不同TNM分期肺癌患者糖脂代谢、Fib、D-D水平变化及与预后的关系

Changes of glucolipid metabolism,Fib and D⁃D levels and their relationship with prognosis in lung cancert patients with different TNM stages

目的探究并分析不同TNM分期肺癌患者糖脂代谢、纤维蛋白原(Fib)、D-二聚体(D-D)水平变化及与预后的关系。方法收集2018年1月至2021年9月期间安徽医科大学第一附属医院东城院区收治的肺癌患者98例作为肺癌组,依据TNM分期不同将其分为Ⅰ、Ⅱ期(n=16)、Ⅲ期(n=44)和Ⅳ期(n=38)。同时收集同期体检中心内100名体检结果正常的人群作为对照组,比较不同TNM分期肺癌患者及对照组的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等糖脂代谢水平及Fib和D-D水平变化情况,并对影响肺癌患者预后的因子进行单、多因素分析。结果FPG、HbA1c、LDL-C、Fib和D-D水平:Ⅳ期>Ⅲ期>Ⅰ、Ⅱ期>对照组,HDL-C水平:Ⅳ期<Ⅲ期<Ⅰ、Ⅱ期<对照组,差异有统计学意义(P<0.05)。将肺癌患者按照1年生存情况分为生存组(n=72)和死亡组(n=26),生存组患者FPG、HbA1c、TC、TG、LDL-C、Fib和D-D低于死亡组,HDL-C高于死亡组,差异有统计学意义(P<0.05)。Logistic多因素回归分析结果显示,高FPG、TC、LDL-C、Fib、D-D、吸烟和TNM分期晚均是影响肺癌患者预后的独立危险因素(P<0.05)。结论肺癌患者糖脂代谢异常程度及血清Fib和D-D水平随TNM分期的升高呈规律性变化,且高水平FPG、TC、LDL-C、Fib和D-D均是肺癌患者不良预后的高危因素,提示或可通过降低机体糖脂代谢异常程度来改善患者预后。

Objective To explore and analyze the changes of glucolipid metabolism,fibrinogen(Fib)and D⁃dimer(D⁃D)levels and their relationship with prognosis in lung cancer patients with different TNM stages.Methods 98 patients with lung cancer treated in the First Affiliated Hospital of Anhui Medical University from January 2018 to September 2021 were collected as the lung cancer group and they were classified into the stageⅠ-Ⅱgroup(n=16),the stageⅢgroup(n=44)and the stageⅣgroup(n=38)according to TNM staging,and 100 people with normal physical examination results in the physical examination center during the same period were collected as the control group.The levels of glucolipid metabolism indicators of fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL⁃C)and high density lipoprotein cholesterol(HDL⁃C)and levels of Fib and D⁃D were compared among patients with lung cancer of different TNM stages and the control group,and the factors affecting the prognosis of patients with lung cancer were analyzed by univariate analysis and multivariate analysis.Results The levels of FPG,HbA1c,TC,TG,LDL⁃C,Fib and D⁃D were shown as stageⅣgroup>stageⅢgroup>stageⅠ~Ⅱgroup>control group while the level of HDL⁃C showed stageⅣgroup<stageⅢgroup<stageⅠ~Ⅱgroup<control group(P<0.05).Patients with lung cancer were divided into the survival group(n=72)and the death group(n=26)according to 1⁃year survival status.The levels of FPG,HbA1c,TC,TG,LDL⁃C,Fib and D⁃D in the survival group were lower than those in the death group,and HDL⁃C was higher than that in the death group(P<0.05).Logistic multivariate regression analysis revealed that high levels of FPG,TC,LDL⁃C,Fib and D⁃D,smoking and advanced TNM stage were independent risk factors for the prognosis of patients with lung cancer(P<0.05).Conclusion The abnormal degree of glucolipid metabolism and levels of serum Fib and D⁃D in patients with lung cancer change regularly with the increase of TNM stage.High levels of FPG,TC,LDL⁃C,Fib and D⁃D are high⁃risk factors for poor prognosis of patients with lung cancer,suggesting that the prognosis of patients can be improved by reducing the abnormal degree of glucolipid metabolism in vivo.