中国普外基础与临床杂志

中国普外基础与临床杂志

血清血脂和脂蛋白水平与乳腺癌发生及其临床病理学特征的相关性分析

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目的 探讨血清血脂和脂蛋白水平对乳腺癌发生的影响,以及血清血脂和脂蛋白水平与乳腺癌临床病理学特征的相关性。 方法 回顾性收集 2014 年 1 月至 2016 年 3 月期间重庆医科大学附属第一医院收治的乳腺癌病例 788 例和乳腺良性疾病患者 395 例,分析其血清血脂和脂蛋白水平[包括血清总胆固醇(total cholesterol,TC)、甘油三脂(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-c)及低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-c)]对乳腺癌发生的影响,以及血清血脂和脂蛋白水平与乳腺癌患者临床病理学特征的相关性。 结果 ① 乳腺癌发生的影响因素:非条件 logistic 回归分析结果显示,身高(OR=0.950,P=0.006)、BMI(OR=1.062,P=0.041)以及血清 LDL-c 水平(OR=1.349,P=0.016)均是乳腺癌发生的独立影响因素,BMI 越大、血清 LDL-c 水平越高,患乳腺癌的风险越大;相反,身高越高,患乳腺癌的风险越小。② 血清血脂和脂蛋白水平与乳腺癌临床病理学特征的相关性:血清 TC 水平与孕激素受体(PR)表达及淋巴结转移均相关(P<0.05),PR 表达阴性者的血清 TC 水平略高于 PR 表达阳性者,淋巴结有转移者的血清 TC 水平略高于无转移者;血清 TG 水平与 BMI 相关(P<0.05),BMI≥25 kg/m2者的血清 TG 水平略高于<25 kg/m2者;血清 HDL-c 水平与 BMI 及肿瘤直径相关(P<0.05),BMI≥25 kg/m2者的血清 HDL-c 水平略低于<25 kg/m2者,肿瘤直径≤2 cm 者的血清 HDL-c 水平略高于>2 cm 者;血清 LDL-c 水平与 BMI、雌激素受体(ER)表达、PR 表达及分子分型相关(P<0.05),BMI≥25 kg/m2者的血清 LDL-c 水平略高于<25 kg/m2者,ER 表达阴性者的血清 LDL-c 水平略高于 ER 表达阳性者,PR 表达阴性者的血清 LDL-c 水平略高于 PR 表达阳性者,Luminal 型患者的血清 LDL-c 水平略低于非 Luminal 型患者。 结论 血脂异常尤其是高 LDL-c 水平与乳腺癌的发生相关,血清血脂和脂蛋白水平可能与乳腺癌组织的激素受体表达、肿瘤分子分型及淋巴结转移情况有一定的相关性,尚需进一步开展随机对照研究证实。

Objective This study aimed to explore the relationship between serum lipid and lipoprotein levels and occurrence of breast cancer, and relationship between serum lipid and lipoprotein levels and clinicopathological characteristics of breast cancer patients. Methods Clinical data of 788 patients with breast cancer and 395 patients with benign breast disease were retrospectively collected, who received treatment in The First Affiliated Hospital of Chongqing Medical University from January 2014 to March 2016, and to explore the relationship between levels of total cholesterol (TC)/triglyceride (TG)/high density lipoprotein cholesterol (HDL-c)/low density lipoprotein cholesterol (LDL-c) and occurrence of breast cancer/ clinicopathological characteristics of breast cancer patients. Results ① Influencing factors that affected the occurrence of breast cancer: multifactor logistic analysis showed that, height (OR=0.950, P=0.006), body mass index (OR=1.062, P=0.041), and serum LDL-c level (OR=1.349, P=0.016) were independent influencing factors for occurrence of breast cancer, people had high body mass index and higher level of serum LDL-c had high risk of breast cancer, but people had high height had low risk of breast cancer. ②Association analysis of serum lipid and lipoprotein levels and clinicopathological characteristics of breast cancer patients: the serum TC level was correlated with expression of progesteronereceptors (PR) and lymph node metastasis status (P<0.05), the serum TC levels of patients with negative-expression of PR and lymph node metastasis were slightly higher than that of patients with positive-expression of PR and non-lymph node metastasis; the serum TG level was associated with body mass index (P<0.05), that the serum TG level of patients with body mass index≥25 kg/m2was slightly higher than that of patients with body mass index<25 kg/m2; the serum HDL-c level was correlated with the body mass index and diameter of the tumor (P<0.05), the serum HDL-c level of the patients with body mass index≥25 kg/m2 was slightly lower than that of patients with body mass index<25 kg/m2, the serum HDL-c level of patients with the tumor diameter≤2 cm was slightly higher than that of patients with the tumor diameter >2 cm; the serum LDL-c level was correlated with body mass index, expression of estrogenreceptors (ER) and PR, and molecular typing ( P<0.05), the serum LDL-c level was slightly higher in patients with body mass index≥25 kg/m2, negative expression of ER and PR, and non Luminal type patients, comparing with patients with body mass index<25 kg/m2, positive expression of ER and PR, and Luminal type patients. Conclusions High level of serum LDL-c is strongly associated with occurrence of breast cancer, and levels of serum lipid and lipoprotein are associated with expression of hormone receptor, molecular type of breast cancer, and status of lymph node, but it needs further randomized controlled studies to confirm.

关键词: 乳腺癌; 血脂; 脂蛋白; 临床病理学特征

Key words: breast cancer; lipid; lipoprotein; clinicopathological characteristics

引用本文: 张艳利, 陈茂山, 杨光伦. 血清血脂和脂蛋白水平与乳腺癌发生及其临床病理学特征的相关性分析. 中国普外基础与临床杂志, 2018, 25(2): 171-177. doi: 10.7507/1007-9424.201707099 复制

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