胰岛素-胰岛素样生长因子-1轴与结直肠癌

刘蕊; 江涛

doi:10.3969/j.issn.1000-8179.2011.10.017

摘要: 摘要 2型糖尿病与结直肠癌均为常见的慢性疾病，并且2型糖尿病患者易并发结直肠癌。国外流行病学发现， 2型糖尿病（type 2 diabetes mellitus， T2DM）患者高胰岛素血症与结直肠癌患病风险增加具有潜在相关性，而且长期接受胰岛素治疗的患者可使这种风险加倍，并随着胰岛素治疗年限的增加其患病风险也增加。高胰岛素血症假说认为，血清异常增高的胰岛素及游离胰岛素生长因子-1 （insulin-like growth factor-1， IGF-1）水平可通过胰岛素-胰岛素样生长因子-1轴促进结直肠上皮细胞增殖转化、抑制细胞凋亡导致结直肠癌的发生，因此胰岛素-IGF-1轴在2型糖尿病患者结直肠癌的发生、发展过程中具有重要作用。由于结直肠癌早期大多无症状或症状不明显，故2型糖尿病患者均应选择合适的筛选形式，有效防止结直肠癌的发生和向晚期发展，以提高患者生存率和生存质量。本文主要就2型糖尿病患者胰岛素治疗与结直肠癌的流行病学以及相关机制胰岛素-胰岛素样生长因子-1轴进行综述，并展望胰岛素-胰岛素样生长因子-1轴在实现结直肠癌靶向治疗的应用前景，为结直肠癌的早期预防和靶向治疗提供有益的参考。

Abstract: Insulin-Insulin-Like Growth Factor-1 Axis and Colorectal CancerRui LIU, Tao JiangCorrespondence to: Rui LIU, E-mail:lr3595@yahoo.com.cnDepartment of Clinical Laboratory, Tianjin Union Medicine Center, Tianjin 300121, ChinaThis work was supported by a grant from the Key Program of Tianjin Municipal Department of Health (Grant no. 06KR10)Abstract Type 2 diabetes mellitus and colorectal cancer are common chronic diseases. Patients with Type 2 diabetes mellitushave an increased risk of developing colorectal cancer. Foreign epidemiological studies show that hyperinsulinemia in the context ofType 2 diabetes mellitus is potentially associated with an increased risk of developing colorectal cancer. The risk is higher if the patientshave been treated with insulin, and there is an increasing risk of cancer with longer duration of insulin treatment. The hyperinsulinemiahypothesis suggests that elevated levels of insulin and free IGF-1 may promote the proliferation and inhibit the apoptosis of colorectalepithelial cell via the insulin-insulin-like growth factor-1 ( IGF-1 ) axis, ultimately resulting in colorectal cancer. Therefore, the role ofthe insulin-IGF-1 axis is important in the development of colorectal cancer among Type 2 diabetics. In addition, because most of the ear-ly symptoms of this disease are not always obvious, all patients with Type 2 diabetes mellitus should choose the appropriate screeningmodality to effectively prevent or suppress the development of colorectal cancer and get a better quality of life. This review summarizesthe epidemiology of insulin therapy among Type 2 diabetes patients with higher colorectal cancer risk and the role of the insulin-IGF-1axis in the development of colorectal cancer. Furthermore, the present study discusses the application of insulin–IGF-1 axis in targetedtherapy for colorectal cancer. This review is intended as a useful reference for the early prevention and targeted therapy of colorectalcancer.Keywords Type 2 diabetes mellitus; Insulin; Insulin-like growth factor-1; Colorectal cancer; Screening