术后辅助化疗对浸润性乳癌病人血脂水平的影响  

EFFECT OF POSTOPERATIVE ADJUVANT CHEMOTHERAPY ON BLOOD LIPIDS IN PATIENTS WITH INVASIVE BREAST CANCER

作　　者：公蒙蒙 王海波[1] GONG Mengmeng;WANG Haibo(Breast Disease Diagnosis and Treatment Center,Qingdao University Affiliated Hospital,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院乳腺病诊疗中心,山东青岛266003 [2]蒙阴县人民医院乳腺外科

出　　处：《青岛大学学报（医学版）》2021年第3期345-349,共5页Journal of Qingdao University(Medical Sciences)

基　　金：山东省自然科学基金资助项目(ZR2017MH016)。

摘　　要：目的探讨以蒽环类药物为主化疗方案对浸润性乳癌病人血脂水平影响。方法回顾性分析232例术后以蒽环类药物为主辅助化疗乳癌病人和198例术后辅助内分泌治疗乳癌者的临床资料,比较化疗和内分泌治疗对血脂水平影响。结果乳癌病人辅助化疗后总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)均较化疗前升高,高密度脂蛋白(HDL)较化疗前下降(t=-10.34~5.31,P<0.01)。Logistic多因素分析显示,年龄≤50岁(OR=2.238,P<0.05)对TG水平有显著影响,组织学Ⅲ级(OR=2.082,P<0.05)、肿瘤长径>2 cm(OR=1.813,P<0.05)对TC水平有显著影响;非三阴性乳癌病人HDL降低显著(OR=3.142,P<0.01)。诺模图分析显示,TC、LDL升高的预测效果较好(AUC=0.747、0.868);TG升高的预测效果一般(AUC=0.661)。化疗后TC升高幅度较内分泌治疗大(Z=-2.43,P<0.05),化疗后TG、HDL、LDL异常幅度和内分泌治疗5年后基本一致(P>0.05)。结论术后辅助化疗可以显著影响浸润性乳癌病人血脂水平,且其变化幅度不亚于内分泌治疗。Objective To investigate the effect of anthracycline-based chemotherapy on blood lipids in patients with invasive breast cancer.Methods A retrospective analysis was performed for the clinical data of 232 patients received anthracycline-based postoperative adjuvant chemotherapy and 198 received adjuvant endocrine therapy after surgery.The effect of chemotherapy versus endocrine therapy on blood lipids was analyzed.Results After adjuvant chemotherapy,the patients with breast cancer had significant increases in total cholesterol(TC),triglyceride(TG),and low-density lipoprotein(LDL)and a significant reduction in high-density lipoprotein(HDL)(t=-10.34 to 5.31,P<0.01).The multivariate logistic analysis showed that age≤50 years(OR=2.238,P<0.05)had a significant effect on TG level,and histological gradeⅢ(OR=2.082,P<0.05)and tumor diameter>2 cm(OR=1.813,P<0.05)had a significant effect on TC level;the patients with non-triple-negative breast cancer had a significantly greater reduction in HDL level(OR=3.142,P<0.01).A nomogram was established and the results showed that the increases in TC and LDL had a better predictive effect,with an area under the ROC curve(AUC)of 0.747 and 0.868,respectively,while the increase in TG had a relatively low predictive effect,with an AUC of 0.661.The independent-samples Mann-Whitney U test showed that the increase in TC after chemotherapy was significantly greater than that after endocrine therapy(Z=-2.43,P<0.05),and the abnormal degrees of TG,HDL,and LDL after chemotherapy were basically the same as those after 5 years of endocrine therapy(P>0.05).Conclusion Postoperative adjuvant chemotherapy can significantly affect the levels of blood lipids in patients with invasive breast cancer,with a comparable degree of impact to endocrine therapy.

关 键 词：乳房肿瘤 化学疗法 辅助 血脂异常 

分 类 号：R737.9[医药卫生—肿瘤]