新辅助化疗对乳腺癌患者血脂影响及因素分析

Influencing factor analysis of neoadjuvant chemotherapy on blood lipid in patients with breast cancer

目的研究新辅助化疗(NAC)对乳腺癌患者血脂水平的影响及相关因素,为降低乳腺癌患者心血管疾病相关死亡率和改善乳腺癌预后提供诊疗依据。方法收集整理青岛大学附属医院乳腺诊疗中心299例完成4～6周期化疗的乳腺癌患者临床病理资料及血脂水平结果,分析患者接受NAC前后的血脂水平变化及相关影响因素。结果接受NAC后乳腺癌患者血清三酯甘油(TG)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平均显著高于术前,而高密度脂蛋白胆固醇(HDL-C)水平低于术前,差异均有统计学意义[(2.26±1.77)mmol/L vs(1.47±1.13)mmol/L、(5.81±1.20)mmol/L vs (5.17±1.07)mmol/L、(3.42±0.89)mmol/L vs (2.87±0.77)mmol/L、(1.28±0.33)mmol/L vs (1.45±0.32)mmol/L,t=-10.02、-9.80、-9.36、9.28,均P<0.01]。单因素分析提示患者肿瘤病理类型(χ~2=7.676,P=0.022)及化疗方案(χ~2=10.747,P=0.005)是接受NAC后血清TG水平升高的相关因素;患者年龄(χ~2=4.065,P=0.044)及是否绝经(χ~2=5.134,P=0.023)与NAC后血清LDL-C水平升高相关;血清HDL-C的降低与患者年龄(χ~2=7.284,P=0.007)、分子分型(χ~2=8.626,P=0.003)及是否绝经(χ~2=9.608,P=0.002)有关,而体质量指数(BMI)和化疗疗效与各血脂水平变化无关。多因素分析显示病理类型为浸润性非特殊癌(OR=3.624,P=0.008)及蒽环类联合紫衫类化疗方案(OR=3.508,P=0.001)是影响TG水平升高的独立危险因素;未绝经(OR=2.237,P=0.017)、分子分型为三阴性(OR=3.184,P=0.001)是影响HDL-C水平降低的独立危险因素。结论NAC后乳腺癌患者各血脂水平的变化对心血管系统及肿瘤复发、转移等预后不利,临床医师应重视患者血脂代谢变化及相关危险因素,定期检测并及时给予指导干预,降低癌症患者心血管疾病的死亡率并改善预后。

Objective To study the effect of neoadjuvant chemotherapy(NAC)on blood lipid level in patients with breast cancer and to analyze the related factors in order to provide diagnostic and therapeutic basis for reducing the mortality of cardiovascular diseases and improving the prognosis of breast cancer.Methods The clinicopathological data and blood lipid levels of two hundred and ninetynine patients with breast cancer with 4 to 6 cycles of chemotherapy were collected and analyzed.The changes of blood lipid levels and related factors after NAC were analyzed.Results The levels of serum triglyceride(TG),total cholesterol(TC)and low density lipoprotein cholesterol(LDL-C)in breast cancer patients after NAC treatment were significantly higher than those before NAC,while the levels of high density lipoprotein cholesterol(HDL-C)were lower than those before NAC treatment[(2.26±1.77)mmol/L vs(1.47±1.13)mmol/L,(5.81±1.20)mmol/L vs(5.17±1.07)mmol/L,(3.42±0.89)mmol/L vs(2.87±0.77)mmol/L,(1.28±0.33)mmol/L vs(1.45±0.32)mmol/L,t=-10.02,-9.80,-9.36,9.28,all P<0.01].Univariate analysis showed that pathological type of tumors(χ^2=7.676,P=0.022)and chemotherapy regimen(χ^2=10.747,P=0.005)were correlated with increased serum TG level after NAC treatment.Age(χ^2=4.065,P=0.044)and menopause(χ^2=5.134,P=0.023)were correlated with increased serum LDL-C level after NAC treatment.The decrease of serum HDL-C was related to age(χ^2=7.284,P=0.007),molecular typing(χ^2=8.626,P=0.003)and menopause(χ^2=9.608,P=0.002),but BMI and chemotherapy efficacy were not related to the changes of blood lipid levels.Multivariate analysis showed that pathological type of non-specific cancer(OR=3.624,P=0.008)and anthracycline combined paclitaxelt chemotherapy(OR=3.508,P=0.001)were independent risk factors for the increase of TG level;premenopause(OR=2.237,P=0.017)and triplenegative molecular typing(OR=3.184,P=0.001)were independent risk factors for the decrease of HDL-C level.Conclusions The changes of blood lipid levels of the patients after neoadjuvant chemotherapy are unfavorable for the prognosis of cardiovascular system and tumor recurrence and metastasis.Clinicians should pay attention to the changes of blood lipid metabolism,regularly detect and give guidance in time to reduce the mortality of cardiovascular diseases and improve the prognosis of breast cancer patients.