编者按：代谢综合征指人体的蛋白质、脂肪、碳水化合物等物质发生代谢紊乱的病理状态，主要包括高血压、血脂异常（甘油三酯偏高、低密度脂蛋白胆固醇偏高、高密度脂蛋白胆固醇偏低）、高血糖（糖尿病、空腹血糖偏高、葡萄糖耐受不良、胰岛素抵抗、高胰岛素血症）、高血黏、高尿酸、肥胖（尤其中心肥胖或称腹部肥胖、向心型肥胖）、脂肪肝、微白蛋白尿、凝血因子异常，可以引起多种疾病增加，如高血压、冠心病、脑卒中、癌症（包括乳腺癌、子宫内膜癌、前列腺癌、胰腺癌、肝胆癌、结肠癌）。代谢综合征与肥胖密切相关，为女性肥胖相关癌的预后因素。代谢综合征还与C反应蛋白相关，其水平升高为癌症风险因素。但是，代谢综合征和C反应蛋白与癌症死亡风险的相关性尚不明确。
2018年3月14日，国际抗癌联盟《国际癌症杂志》在线发表美国印第安纳大学的研究报告，调查了代谢综合征、代谢综合征五大指标（腰围、收缩压、甘油三酯、高密度脂蛋白胆固醇、葡萄糖）和C反应蛋白与女性癌症死亡是否相关。
该研究从1988～1994年美国全国健康与营养问卷调查III（NHANESIII）年龄≥18岁符合条件非妊娠女性1万104例，确定癌症死亡400例，其中肥胖相关癌症（乳腺癌、结直肠癌、胰腺癌、子宫内膜癌）死亡140例，并与全国死亡指数关联。通过多因素比例风险回归，推算癌症死亡的多因素（年龄，种族，学历，是否经常运动，是否吸烟，是否饮酒，是否使用降糖、降压、降脂药物）校正后风险比。
结果发现，有、无代谢综合征者相比：
所有癌死亡风险高1.33倍（95%：1.04～1.70）
肥胖癌死亡风险高1.13倍（95%：0.70～1.81）
乳腺癌死亡风险高2.11倍（95%：1.09～4.11）
代谢综合征五大指标（腰围、收缩压、甘油三酯、高密度脂蛋白胆固醇、葡萄糖）全部异常与全部正常者相比：
所有癌死亡风险高1.73倍（95%：1.12～2.68）
肥胖癌死亡风险高2.09倍（95%：1.00～4.37）
乳腺癌死亡风险高3.83倍（95%：1.34～10.9）
血压（收缩压）最高1/4（≥136mmHg）与最低1/4（≤107mmHg）者相比：
所有癌死亡风险高1.32倍（95%：0.83～2.09，趋势P=0.0225）
肥胖癌死亡风险高2.50倍（95%：1.02～6.12，趋势P=0.0034）
乳腺癌死亡风险高1.44倍（95%：0.50～4.14，趋势P=0.1768）
血糖（葡萄糖）最高1/4（≥101mg/dL）与最低1/4（≤84mg/dL）者相比：
所有癌死亡风险高1.39倍（95%：0.98～1.98，趋势P=0.0163）
肥胖癌死亡风险高2.18倍（95%：1.04～4.60，趋势P=0.0337）
乳腺癌死亡风险高3.19倍（95%：1.11～9.20，趋势P=0.0176）
腰围最大1/4（≥100.9cm）与最小1/4（≤ 79.1cm）者相比：
所有癌死亡风险高1.13倍（95%：0.78～1.62，趋势P=0.2545）
肥胖癌死亡风险高1.00倍（95%：0.53～1.89，趋势P=0.7138）
乳腺癌死亡风险高3.46倍（95%：1.14～10.5，趋势P=0.0049）
C反应蛋白和代谢综合征其他指标（甘油三酯、高密度脂蛋白胆固醇）与所有癌、肥胖相关癌、乳腺癌的死亡风险无显著相关性。
因此，代谢综合征的严重程度，与所有癌和乳腺癌的死亡风险增加相关，其中腰围、血压、血糖是肥胖相关癌和乳腺癌的死亡风险独立预测因素。
Int J Cancer. 2018 Mar 14. [Epub ahead of print]
Associations of metabolic syndrome and C-reactive protein with mortality from total cancer, obesity-linked cancers and breast cancer among women in NHANES III.
Wambui G. Gathirua-Mwangi, Yiqing Song, Patrick O. Monahan, Victoria L. Champion, Terrell W. Zollinger.
Indiana University, Indianapolis, IN.
What's new?
Metabolic syndrome (MetS) is closely associated with obesity and is a prognostic factor in obesity-linked cancers in women. MetS also is correlated with C-reactive protein (CRP), elevated levels of which are a risk factor for cancer. Whether MetS and CRP are jointly linked to cancer mortality, however, is unclear. In this study, MetS severity was associated with an increased risk of total cancer mortality and breast cancer mortality. Of MetS components, waist circumference, blood glucose and blood pressure were most strongly associated with mortality. CRP alone, however, was not significantly associated with total cancer, obesity-linked or breast cancer mortality.
Although metabolic syndrome (MetS) is a prognostic factor for cancer occurrence, the association of MetS and cancer mortality remains unclear. The purpose of this study was to evaluate whether MetS, components of MetS and C-reactive protein (CRP) are associated with cancer mortality in women. A total of 400 cancer deaths, with 140 deaths from obesity-linked-cancers (OLCas), [breast (BCa), colorectal, pancreatic and endometrial], linked through the National Death Index, were identified from 10,104 eligible subjects aged ≥18 years. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HR) for cancer mortality. MetS was associated with increased deaths for total cancer [HR=1.33, 95% confidence interval (CI) 1.04-1.70] and BCa [HR=2.1, 95% CI, 1.09-4.11]. The risk of total cancer [HR=1.7, 95% CI, 1.12-2.68], OLCas [HR=2.1, 95% CI, 1.00-4.37] and BCa [HR=3.8, 95% CI, 1.34-10.91] mortality was highest for women with all MetS components abnormal, compared to those without MetS. Linear associations of blood-pressure [HR=2.5, 1.02-6.12, Quartile (Q) 4 vs Q1, p trend=0.004] and blood-glucose [HR=2.2, 1.04-4.60, Q4 vs. Q1, p trend=0.04] with total-OLCas mortality were observed. A threefold increased risk of BCa mortality was observed for women with enlarged waist circumference, ≥100.9 cm, [HR=3.5, 1.14-10.51, p trend=0.008] and in those with increased blood glucose, ≥101 mg/dL, [HR=3.2, 1.11-9.20, p trend=0.03] compared to those in Q1. None of the components of MetS were associated with total-cancer mortality. CRP was not associated with cancer mortality. In conclusion, MetS is associated with total-cancer and breast-cancer mortality, with waist circumference, blood pressure and blood glucose as independent predictors of OLCas and BCa mortality.
DOI: 10.1002/ijc.31344
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