儿童胰腺接受放射可有糖尿病风险
2012-08-24 17:46:36   来源： 丁香园   作者：  评论：0 点击：

1. Children with cancer who undergo radiation to the pancreas are at increased risk for developing diabetes decades later, particularly when the exposure involves high doses, European researchers found.

欧洲的研究人员发现，儿童癌症胰腺接受辐射可导致在几十年后发展为糖尿病的风险增加，特别是当暴露于高剂量辐射时。
2.The estimated relative risk for later diabetes was 1.61 (95% CI 1.21 to 2.68) when the radiation dose to the pancreas totaled 1 Gy, according to Florent de Vathaire, MD, of the Institut Gustave Roussy in Villejuif, France, and colleagues.

根据Florent de Vathaire和他的同事的研究，估计发展为糖尿病的相对风险为1.61（95%可信区间1.21至2.68）时胰腺的辐射剂量为1戈瑞。而Florent de Vathaire博士是法国古斯塔夫研究所的研究员。
3.But among children who were exposed to doses of 10 Gy and higher to the tail of the pancreas, where most of the islets of Langerhans are found, the relative risk rose to 11.5 (95% CI ), the researchers reported online in Lancet Oncology.

但根据研究人员报告在“柳叶刀：肿瘤学”在线上的结果，在胰尾暴露于10戈瑞剂量或更高的儿童之中，其中大部分胰岛被发现有朗格汉斯细胞，发生糖尿病的相对风险上升到11.5（95%可信区间）。
4."Our investigation emphasizes the importance of long-term follow-up of childhood cancer survivors," they advised.

“我们的研究强调对儿童癌症幸存者长期的后续的跟踪的重要性，“他们提出。
5.Childhood cancer survivors are at risk for various health difficulties later in life, including disorders of the endocrine system, and one earlier study identified a link with diabetes among patients who had undergone radiation therapy.

儿童癌症幸存者在以后的生活处于各种健康问题的风险中，包括内分泌系统疾病，而之前的研究确定了糖尿病与经历了放射治疗的联系。
6.To confirm this in a large cohort, de Vathaire and colleagues contacted 2,520 individuals in France and the U.K. who had been treated for lymphoma or a solid cancer between 1985 and 1995 and survived for at least 20 years. Their medical records were examined to ascertain the details of their treatment. Diabetes was patient-reported and the diagnosis was confirmed with their medical doctors.

为了在一个大型队列试验中确认这一点，de Vathaire 和同事联系了2520个1985和1995年之间在法国和英国已治疗淋巴瘤或实体癌症且存活至少20年的病人。他们的医疗记录被进行审查以确定治疗的细节。糖尿病病人由个人申报和而诊断由医疗医生确认。
7.A total of 65% had undergone radiation for malignancies including nephroblastoma, neuroblastoma, non-Hodgkin's lymphoma, and tumors of the central nervous system.

共有65%的个体经历了恶性肿瘤包括肾母细胞瘤，神经母细胞瘤，非霍奇金淋巴瘤，与中枢神经系统肿瘤的辐射。
8.Three-quarters had received a single course of of radiotherapy, while smaller numbers were given multiple courses.

四分之三收到了单一疗程放射治疗，而小部分接受多个疗程。
9.The mean radiation dose to the body of the pancreas was 12 Gy, while the dose to the tail averaged 8.8 Gy.

对胰体的平均辐射剂量是12戈瑞，而胰尾剂量为8.8戈瑞。
10.During 30 years of follow-up, 65 patients developed confirmed diabetes. The condition was rare before adulthood, but these cumulative incidence rates were seen by age 45:

• Overall, 5.5% (95% CI 4.1 to 7.5)
• No radiation treatment, 2.3% (95% CI 0.8 to 6.4)
• Radiation treatment, 6.6% (95% CI 4.8 to 9, P=0.0003)

在30年随访过程中，65例被确诊糖尿病。条件是罕见的成年之前，但45岁后这些累积发病率开始显现：

总体，5.5%（95%可信区间4.1 - 7.5）

无辐射治疗，2.3%（95%可信区间0.8 - 6.4）

放射治疗，6.6%（95%可信区间为4.8 - 9，P= 0.0003）

11.There also was a clear dose-response effect, with a cumulative incidence at age 45 of 16.3% for individuals with exposure to the tail of the pancreas exceeding 10 Gy.

有一个明确的剂量反应效应，在45岁、胰尾接触超过10戈瑞个人的累积发病率为16.3%。
12.The dose-response effect was independent of body mass index and was apparent in both insulin-dependent and non-insulin dependent diabetes as well as in both men and women.

剂量反应效应是独立于身体质量指数且在男人和女人、胰岛素依赖型和非胰岛素依赖型糖尿病均明显。
13.The youngest patients were more susceptible to later diabetes, with an excess relative risk of 1.19 per Gy (95% CI 0.38 to 3.49, P=0.018) in those who had been treated with radiation before age 2 years.

最年轻的患者更容易受到未来的糖尿病困扰，曾2年前接受放射治疗的病人，其过剩相对风险为1.19每戈瑞（95%可信区间0.38 - 3.49，P= 0.018）。
14.The type of cancer also was a strong factor, with the highest incidence of diabetes at age 45 occurring among patients having had nephroblastoma, at 14.7% (95% CI 9.6 to 22.2) compared with 3.1% (95% CI 2.1 to 4.6) for other malignancies. The study cohort did not include leukemia survivors, who are at high risk of obesity and diabetes, the authors said.

作者们说，癌症的类型也是一个强有力的因素，在45岁及以上最高的糖尿病发病率发生在有肾母细胞瘤的患者，占14.7% （95%可信区间9.6至22.2）。而其他恶性肿瘤为3.1%（95%可信区间2.1至4.6）。该队列研究不包括有肥胖和糖尿病高风险的白血病幸存 者。
15.Chemotherapy overall did not appear to influence diabetes risk, nor did radiation exposure to organs other than the pancreas.

化疗整体似乎并没有影响糖尿病的风险，也不针对胰腺以外器官。
16.Still, radiation does have other potentially relevant abdominal effects, such as damage to subcutaneous adipose tissue, according to Kevin C. Oeffinger, MD, and Charles A. Sklar, MD, of Memorial Sloan-Kettering Cancer Center in New York City.

不过，辐射也有其他可能导致相关的腹部损伤，例如对皮下脂肪组织，纽约市斯隆-凯特林癌症中心的凯文. 奥芬格博士和查尔斯. 斯克拉博士的介绍道。
17."We hypothesize that with the loss of the normal abdominal subcutaneous depot, fat accumulation occurring with aging is preferentially stored in the deep viscera," Oeffinger and Sklar wrote in an accompanying commentary.

“我们假设如果丧失正常腹部皮下注射，脂肪积累的发生通常是优先存储在深部脏器，“奥芬格和斯克拉写的一篇评论中说。
18."Because visceral adiposity is strongly linked to insulin resistance, we speculate that this preferential increase in visceral adiposity might contribute to relative beta-cell insufficiency with insufficiency with insulin resistance developing in adulthood," they noted.

“因为内脏肥胖与胰岛素抵抗是密切相关的，我们推测，这一内脏肥胖的增加可能有助于成年时胰岛素抵抗于胰岛β细胞功能不全的发展，”他们提示说。
19.Limitations of the study included the chance of reporting bias, the exclusion of patients who died, and reliance on the less accurate radiation dose estimations than those used today.

该研究的局限性包括机会性报告偏见，排除死亡病人，并依赖于相比于现在不太准确的辐射剂量估计。
20.Nonetheless, when children with cancer are being treated with radiation, exposure to the pancreas should be as minimal as possible and should not exceed "a few Gy," de Vathaire and colleagues cautioned.

然而，当儿童癌症患者正在接受辐射治疗时，接触到胰腺的剂量应尽可能最小，不应超过“几个戈瑞，”de vathaire和他的同事警告。
21.The study was funded by the Ligue Nationale Contre le Cancer, the Institut de Recherche en Santé Publique, the Programme Hospitalier de Recherche Clinique, the Institut National du Cancer, the Agence Française de Sécurité Sanitaire et des Produits de Santé, and the Fondation Pfizer pour la santé de l'enfant et de l'adolescent.

该研究由联盟国家癌症研究所、公共保健研究所、国家癌症临床项目研究会,法国食品安全及卫生产品开发署以及辉瑞儿童青少年卫生基金会联合资助。

22.The authors declared no conflicts of interest.

作者宣称没有利益冲突。