血脂水平的变化与肺癌疗效的关系

Relationship between blood lipid levels and the curative efficacy of lung cancer

目的分析肺癌患者接受抗肿瘤治疗后血脂水平的变化与疗效之间的关系,寻找监测和评价疗效方便可及的手段。方法本研究为病例对照研究。采用非随机抽样的方法选取2021年1月至11月西安交通大学第二附属医院呼吸与危重症医学科111例肺癌患者。根据不同的疗效评价,将完全缓解、部分缓解及疾病稳定中未达到部分缓解的患者纳入病灶缩小组(85例),将疾病进展及疾病稳定中未达到疾病进展的患者纳入病灶增大组(26例)。收集2组患者的性别、年龄、临床分期、病理类型、ECOG PS评分资料并进行比较。比较2组治疗前后(规范治疗2周期)的血脂水平[总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)]。采用受试者工作特征曲线分析血脂对于疗效评估的效能。结果治疗前2组TC、HDL-C、LDL-C、ApoA1、ApoB水平差异无统计学意义(P值均>0.05);治疗后病灶缩小组的TC、HDL-C、LDL-C、ApoA1、ApoB水平均高于病灶增大组,差异均有统计学意义(P值均<0.05)。治疗后病灶缩小组TC、HDL-C、LDL-C、ApoA1、ApoB均较治疗前水平升高,分别为TC(4.61±0.91)mmol/L比(4.17±0.81)mmol/L;HDL-C(1.16±0.30)mmol/L比(1.05±0.29)mmol/L;LDL-C(2.97±0.66)mmol/L比(2.72±0.61)mmol/L;ApoA1(1.22±0.25)g/L比(1.09±0.27)g/L;ApoB(0.87±0.22)g/L比(0.81±0.20)g/L,差异均有统计学意义(t值分别为5.79、4.84、4.74、5.59、3.44,P值均<0.05)。治疗后病灶增大组TC、HDL-C、LDL-C、ApoA1、ApoB水平均较治疗前降低,分别为TC(3.94±0.84)mmol/L比(4.05±0.91)mmol/L;HDL-C(1.02±0.21)mmol/L比(1.05±0.26)mmol/L;LDL-C(2.52±0.65)mmol/L比(2.63±0.61)mmol/L;ApoA1(1.08±0.24)g/L比(1.12±0.26)g/L;ApoB(0.77±0.17)g/L比(0.78±0.17)g/L,但差异均无统计学意义(t值分别为0.97、0.91、1.26、1.06、0.42,P值均>0.05)。受试者工作特征曲线结果显示:TC最佳临界值为4.1 mmol/L时,评价疗效的敏感度最高(75.3%);HDL-C最佳临界值为1.195 mmol/L时,评价疗效的特异度最高(80.8%);LDL-C最佳临界值为2.8 mmol/l时,评价疗效的特异度最高(73.1%);ApoA1最佳临界值为1.215 g/L时,评价疗效的特异度最高(80.8%);ApoB最佳临界值为0.865 g/L,评价疗效的特异度最高(73.1%)。结论TC、HDL-C、LDL-C、ApoA1、ApoB可能作为肺癌患者疗效监测评估的另一项指标。而治疗后血脂水平的升高可能提示癌负荷的减小,预示更好的疗效。

Objective To analyze the relationship between the blood lipid levels and the curative efficacy in patients with lung cancer managed by anti-tumor therapies,thus seeking for convenient and accessible approaches to monitor and evaluate the curative efficacy.Methods This is a case-control study.A non-random sampling was performed,a total of 111 eligible lung cancer patients treated in the Department of Respiratory and Critical Care Medicine of the Second Affiliated Hospital of Xi′an Jiaotong University from January 2021 to November 2021 were retrospectively recruited.Based on their curative efficacy,lung cancer patients with complete remission,partial remission and those with stable disease but did not achieve partial remission were allocated in the lesion reduction group(n=85);Patients with disease progression and those with stable disease but did not achieve disease progression were allocated in lesion enlargement group(n=26).Their gender,age,the Eastern Cooperative Oncology Group Performance Status(ECOG PS)score,pathological type,and tumor staging between groups were compared.In addition,blood lipids before and after 2-cycle treatment were compared,including total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1)and apolipoprotein B(ApoB).The receiver operating characteristic(ROC)curves were used to analyze the efficacy of blood lipids for efficacy assessment.Results Before treatment,there were no significant differences in baseline TC,HDL-C,LDL-C,ApoA1 and ApoB between lesion reduction group and lesion enlargement group(all P>0.05).Blood lipid levels in lesion reduction group after treatment were all significantly higher than those of lesion enlargement group(all P<0.05).After treatment,TC([4.61±0.91]mmol/L vs[4.17±0.81]mmol/L,t=5.79),HDL-C([1.16±0.30]mmol/L vs[1.05±0.29]mmol/L,t=4.84),LDL-C([2.97±0.66]mmol/L vs[2.72±0.61]mmol/L,t=4.74),ApoA1([1.22±0.25]g/L vs[1.09±0.27]g/L,t=5.59)and ApoB([0.87±0.22]g/L vs[0.81±0.20]g/L,t=3.44)in lesion reduction group were significantly higher than those before treatment(all P<0.05).After treatment,TC(3.94±0.84 mmol/L vs 4.05±0.91 mmol/L,t=0.97),HDL-C([1.02±0.21]mmol/L vs[1.05±0.26]mmol/L,t=0.91),LDL-C([2.52±0.65]mmol/L vs[2.63±0.61]mmol/L,t=1.26),ApoA1([1.08±0.24]g/L vs[1.12±0.26]g/L,t=1.06)and ApoB([0.77±0.17]g/L vs[0.78±0.17]g/L,t=0.42)in lesion enlargement group were lower than those before treatment,although no significant differences were detected(all P>0.05).ROC curves showed that TC(75.3%)presented the highest sensitivity in diagnosing lung cancer at the cut-off values of 4.1 mmol/L,and HDL-C(80.8%),LDL-C(73.1%),ApoA1(80.8%)and ApoB(73.1%)presented the highest specificity at the cut-off values of 1.195 mmol/L,2.8 mmol/L,1.215 g/L,and 0.865 g/L,respectively.Conclusions TC,HDL-C,LDL-C,ApoA1 and ApoB are promising indicators for monitoring and evaluating the therapeutic efficacy of lung cancer patients.Increases in blood lipid levels after treatment indicate the reduction of lung cancer load,indicating a better efficacy.