一些多形性胶质母细胞瘤 (GBM) 的特征是存在宝石细胞 (GC)，这是一种反应性星形胶质细胞的独特表型。某些GC可以被识别为肿瘤细胞，但这些细胞也被发现与中枢神经系统非肿瘤病变中的糖尿病有关。我们的目的是寻找新诊断 GBM 患者的胰岛素抵抗代谢特征与 GC 存在之间的相关性。回顾性提取组织学确诊的 GBM 患者的医疗记录，了解不同的全身代谢变量。对 GBM、患有和不患有 GC 的糖尿病患者进行了基于统计的比较。糖尿病控制不佳（即血红蛋白A1C ⩾ 8.0）的患者也对两组进行了比较。我们的研究共纳入了220例新诊断的GBM患者。 58 名（26.3%）患者入院时有 2 型糖尿病（DM2）病史。 GC-GBM 组的 DM2 控制不良率几乎是非 GC GBM 组的两倍（18.75% vs 9.5%；P = .130）。在 DM2 队列中，GC-GBM 亚组与胰岛素抵抗相关的人口和代谢特征显着相关，例如男性占主导地位（89% vs 50%，P = .073）和病态肥胖（体重⩾85 kg：OR 6.16；P = .0019，平均BMI：34.1±11.42 vs 28.7±5.44；有和没有GC组的P = .034，分别）。在控制不佳的 DM2 组中，GC-GBM 患者在诊断前没有使用胰岛素，而非 GC GBM 患者中这一比例为 61.1%（OR = 0.04，P = .045）。 与显着相关的全身代谢因素胰岛素抵抗（DM2、病态肥胖、男性）与 GBM 的独特组织学表型相关，其特征是存在 GC。这一特征在未使用合成胰岛素的控制不佳的 DM2 GBM 患者中尤为突出。这一新发现可能会增加关于星形胶质细胞和与高级别神经胶质瘤相关的星形胶质细胞中葡萄糖代谢的相关性的不断增长的数据。在 GBM 患者中，患者代谢状态、肿瘤组织学表型、肿瘤分子变化、抗糖尿病药物的使用以及这些因素对生存的影响之间的相关性值得进一步研究。© 作者 2023。

Some glioblastoma multiforme (GBM) are characterized by the presence of gemistocytes (GCs), a unique phenotype of reactive astrocytes. Certain GCs can be identified as neoplastic cells but these cells were also found to be associated with diabetes in non-neoplastic lesions of the central nervous system. Our aim was to find a correlation between insulin - resistance metabolic features and the presence of GCs in patients with newly diagnosed GBM.Medical records from histologically confirmed GBM patients were retrospectively extracted for different systemic metabolic variables. A statistic-based comparison was made between GBM, diabetic patients with and without GC. Patients with poorly controlled diabetes (ie, hemoglobin A1C ⩾ 8.0) were also compared between the 2 groups.A total of 220 newly diagnosed GBM patients were included in our study. 58 (26.3%) patients had a history of diabetes mellitus type 2 (DM2) at the time of admission. The rate of poorly-controlled DM2 was nearly as twice in the GC-GBM group than in the non-GC GBM group (18.75% vs 9.5%; P = .130). In the DM2 cohort, the subgroup of GC-GBM was significantly associated with demographic and metabolic features related to insulin resistance such as male gender predominance (89% vs 50%, P = .073) and morbid obesity (weight ⩾85 kg: OR 6.16; P = .0019 and mean BMI: 34.1 ± 11.42 vs 28.7 ± 5.44; P = .034 for group with and without GCs, respectively). In the poorly-controlled DM2 group, none of the GC-GBM patients were using insulin prior to diagnosis, compared to 61.1% in the non-GC GBM patients (OR = 0.04, P = .045).Systemic metabolic factors related to marked insulin resistance (DM2, morbid obesity, male gender) are associated with a unique histologic phenotype of GBM, characterized by the presence of GCs. This feature is prominent in poorly-controlled DM2 GBM patients who are not using synthetic insulin. This novel finding may add to the growing data on the relevance of glucose metabolism in astrocytes and in astrocytes associated with high-grade gliomas. In GBM patients, a correlation between patients' metabolic status, tumor's histologic phenotype, tumor's molecular changes, use of anti-diabetic drugs and the respective impact of these factor on survival warrants further investigation.© The Author(s) 2023.