脂质代谢和系统炎症水平与肾细胞癌骨转移的相关性分析  

Association of dyslipidemia and systematic inflammation with renal cell carcinoma bone metastasis

作　　者：黄子雄 杜依青 张晓鹏[1] 刘士军[1] 徐涛[1] Huang Zixiong;Du Yiqing;Zhang Xiaopeng;Liu Shijun;Xu Tao(Department of Urology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《中华泌尿外科杂志》2020年第12期901-905,共5页Chinese Journal of Urology

摘　　要：目的:探讨异常的脂质代谢、系统炎症指标对肾细胞癌骨转移的影响。方法:回顾性分析2009年11月至2017年11月北京大学人民医院收治的239例肾细胞癌患者的临床资料,其中68例出现骨转移(骨转移组,56例为同时性转移,12例为异时性转移),171例未发生骨转移(对照组)。骨转移组男53例,女15例;年龄(59.47±11.41)岁;49例(72.1%)有吸烟史,41例(60.3%)既往合并高血压病,56例(82.4%)既往合并糖尿病。对照组男116例,女55例;年龄(58.61±11.10)岁;119例(69.6%)有吸烟史,92例(53.8%)既往合并高血压病,138例(80.7%)既往合并糖尿病。两组患者一般资料比较差异无统计学意义(P>0.05)。骨转移组平均体质指数[(24.25±4.00)kg/m 2]低于对照组[(25.41±3.67)kg/m 2](P<0.05)。骨转移组原发肾肿瘤分期T 1期29例、T 2期7例、T 3期18例、T 4期13例,对照组肾肿瘤分期T 1期128例、T 2期8例、T 3期29例、T 4期6例。统计患者肾肿瘤切除手术术前血脂指标:总甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)含量;系统炎症指标:中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)。使用单因素分析和二元多因素logistic回归分析骨转移组和对照组间血脂指标、系统炎症指标的差异。结果:骨转移组LDL-C[(2.89±0.76)mmol/L]高于对照组[(2.61±0.81)mmol/L,P<0.05];而TC、TG、HDL-C两组比较差异无统计学意义(P均>0.05)。骨转移组NLR(3.74±2.23)显著高于对照组(2.23±1.68,P<0.001);骨转移组PLR(193.88±139.43)显著高于对照组(122.67±54.66,P<0.001)。多因素logistic回归分析结果显示,调整一般资料、肿瘤分期、病理亚型后,血清LDL-C水平升高与肾细胞癌骨转移的发生相关(HR=1.766,95%CI 1.025~3.043,P<0.05);在初次诊断肾细胞癌时,NLR比值>3的患者,合并出现或后期发生骨转移的概率是比值≤3者的5.052倍(95%CI 1.987~12.845,P<0.05);PLR升高与肾细胞癌发Objective To investigate if lipid metabolism or systematic inflammation played roles in RCC bone metastasis(RCC-BM).Methods A series of 239 RCC patients from Peking University People's Hospital between Nov.2009 and Nov.2017 was retrospectively reviewed.Sixty-eight patients had RCC-BM in which 56 had synchronal and 12 had metachronous metastasis(RCC-BM group).The other 171 patients without any metastasis were set as control group.The baseline age was(59.47±11.41)years in RCC-BM group and(58.61±11.10)years in control group(P>0.05).There were 53 males and 15 females in RCC-BM group,116 males and 55 females in control group(P>0.05).Somking history(72.1%in RCC-BM group,69.6%in control group)and concomitant hypertension(60.3%in RCC-BM group,53.8%in control group),diabetes mellitus(82.4%in RCC-BM group,80.7%in control group)were comparable between two groups(P>0.05).Significantly lower body mass index[BMI,(24.25±4.00)kg/m2]was found in RCC-BM group comparing to that in control group[(25.41±3.67)kg/m2](P<0.05).RCC stages in RCC-BM group:T129 cases,T27 cases,T318 cases,T413 cases;RCC stages in control group:T1128 cases,T28 cases,T329 cases,T46 cases.Preoperative serum lipid profiles(total triglyceride/TG,total cholesterol/TC,low density lipoprotein cholesterol/LDL-C,high density lipoprotein cholesterol/HDL-C levels)were collected.Neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)were calculated as inflammatory parameters.Binary multivariate logistic regression and univariate analysis(t test,chi-squared test)were performed.Results Significantly increasing LDL-C levels[(2.89±0.76)mmol/L]were found among RCC-BM patients comparing to non-metastatic RCC control patients[(2.61±0.81)mmol/L,P<0.05].NLR(3.74±2.23 in RCC-BM group,2.23±1.68 in control group)and PLR(193.88±139.43 in RCC-BM group,122.67±54.66 in control group)significantly elevated in RCC-BM group(P<0.001).Serum LDL-C level was determined to increase hazard ratios of progressing RCC-BM after balancing baseline features,T stages and histologic

关 键 词：癌 肾细胞 骨转移 血脂代谢异常 中性粒细胞-淋巴细胞比值 血小板-淋巴细胞比值 

分 类 号：R737.11[医药卫生—肿瘤]