血脂水平与中晚期鼻咽癌患者临床特征及生存预后的研究  

A study of blood lipid levels with clinical characteristics and survival prognosis of patients with middle-to late-stage nasopharyngeal carcinoma

作　　者：寇立勇 吴平[2] 孙静 陈炜 葛晓松[3] Kou Liyong;Wu Ping;Sun Jing;Chen Wei;Ge Xiaosong(Department of General Practice,Affiliated Hospital of Jiangnan University,Wuxi 214122,Jiangsu,China;Department of Nutrition,Affiliated Hospital of Jiangnan University,Wuxi 214122,Jiangsu,China;Department of Medical Oncology,Affiliated Hospital of Jiangnan University,Wuxi 214122,Jiangsu,China)

机构地区：[1]江南大学附属医院全科医学科,江苏无锡214122 [2]江南大学附属医院营养科,江苏无锡214122 [3]江南大学附属医院肿瘤内科,江苏无锡214122

出　　处：《肿瘤代谢与营养电子杂志》2024年第4期505-511,共7页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：江苏省卫生健康委科研项目(Z2023020);无锡市软科学研究项目(KX-24-B34);无锡市江南大学附属医院临床研究与转化医学研究项目(LCYJ202347);无锡市卫生健康委科研项目(HB2023063)。

摘　　要：目的探讨中晚期鼻咽癌患者血清脂质水平与临床特征、生存预后的相关性。方法回顾性分析2008年1月至2018年1月于江南大学附属医院238例初诊Ⅲ~Ⅳ期鼻咽癌患者,收集血清脂质相关指标高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)、胆固醇和甘油三酯,采用单因素和多因素Cox回归模型分析、Kaplan-Meier生存曲线和受试者操作特征(ROC)曲线等进行统计分析和临床预后评价。结果年龄≥55岁鼻咽癌患者的ApoA1水平明显高于年龄<55岁鼻咽癌患者(P=0.013)。女性患者HDL-C水平明显高于男性患者(P=0.001)。单因素Cox回归模型分析结果显示,胆固醇与鼻咽癌患者总生存(OS)期差异有统计学意义(HR=1.626,95%CI=1.065~2.482,P=0.024)。进一步对P<0.1的ApoB、ApoE和胆固醇纳入多因素Cox回归模型分析,结果显示高胆固醇是鼻咽癌预后的危险因素(HR=1.613,95%CI=1.058~2.460,P=0.026)。不同基线胆固醇水平下,HDL-C(P=0.024)、LDL-C(P=0.001)和ApoB(P=0.001)水平差异具有统计学意义。低胆固醇患者的生存期比高胆固醇患者长,低胆固醇患者具有更长的总生存期(P=0.025)。ROC曲线分析显示,胆固醇预测鼻咽癌预后的曲线下面积差异具有统计学意义,提示胆固醇对中晚期鼻咽癌患者生存具有预测能力(AUC=0.581,95%CI=0.505~0.656,P=0.037)。结论中晚期鼻咽癌患者不同临床特征间血脂存在明显差异;血清胆固醇是预测鼻咽癌患者预后的因素,且高胆固醇是鼻咽癌患者的危险因素,与患者不良预后相关。Objective To explore the correlation between serum lipid levels and clinical characteristics and survival prognosis of patients with middle-to late-stage nasopharyngeal carcinoma(NPC).Method To retrospectively analyze 285 patients with NPC stageⅢ-Ⅳin Affiliated Hospital of Jiangnan University,and collect serum lipid-related indexes of high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),apolipoprotein E(ApoE),cholesterol(CHOL),and triglyceride(TG).Statistical analysis and clinical prognostic evaluation were performed using univariate and multivariate Cox regression,Kaplan-Meier survival curves and ROC curves.Result ApoA1 was significantly higher in NPC patients aged≥55 years than in NPC patients aged<55 years(P=0.013).Further grouped by gender,the results showed that HDL-C was significantly higher in the female group than in the male group(P=0.001).The results of Cox one-way analysis showed that the difference in OS between high CHOL level and NPC patients was statistically significant(HR=1.626,95%CI=1.065-2.482,P=0.024).Further ApoB,ApoE and CHOL with P<0.1 were included in a multifactorial Cox proportional risk analysis,which showed that CHOL was a risk factor for NPC prognosis(HR=1.613,95%CI=1.058-2.460,P=0.026).The differences in HDL-C(P=0.024),LDL-C(P=0.001)and ApoB(P=0.001)were statistically significant at different baseline CHOL levels.Survival time was longer in the low CHOL group than in the high CHOL group,and the low CHOL group had a higher overall survival time(P=0.025).ROC curve analysis showed that the area under the curve of CHOL predicting NPC prognosis(AUC=0.581,95%CI=0.505-0.656,P=0.037).Conclusion Significant differences in serum lipids were found between the different clinical features of patients with middle and advanced NPC;Serum CHOL emerged as an independent predictor of prognosis in patients with middle and advanced NPC,and High cholesterol level is a risk factor for nasopharyngeal carcinoma patients a

关 键 词：鼻咽癌 血脂 胆固醇 预后 临床特征 肿瘤分期 影响因素 代谢异常 

分 类 号：R739.63[医药卫生—肿瘤]