术前血脂水平与可切除非小细胞肺癌预后的相关性分析

发布时间：2018-03-29 17:13

  本文选题：血脂　切入点：可切除非小细胞肺癌　出处：《山东大学》2016年硕士论文

【摘要】：背景：目前非小细胞肺癌(Non-small cell lung cancer,NSCLC)占主支气管癌的85%,是世界上死亡率最高的恶性肿瘤之一。在肿瘤的发生和发展过程中,机体的代谢活动会产生相应的变化。在机体内,脂质的主要功能是储存能量,作为主要的成分构成细胞膜并且参与形成重要的信号分子。肿瘤发生后,机体内的血脂含量也会产生相应的改变。因此,关于肺癌患者血脂代谢的研究对疾病的诊断和预后具有十分重要的临床意义。然而,脂质代谢在肿瘤发展中的作用还没有得到充分地研究,总胆固醇(TC,total cholesterol)、高密度脂蛋白胆固醇(HDL,high density lipoprotein cholesterol)、甘油三酯(TG,triglyceride)和低密度脂蛋白胆固醇(LDL, low density lipoprotein cholesterol)在肺癌预后中的作用也并不能够完全明确。本研究旨在探讨术前血脂水平与可切除非小细胞肺癌预后的关系。目的：本研究主要分析可切除非小细胞肺癌患者术前血脂水平与患者预后和病理特点的相关性,探讨其对可切除非小细胞肺癌的预后有无影响,以期能为肺癌的治疗提供新的方向。方法：回顾性收集2009年1月至2010年12月于山东大学齐鲁医院胸外科接受手术治疗的非小细胞肺癌患者的临床资料,排除接受术前新辅助放/化疗者、肿瘤无法切除者、合并其他肿瘤者、合并糖尿病及高脂血症等血脂代谢异常疾病者,服用任何影响脂质代谢的药物者、无血脂检查者以及随访失访者,共纳入165例患者。随访并分析患者的年龄、性别、吸烟情况、术前血清TC水平、术前血清TG水平、术前血清HDL水平、术前血清LDL水平、病理学类型、分化程度、病灶部位、肿瘤直径、pTNM分期等对可切除非小细胞肺癌患者的总生存时间(OS, overall survival)以及无进展生存时间(PFS, progression-free survival)的影响。pTNM分期依据是2009年IASLC国际肺癌分期(第七版),TC、HDL、LDL分组标准依据NCEP ATPIII血脂异常指南。采用SPSS 17.0软件进行统计分析,运用卡方检验、Kaplan-Meier生存曲线、COX比例风险模型等统计学方法处理相关数据,P0.05时有统计学意义。结果：本研究共纳入患者165例,其中,男性患者115例(69.3%),女性患者50例(30.3%),年龄在35-82岁(60.61±9.68)。术前血清TC水平是可切除非小细胞肺癌预后的独立影响因素,术前血清TC水平≥200mg/dl组的患者总生存时间(P=0.005)以及无进展生存时间(P=0.006)均优于术前血清TC水平200mg/dl组,术前血清TG、HDL、LDL水平与可切除非小细胞肺癌的预后均不具有显著相关性(P0.05)。结论：术前血清TC水平是影响可切除非小细胞肺癌患者预后的独立影响因素,术前血清TC水平降低提示患者预后不良。血脂相关指标的检测可用于预测术后非小细胞肺癌患者的生存时间,是评价肿瘤患者预后的重要工具。
[Abstract]:Background: Non-small cell lung cancer (NSCLC) accounts for 85% of primary bronchial cancer and is one of the most fatal malignant tumors in the world. The main function of lipids is to store energy, as a major component of the cell membrane and participate in the formation of important signaling molecules. The study of lipid metabolism in patients with lung cancer is of great clinical significance in the diagnosis and prognosis of lung cancer. However, the role of lipid metabolism in tumor development has not been fully studied. The role of total cholesterol, high density lipoprotein cholesterol, triglyceride and low density lipoprotein cholesterol in the prognosis of lung cancer is not entirely clear. Objective: to study the relationship between preoperative blood lipid level and prognosis and pathological features of resectable non-small cell lung cancer (NSCLC). To investigate whether it has influence on the prognosis of resectable non-small cell lung cancer. Methods: from January 2009 to December 2010, the clinical data of patients with non-small cell lung cancer (NSCLC) undergoing surgical treatment in thoracic surgery of Qilu Hospital, Shandong University, were retrospectively collected. Those who received preoperative neoadjuvant radiotherapy / chemotherapy, patients with unresectable tumors, patients with other tumors, patients with dyslipidemia such as diabetes mellitus and hyperlipidemia, and those who took any drugs affecting lipid metabolism, The age, sex, smoking status, serum TC level, serum TG level, preoperative serum HDL level, preoperative serum LDL level of the patients were analyzed. Pathological type, degree of differentiation, location of lesion, Effects of tumor diameter and pTNM staging on Total Survival time (overall survival) and Progressive Survival of patients with resectable Non-small Cell Lung Cancer. PTNM staging is based on the IASLC International Lung Cancer staging 2009 (7th edition). NCEP ATPIII dyslipidemia guidelines. SPSS 17.0 software was used for statistical analysis. There was statistical significance when using Kaplan-Meier survival curve and Cox proportional risk model to process the relevant data (P0.05). Results: 165 patients were included in this study. 115 cases of male and 50 cases of female, aged 35-82 years, had 60.61 卤9.68. The preoperative serum TC level was an independent factor influencing the prognosis of resectable non-small cell lung cancer (NSCLC). The total survival time of patients with preoperative serum TC level 鈮，

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