非小细胞肺癌患者术前血清微小RNA-638表达与血脂代谢及预后的相关性

Correlation among preoperative serum microRNA-638 expression,lipid metabolism and prognosis inpatients with non-small cell lung cancer

目的探讨非小细胞肺癌(NSCLC)患者术前血清微小RNA-638(miR-638)表达与血脂代谢特点及预后的相关性。方法选取2013年2月至2014年3月在湖北省第三人民医院拟接受手术的201例NSCLC患者(NSCLC组),另选取同期在本院健康门诊进行体检的30例健康志愿者为对照组。检测血清总胆固醇、三酰甘油、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)水平;提取血清RNA,采用逆转录聚合酶链反应法检测miR-638 mRNA表达量。随访截至2019年1月31日,绘制Kaplan-Meier生存曲线,并进行Log-rank分析。结果NSCLC组患者血清总胆固醇、HDL水平和miR-638 mRNA表达量均明显低于对照组[(3.4±0.8)mmol/L比(4.5±0.8)mmol/L、(1.15±0.34)mmol/L比(1.37±0.29)mmol/L、(0.82±0.21)比(1.00±0.16)],差异均有统计学意义(均P<0.01)。HDL低水平(<1.04 mmol/L)患者中miR-638低表达者占比明显高于miR-638高表达者占比[82.2%(97/118)比17.8%(21/118)],差异有统计学意义(P<0.001)。经Pearson相关性分析,NSCLC患者血清miR-638表达与HDL水平呈正相关(R^2=0.479,P<0.001)。年龄≥60岁和p TNM分期Ⅲ期患者中血清miR-638低表达者占比较高(P=0.014、0.039)。Kaplan-Meier生存曲线分析显示,miR-638低表达患者的术后5年生存率低于高表达患者[39.0%(46/118)比68.7%(57/83)],差异有统计学意义(Log-rankχ~2=20.172,P<0.001)。经亚组分析,p TNM分期Ⅰ~Ⅱ期患者或者Ⅲ期患者中miR-638低表达患者的5年生存率均低于高表达患者(均P<0.05)。结论NSCLC患者血清miR-638表达较健康人群降低,且与HDL水平呈正相关;miR-638低表达者术后5年生存率相对较低,可作为预后判断的辅助工具。

Objective To explore the correlation among preoperative serum miRNA-638( miR-638 expression,lipid metabolism and the prognosis after radical surgery in patients with non-small cell lung cancer(NSCLC). Methods From February 2013 to March 2014,201 NSCLC patients( NSCLC group) undergoing radical surgery and 30 healthy volunteers( control group) were enrolled at the Third People’ s Hospital of Hubei Province. Serum contents of total cholesterol( TC),triglyceride,high density lipoprotien( HDL) and low density lipoprotien( LDL) were tested before surgery. Expression of miR-638 mRNA in serum was detected by reverse transcription polymerase chain reaction. All NSCLC patients were followed up until January 31 st 2019 and the overall survival condition was analyzed by Kaplan-Meier curve and Log-rank test. Results Levels of serum TC,HDL and miR-638 mRNA in NSCLC group were significantly lower than those in control group[(3. 4 ± 0. 8)mmol/L vs(4. 5 ± 0. 8)mmol/L,(1. 15 ± 0. 34)mmol/L vs(1. 37 ± 0. 29)mmol/L,(0. 82 ± 0. 21) vs(1. 00 ± 0. 16)](all P < 0. 01). Most patients with low HDL( < 1. 04 mmol/L) showed low miR-638 expression[82. 2%(97/118) vs high miR-638 expression rate 17. 8%(21/118)]( P < 0. 001). Pearson analysis showed that miR-638 expression was positively correlated with HDL( R^2= 0. 479,P < 0. 001). Patients over 60 years old and with p TNM stage Ⅲshowed lower miR-638 expression( P = 0. 014,0. 039). Kaplan-Meier curve analysis showed lower 5-year survival rate in low miR-638 expression[39. 0%(46/118) vs 68. 7%(57/83) in high miR-638 expression]( Log-rank χ~2=20. 172,P < 0. 001). In subgroup analysis there were lower 5-year survival rates in p TNM stageⅠ-Ⅱ and stage Ⅲpatients with low miR-638 expression than those with high miR-638 expression(both P < 0. 05). Conclusions Serum miR-638 mRNA expression decreases in NSCLC patients and its serum level is positively correlated with HDL.Patients with low miR-638 expression have poor 5-year survival outcome,indicating that miR-638 may be a potential indicator for the prognosis.