎的回溯性世代研究，分析3,937名研究對象從2011年1月1日至2017年12月31日之子宮頸抹片與切片檢查資料。研究對象於研究期間至少進行兩次的子宮頸抹片檢查，任一次抹片檢查異常者均進一步進行病理切片確認。研究對象以空腹血糖值分為三組（空腹血糖＜100 mg/dL、100-125 mg/dL、以及≥ 126 mg/dL）進行統計分析，並以對數迴歸模型分析，並調整多項干擾因子，以了解較高空腹血糖組是否較易造成子宮頸上皮細胞病變，或較難以從癌前病變回復。所有的p值皆以雙尾檢定來計算。結果：3937名受試者中，第一次抹片檢查異常率為12.9%，第二次抹片檢查異常率則增加至16.2%，在調整干擾因子之效應後，相較於空腹血糖正常者，空腹血糖為100-125 mg/dL者（odds ratio [OR] 1.47, 95% confidence interval [CI]1.00-2.16）與≥ 126 mg/dL者（OR 1.85, 95% CI 0.99-3.45）呈現顯著較高的子宮頸上皮細胞惡化危險性，以及較差的子宮頸上皮細胞回復率（OR 0.29, 95%CI 0.13-0.64，與OR 0.08, 95% CI 0.02-0.28）。結論：高空腹血糖可能是影響子宮頸癌前病變發展的重要因子。

Purpose: There are several mechanisms involved in the process of cervical epithelial carcinogenesis. We all know that Type 2 diabetes is connected with higher cancer mortality, including cervical cancers. Nevertheless, there is no sufficient evidence linking higher blood glucose to greater cervical epithelial morbidity. The study accordingly aims at exploring whether higher serum glucose level induces pathogenesis of cervical epithelial cells. Methods: The research is a retrograde cohort study based on a single hospital database containing all the Pap smear and cervical biopsy data of 3,937 subjects collected during the period from January, 2011 to December, 2017. Every subject received at least two pap-smear exams during the study period, and those with abnormality confirmed in one pap smear were required to have cervical biopsy. All subjects were stratified by fasting serum glucose level into three groups (fasting serum glucose ＜ 100 mg/dL, 100-125 mg/dL, and ≥ 126 mg/dL). Logistic regression model was used for analysis to adjust multiple risk factors, and p value was double-sided. Results: The abnormality rate read 12.9% in the first pap-smear test increased to 16.2% in the second test. With multiple risk factors adjusted, compared with those with normal fasting serum glucose, subjects with higher fasting serum glucose showed not only a higher rate of exacerbated pap smears and cervical biopsy outcomes (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.00-2.16 in glucose level 100-125 mg/dL , and OR 1.85, 95% CI 0.99-3.45 in glucose level ≥ 126 mg/dL) but also a lower rate of regressing from cervical pre-cancer lesions (OR 0.29, 95% CI 0.13-0.64 in glucose level 100-125 mg/dL, and OR 0.08, 95% CI 0.02-0.28 in glucose level ≥ 126 mg/dL). Conclusion: High fasting serum glucose may lead to worsening of cervical epithelial pre-cancer lesions and prevent cervical pre-cancer lesions from regressing.

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