冠心病合并结直肠癌对血脂水平的影响及他汀类药物调脂的意义

Changes of blood lipids in colorectal cancer patients with coronary heart disease and value of lipid-lowering therapy with statins

目的通过对32例结直肠癌合并冠心病患者血脂水平及他汀治疗效果的研究,探讨此类患者血脂水平变化的意义和他汀类药物调脂治疗的安全有效性。方法临床和病理确诊为结直肠癌的32例冠心病患者在基线水平、患癌后手术前和手术后阿托伐他汀治疗6月测定其血总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白-胆固醇(HDL-C)和低密度脂蛋白-胆固醇(LDL-C),脂蛋白(a)[Lp(a)]水平。对照组为30例血脂检查TC均≥5.70mmol/L的冠心病患者。结果30例对照组患者在阿托伐他汀20mg治疗6个月后,TC、TG、LDL-C均显著下降,并一直持续至12个月(P<0.01),而HDL-C和Lp(a)没有显著变化。32例结直肠癌合并冠心病患者基线水平的TC、TG、LDL-C和HDL-C在其癌症确诊后均明显降低(P<0.01),而Lp(a)却增高(P<0.05),术后继续阿托伐他汀治疗的患者TC、TG和LDL-C水平进一步降低(P<0.05),HDL-C升高(P<0.05),Lp(a)水平未发生明显变化。对照组TC和LDL-C显著高于癌症组(P<0.05),后者Lp(a)显著增高(P<0.05)。阿托伐他汀治疗6个月后,癌症组LDL-C和HDL-C水平进一步降低(P<0.05),TC和Lp(a)水平两者没有显著差异。结论结直肠癌患者Lp(a)水平的升高可能与其抗肿瘤效应有关,合并冠心病的直结肠癌患者血脂谱的变化为在此类患者中进行调脂治疗的安全性提出了新的课题。

Objective To investigate the changes of blood lipid in patients with colorectal cancer complicated by coronary heart disease （CHD） and the effect of lipid-lowering therapy with statins in these patients. Methods In 32 pathologically confirmed colorectal cancer patients with CHD, the concentrations of total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein-cholesterol （HDL-C）, low-density lipoprotein-cholesterol （LDL-C） and lipoprotein （a） [ Lp（a）] were detected at the baseline, before and after the operation, and at 6 months of postoperative atorvastatin treatment. Thirty patients with TC over 5.70 mmol/L and established coronary artery disease served as the control group. Results TC, TG and LDL-C in the 30 control patients were significantly decreased after 6 months of 20 mg atorvastatin treatment, and even further decreased till 12 months （P〈0.01）, but no significant changes occurred in HDL-C and Lp（a）. The baseline level of TC, TG, LDL-C and HDL-C were significantly decreased （P〈0.01）, while Lp （a） increased （P〈0.05） in the 32 cancer patients with CHD. Continuing atorvastatin treatment further decreased TC, TG and LDL-C （P〈0.05）and increased HDL-C （P〈0.05） without affecting Lp（a）. The cancer patients had significantly lower TC and LDL-C levels than the control group （P〈0.05）, but had significantly increased Lp（a） （P〈0.05）. Six months of atorvastatin treatment further decreased LDL-C and HDL-C in the cancer patients （P〈0.05）, while TC and Lp（a） had no significant changes. Conclusions Increased Lp（a） in colorectal cancer patients can be associated with its anti-tumor effect. Alterations in the blood lipid profile raises a new issue concerning the safety of lipid-lowering therapy in colorectal cancer patients complicated by CHD.