糖脂代谢异常与结直肠癌发病风险的前瞻性队列研究

A prospective cohort study on glycolipid metabolic abnormalities and incident colorectal cancer risk

  • 摘要:目的】 基于自然人群队列,探讨多项糖脂代谢指标及其异常累积负担与结直肠癌发病风险的关系,并分析糖脂代谢异常在吸烟、饮酒和体力活动与结直肠癌发病之间的中介作用。【方法】 纳入江苏省泰州市自然人群队列“泰州队列”2011—2014年招募并符合纳入标准的17 897名参与者。采用Cox比例风险回归模型评估糖脂代谢常规指标、衍生指标以及基于总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖和胰岛素构建的糖脂代谢异常指数与结直肠癌发病风险的关联。应用限制性立方样条分析主要指标的剂量-反应关系,绘制受试者工作特征曲线比较不同糖脂代谢指标及糖脂代谢异常指数的预测效能,利用中介效应模型评估糖脂代谢异常指数在吸烟、饮酒和体力活动与结直肠癌发病关系中的中介作用。【结果】 随访时长中位数为11.2年,其间共识别出102例结直肠癌新发病例,发病密度每10万人年中51.2例。调整混杂因素后,Cox比例风险回归模型分析显示高密度脂蛋白胆固醇降低者的结直肠癌发病风险为正常者的1.74倍(HR=1.74,95% CI: 1.03~2.95),低密度脂蛋白胆固醇升高者的结直肠癌发病风险为正常者的1.78倍(HR=1.78,95% CI: 1.05~3.02),空腹血糖异常者的结直肠癌发病风险为正常者的1.86倍(HR=1.86,95% CI: 1.15~3.02);而在多变量限制性立方样条模型中空腹血糖水平与结直肠癌发病风险呈近似线性递增关系。糖脂代谢异常指数与结直肠癌风险呈明显梯度关系,异常糖脂代谢指标≥3项者的结直肠癌发病风险为无异常者的3.08倍(HR=3.08,95% CI: 1.60~5.92) ,其曲线下面积为0.795,高于各单项糖脂指标及其他联合指标;性别分层分析结果与全人群结果一致。糖脂代谢异常在吸烟、饮酒和体力活动与结直肠癌之间存在部分中介效应,中介比例分别为8.33%、9.45%和9.04%。【结论】 糖脂代谢异常与结直肠癌发病风险升高相关。糖脂代谢异常指数与结直肠癌风险呈递增关系且具有较好区分度,并且在总人群中糖脂代谢异常对吸烟、饮酒和体力活动与结直肠癌发病的关联表现出部分中介作用。

     

    Abstract: Objective To investigate the associations of multiple glycolipid metabolic indicators and their cumulative abnormality burden with incident colorectal cancer risk in a general population-based prospective cohort, and to examine the mediating role of glycolipid metabolic abnormalities in the relationships between smoking, alcohol consumption, physical activity, and colorectal cancer incidence. Methods A total of 17 897 eligible participants recruited from the Taizhou cohort from 2011 and 2014 were included. Cox proportional hazards regression models were used to assess the associations of conventional and derived glycolipid indicators, as well as a glycolipid abnormality index constructed from total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, and insulin, with incident colorectal cancer risk. Restricted cubic spline models were applied to evaluate dose-response relationships for major indicators. Receiver operating characteristic curves were generated to compare predictive performance across indicators. Mediation analyses were conducted to assess the mediating effects of the glycolipid abnormality index on the associations between smoking, alcohol consumption, physical activity, and colorectal cancer incidence. Results During a median follow-up of 11.2 years, 102 incident colorectal cancer cases were identified, with an incidence density of 51.2 per 100 000 person-years. After adjustment for potential confounders, Cox proportional hazards regression analyses showed that decreased high-density lipoprotein cholesterol was associated with a 1.74-fold higher risk of colorectal cancer (HR=1.74, 95%CI: 1.03-2.95), elevated low-density lipoprotein cholesterol was associated with a 1.78-fold higher risk (HR=1.78, 95%CI: 1.05-3.02), and abnormal fasting plasma glucose was associated with a 1.86-fold higher risk (HR=1.86, 95%CI: 1.15-3.02). Fasting plasma glucose showed an approximately linear increasing association with colorectal cancer risk. The glycolipid abnormality index showed a clear gradient association with colorectal cancer risk; participants with three or more abnormal indicators had a 3.08-fold higher risk than those without abnormalities (HR=3.08, 95%CI: 1.60-5.92). The area under the curve was 0.795, higher than that of individual glycolipid indicators and other combined indices, and sex-stratified analyses showed generally consistent patterns. Glycolipid metabolic abnormalities partially mediated the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence, with mediation proportions of 8.33%, 9.45%, and 9.04%, respectively. Conclusion Glycolipid metabolic abnormalities were associated with an increased risk of colorectal cancer incident. The glycolipid abnormality index showed an increasing relationship with colorectal cancer risk and demonstrated better discrimination, and it partially mediated the associations between smoking, alcohol consumption, physical activity, and colorectal cancer incidence in the overall population.

     

/

返回文章
返回