【摘要】最近发表的一些体外研究发现，正常细胞系中长效胰岛素类似物的IGF-1受体亲和力与人胰岛素相似;在某些肿瘤细胞系中，长效胰岛素类似物的促有丝分裂作用高于人胰岛素。而临床上胰岛素类似物注射入人体内后会迅速发生转化，如甘精胰岛素(Gla)在体内循环中则主要以代谢产物M1的形式存在，而M1的促有丝分裂潜能低于人胰岛素。关于糖尿病视网膜病变的临床研究提示，在体内Gla的确不增加IGF-1受体亲和力。而且，最新的临床研究也未提示Gla会增加肿瘤风险。因此国际多个研究机构均声明，患者可根据处方说明或咨询医师使用长效胰岛素类似物。

　　【关键词】肿瘤，甘精胰岛素， IGF-I, 胰岛素，胰岛素类似物

　　Safety of long acting insulin analogues discussed from the IGF-I receptor affinity GAO Yan. The First Hospital, Peking University, Beijing 100034, China

　　Corresponding author: GAO Yan, E-mail:

　　【Summary】 It has been postulated that certain insulin analogues may display increased mitogenic potential and promote the growth of some cancers through binding to IGF-1 receptors. We reviewed recent literatures which made investigations on the IGF-I receptor affinity and mitogenic potential of insulin analogues, and the risk of malignant neoplasms in diabetic patients treated with insulin analogues. In the in vitro studies, long acting insulin analogues were found to have similar IGF-1 receptor affinity with human insulin in non-malignant cells but have greater mitogenic potential in some malignant cell lines. However, the in vitro studies showed that these are irrelevant to clinical practice because insulin analogues molecule is transformed rapidly once injected. Insulin detemir binds to albumin rapidly, and act in the form of albumin-bound protein in vivo. While most abundant circulating form of insulin glargine is metabolite M1, which shows decreased mitogenic potential compared with human insulin. Clinical study about diabetic retinopathy suggests that insulin glargine does not increase IGF-1 receptor affinity in vivo. Furthermore, there is no increased risk of cancer from insulin glargine reported in the new clinical studies. In response, the Food and Drug Administration, American Diabetes Association, American Association of Clinical Endocrinologists, and European Association for the Study of Diabetes have formally stated that patients should continue to follow the recommendations in the drug label to take insulin glargine or consult physicians for instruction.

　　【Key words】 Cancer; Glargine; IGF-I; Insulin; Insulin analogues