结直肠癌患者中2型糖尿病与非酒精性脂肪性肝病的性别特异性共现模式：一项基于电子病历的回顾性系列研究

摘要(中文译文)

结直肠癌（CRC）是全球重大健康负担，也是全球最常见的恶性肿瘤之一。其与代谢性合并症的关联正受到越来越多的关注。2型糖尿病（T2DM）和非酒精性脂肪性肝病（NAFLD）是两种相互关联的代谢性疾病，越来越多地被认为参与CRC的发病机制，可能通过胰岛素抵抗、慢性炎症、氧化应激及肠-肝轴失调等途径发挥作用。然而，关于二者在CRC患者中的共现情况及性别特异性分布的证据有限，尤其是在亚洲人群的真实临床环境中。本研究探讨了CRC患者中T2DM和NAFLD的性别特异性患病率及共现模式，并利用电子病历（EMRs）评估了相关的代谢特征。我们开展了一项基于电子病历的回顾性系列研究，纳入在中国某三级医院接受治疗的438例CRC患者，所有患者均符合严格的纳入标准，包括完整的诊断病史及2020年1月至2024年12月期间的结肠镜检查。T2DM和NAFLD的诊断依据医生明确记录的病历予以确认。采用描述性统计和双变量分析（卡方/Fisher精确检验及适当的参数或非参数检验）评估患病模式及代谢指标。T2DM和NAFLD在男性CRC患者中的患病率（分别为10.04%和8.18%）高于女性（5.92%和4.73%）。然而，两种疾病的共现较为罕见（0.68%）。合并T2DM或NAFLD的患者表现出独特的代谢异常，包括血糖升高、肝酶升高及血脂谱改变。双变量分析确定AST为NAFLD的潜在鉴别标志物。由于共现罕见（3/438，0.68%），精确分析未显示共现存在性别差异的证据（男性 vs. 女性 OR=1.26，95% CI 0.11-13.99；P=1.00）。本研究揭示了CRC患者中T2DM和NAFLD存在明显的性别特异性患病模式；然而，共现较为罕见，限制了推断性分析。这些发现强调需要更大规模的前瞻性研究，采用更精确的确认方法，以更好地描述CRC中代谢性合并症的模式，尤其是从性别特异性的角度。

Abstract

Colorectal cancer (CRC) is a major global health burden and one of the most prevalent malignancies worldwide. Its association with metabolic comorbidities is receiving increasing attention. Type 2 Diabetes Mellitus (T2DM) and Non-Alcoholic Fatty Liver Disease (NAFLD) are two interrelated metabolic disorders increasingly implicated in CRC pathogenesis, possibly via insulin resistance, chronic inflammation, oxidative stress, and gut-liver axis dysregulation. However, limited evidence exists on their co-occurrence and sex-specific distribution among CRC patients, particularly within real-world clinical settings in Asian populations. This study explored the sex-specific prevalence and co-occurrence patterns of T2DM and NAFLD among CRC patients and evaluated associated metabolic profiles using electronic medical records (EMRs). We conducted a retrospective EMR-based series study involving 438 CRC patients treated at a tertiary hospital in China, all of whom met strict inclusion criteria, including a complete diagnostic history and colonoscopy between January 2020 and December 2024. Diagnoses of T2DM and NAFLD were confirmed based on explicit physician-documented records. Descriptive statistics and bivariate analyses (chi-square/Fisher's exact and appropriate parametric or non-parametric tests) were used to evaluate prevalence patterns and metabolic indicators. T2DM and NAFLD were more prevalent in male CRC patients (10.04 and 8.18%, respectively) than in females (5.92 and 4.73%). However, the co-occurrence of both conditions was rare (0.68%). Patients with T2DM or NAFLD showed distinctive metabolic abnormalities, including elevated blood sugar, liver enzymes, and altered lipid profiles. Bivariate analysis identified AST as a potential differentiating marker for NAFLD. Because co-occurrence was rare (3/438, 0.68%), exact analysis showed no evidence of a sex difference in co-occurrence (male vs. female OR = 1.26, 95% CI 0.11-13.99; = 1.00). This study highlights distinct sex-based prevalence patterns of T2DM and NAFLD in CRC patients; however, co-occurrence was rare, limiting inferential analyses. These findings emphasize the need for larger, prospective studies with refined ascertainment to better characterize metabolic comorbidity patterns in CRC, particularly from a sex-specific perspective.

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