Clinical study on inflammatory response mediated tumor marker elevation in patients with type 2 diabetes mellitus: propensity matching study and mediating model study / 中国医师进修杂志

ABSTRACT

Objective:To compare the expression of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) between type 2 diabetes mellitus (T2DM) and non-diabetic patients, and investigate the role of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and high sensitive C-reactive protein (hs-CRP) in the regulation of CA19-9 and CEA.Methods:From January to December 2016, a total of 146 patients with T2DM (T2DM group) were selected in Qinhuangdao Military Hospital of Hebei Province. According to age, gender, body mass index (BMI), waist circumference and hip circumference, propensity score was matched. A total of 146 healthy control group matches were completed according to the nearest neighbor matching method of 1∶1. According to the glycated hemoglobin (HbA 1c), the patients with T2DM were divided into 4 groups HbA 1c<7% 16 cases (A subgroup), 7% ≤ HbA 1c<9% 38 cases (B subgroup), 9% ≤ HbA 1c<11% 44 cases (C subgroup), HbA 1c ≥ 11% 48 cases (D subgroup). The mediating effects of IL-6, TNF-α and hs-CRP in CA19-9 and CEA levels in patients with T2DM were determined by stepwise linear regression. Results:The fasting plasma glucose (FBG), HbA 1c, IL-6, TNF-α, hs-CRP, CA19-9 and CEA in T2DM group were significantly higher than those in control group (9.95 ± 2.98) mmol/L vs. (4.89 ± 0.77) mmol/L, (9.85 ± 2.18)% vs. (5.71 ± 1.91)%, (46.51 ± 13.17) ng/L vs. (32.41 ± 13.74) ng/L, (45.41 ± 17.25) ng/L vs. (21.54 ± 15.01) ng/L, (4.99 ± 3.51) mg/L vs. (3.19 ± 3.15) mg/L, (13.35 ± 5.34) U/L vs. (8.58 ± 1.08) U/L and (2.51 ± 1.04) μg/L vs. (2.14 ± 1.01) μg/L, and there were statistical differences ( P<0.01). There were no statistical differences in gender composition, waist circumference, hip circumference, disease course and FBG among A subgroup, B subgroup, C subgroup and D subgroup ( P>0.05). There were statistical differences in the age, BMI, IL-6, TNF-α, hs-CRP, CA19-9 and CEA among 4 subgroups ( P<0.01 or <0.05). In patients with T2DM, the HbA 1c was positively correlated with IL-6, TNF-α, hs-CRP, CA19-9 and CEA ( r=0.863, 0.802, 0.495, 0.883 and 0.766; P<0.01). The IL-6, TNF-α and hs-CRP had some mediating effects in HbA 1c regulation of CA19-9 20.5% (0.181/0.883), 17.8% (0.157/0.883) and 8.2% (0.072/0.883), respectively; the TNF-α had some mediating effect in HbA 1c regulation of CEA 24.0% (0.184/0.766). Conclusions:There is a correlation between the levels of tumor markers and blood glucose in patients with T2DM, and inflammatory response is a potential regulatory variable.