PO.PR02.03 · 预防研究
胰岛素抵抗替代标志物与结直肠癌风险之间的关联：来自一项韩国成人大规模前瞻性队列的结果
Association between proxy markers of insulin resistance and colorectal cancer risk: results from a large scale prospective cohort of Korean adults
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摘要 Abstract
中文摘要
背景：结直肠癌（CRC）仍是韩国最常见的癌症之一，凸显了识别可改变风险因素的重要性。尽管胰岛素抵抗已被认为与CRC的发生有关，但现有证据仍不一致，且胰岛素抵抗的直接测量在临床实践中并非常规采集。这一局限凸显了在流行病学和临床环境中使用简单的胰岛素抵抗替代标志物的潜在效用。在本研究中，我们调查了几种胰岛素抵抗替代标志物与韩国成人CRC风险之间的关联。
方法：利用韩国基因组与流行病学研究健康受检者队列的数据，我们采用Cox回归模型评估了几种胰岛素抵抗替代标志物（包括TG/HDL比值、甘油三酯-葡萄糖指数（TyG）、TyG-BMI指数、TyG-腰围指数（TyG-WC）、TyG-腰高比指数（TyG-WHTR）以及胰岛素抵抗代谢评分（METS-IR））与CRC风险之间的关联。亚组分析按性别、年龄、糖尿病状态和既往筛查经历进行分层，并基于不同随访时长进行了敏感性分析。
结果：在中位随访9.3年期间，在106,965名40-69岁的韩国人（36,899名男性和70,066名女性）中观察到795例新发CRC病例。对于TG/HDL比值，最高四分位组个体的CRC风险显著高于最低四分位组（HR：1.23，95% CI：1.00-1.53）。TyG和TyG-WC指数也观察到类似模式，第4四分位与CRC发病率增加相关（TyG Q4 HR：1.30，95% CI：1.04-1.63；TyG-WC Q4 HR：1.36，95% CI：1.01-1.83）。最后，METS-IR指数呈现出分级关联，最高四分位与CRC发病率显著相关（Q4 HR：1.26，95% CI：1.02-1.57）。
结论：在这项大规模人群队列中，多种胰岛素抵抗替代标志物与结直肠癌风险增加独立相关，在最高四分位中观察到最强的效应。这些发现表明，与胰岛素抵抗相关的代谢失调参与了结直肠癌的发生，且简单的脂质-葡萄糖-人体测量学标志物可能有助于识别高风险个体。
查看英文原文 English abstract
Background : Colorectal cancer (CRC) remains one of the most common cancers in Korea, underscoring the importance of identifying modifiable risk factors. Although insulin resistance has been implicated in CRC development, existing evidence remains inconsistent, and direct measures of insulin resistance are not routinely collected in clinical practice. This limitation highlights the potential utility of simple proxy markers of insulin resistance in epidemiologic and clinical settings. In this study, we investigated the associations between several proxy insulin resistance markers and CRC risk among Korean adults.
Methods: Using data from the Korean Genome and Epidemiology Study Health Examinee cohort, we evaluated the associations between several proxy markers of insulin resistance, including the TG/HDL ratio, triglyceride-glucose index (TyG), TyG-BMI index, TyG-waist circumference index (TyG-WC), TyG-waist-to-height ratio index (TyG-WHTR), and the metabolic score for insulin resistance (METS-IR), and CRC risk using Cox regression models. Subgroup analyses were stratified by sex, age, diabetes status, and prior screening experience, and sensitivity analyses were conducted based on varying follow-up durations.
Results: During a median follow-up period of 9.3 years, 795 new CRC cases were observed among 106,965 Koreans aged 40-69 years (36,899 men and 70,066 women). For the TG/HDL ratio, individuals in the highest quartile had a significantly elevated CRC risk compared with the lowest quartile (HR: 1.23, 95% CI: 1.00-1.53). A similar pattern was observed for the TyG and TyG-WC indices, where quartile 4 was associated with increased CRC incidence (TyG Q4 HR: 1.30, 95% CI: 1.04-1.63; TyG-WC Q4 HR: 1.36, 95% CI: 1.01-1.83). Finally, the METS-IR index showed a graded association, and the highest quartile was significantly associated with CRC incidence (Q4 HR: 1.26, 95% CI: 1.02-1.57).
Conclusions: In this large population-based cohort, multiple surrogate markers of insulin resistance were independently associated with an increased risk of colorectal cancer, with the strongest effects observed in the highest quartiles. These findings indicate that metabolic dysregulation related to insulin resistance contributes to colorectal carcinogenesis and that simple lipid-glucose-anthropometric markers may help identify individuals at elevated risk.
利益披露 Disclosure
S. Min, None..
H. Lee, None..
S. Cho, None..
S. Lee, None..
J. Kim, None..
J. Choi, None..
D. Kang, None.