血脂、CA153水平与乳腺癌发生及临床病理特征的关系

摘要/Abstract

摘要：

目的探讨血脂、CA153水平与乳腺癌发生及患者临床病理特征之间的关系。方法收集2017年1月至2018年5月在南京大学医学院附属鼓楼医院确诊并接受治疗的198例乳腺癌患者作为病例组,选取同期按1∶1年龄匹配的198例体检健康女性作为对照组。采集5 ml空腹静脉血以测量所有研究对象的血脂水平及乳腺癌患者的CA153水平。比较两组的血脂水平差异,采用logistic回归模型分析乳腺癌发生的危险因素;针对165例未接受新辅助化疗的乳腺癌患者,采用独立样本t检验比较不同病理特征患者的血脂及CA153水平,采用Pearson相关分析计算血脂等变量与CA153之间的相关性。结果病例组与对照组的甘油三酯(TG)水平分别为(1.22±0.73)mmol/L和(1.06±0.52)mmol/L,差异有统计学意义(t=2.559,P=0.011);总胆固醇(TC)水平分别为(4.47±0.86)mmol/L和(4.99±0.80)mmol/L,差异有统计学意义(t=-6.228,P<0.001);高密度脂蛋白胆固醇(HDL-C)水平分别为(1.32±0.34)mmol/L和(1.53±0.38)mmol/L,差异有统计学意义(t=-5.913,P<0.001)。较高的TC和HDL-C水平均为乳腺癌发生的独立保护因素(OR=0.350,P<0.001;OR=0.531,P=0.013)。淋巴结阳性和阴性患者TC水平分别为(4.36±0.73)mmol/L和(4.67±0.83)mmol/L,差异有统计学意义(t=-2.518,P=0.013);低密度脂蛋白胆固醇(LDL-C)水平分别为(2.53±0.58)mmol/L和(2.77±0.70)mmol/L,差异有统计学意义(t=-2.312,P=0.022)。临床分期为Ⅰ期患者和Ⅱ、Ⅲ期患者TC水平分别为(4.90±0.89)mmol/L和(4.46±0.76)mmol/L,差异有统计学意义(t=2.855,P=0.005);LDL-C水平分别为(2.95±0.71)mmol/L和(2.60±0.63)mmol/L,差异有统计学意义(t=2.705,P=0.008)。三阴性乳腺癌患者的CA153水平[(14.94±7.45)U/ml]显著高于非三阴性乳腺癌患者[(11.96±5.96)U/ml],差异有统计学意义(t=2.359,P=0.020)。CA153水平与TG水平呈正相关(r=0.167,P=0.032)。结论血脂异常与乳腺癌风险增加有关,不同淋巴结状态及肿瘤分期的患者血脂水平也不尽相同,CA153水平与TG水平存在正相关。

关键词:乳腺肿瘤,血脂异常,甘油三酯类,胆固醇,CA153

Abstract:

ObjectiveTo explore the relationships between serum lipids, CA153 level and breast cancer incidence and clinicopathological features of patients.MethodsA total of 198 patients with breast cancer diagnosed and treated at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were enrolled as the case group, and 198 healthy women were selected with 1∶1 age pairing as controls. Five milliliters of fasting venous blood was collected to measure serum lipids levels in all subjects and CA153 levels in breast cancer patients. The difference of serum lipids levels between the two groups was compared. Logistic regression model was used to analyze the risk factors of breast cancer. For 165 breast cancer patients who did not receive neoadjuvant chemotherapy, independent samplet-test was used to compare serum lipids and CA153 levels in breast cancer patients with different pathological features, and Pearson correlation analysis was used to calculate the correlation between variables and CA153.ResultsThe triglyceride (TG) levels in the case group and the control group were (1.22±0.73) mmol/L and (1.06±0.52) mmol/L respectively, and the difference was statistically significant (t=2.559,P=0.011); the total cholesterol (TC) levels were (4.47±0.86) mmol/L and (4.99±0.80) mmol/L respectively, and the difference was statistically significant (t=-6.228,P<0.001); the high-density lipoprotein cholesterol (HDL-C) levels were (1.32±0.34) mmol/L and (1.53±0.38) mmol/L respectively, and the difference was statistically significant (t=-5.913,P<0.001). Higher TC and HDL-C levels were independent protective factors for breast cancer (OR=0.350,P<0.001;OR=0.531,P=0.013). The TC levels in lymph node positive and lymph node negative patients were (4.36±0.73) mmol/L and (4.67±0.83) mmol/L respectively, and the difference was statistically significant (t=-2.518,P=0.013); low-density lipoprotein cholesterol (LDL-C) levels were (2.53±0.58) mmol/L and (2.77±0.70) mmol/L respectively, and the difference was statistically significant (t=-2.312,P=0.022). The TC levels in patients with stage Ⅰ and stage Ⅱ/Ⅲ were (4.90±0.89) mmol/L and (4.46±0.76) mmol/L respectively, and the difference was statistically significant (t=2.855,P=0.005); LDL-C levels were (2.95±0.71) mmol/L and (2.60±0.63) mmol/L respectively, and the difference was statistically significant (t=2.705,P=0.008). The level of CA153 in triple-negative breast cancer patients [(14.94±7.45) U/ml] was significantly higher than that in non-triple-negative breast cancer patients [(11.96±5.96) U/ml], and the difference was statistically significant (t=2.359,P=0.020). The level of CA153 was positively correlated with the level of TG (r=0.167,P=0.032).ConclusionDyslipidemia is associated with an increased risk of breast cancer. The levels of serum lipids vary among patients with different lymph node status and tumor stages. CA153 level is positively correlated with TG level to some extent.

Key words:Breast neoplasms,Dyslipidemias,Triglycerides,Cholesterol,CA153

赵怡欣, 管忆楠, 张寅, 史先彪, 姚永忠. 血脂、CA153水平与乳腺癌发生及临床病理特征的关系[J]. 国际肿瘤学杂志, 2020, 47(2): 70-76.

Zhao Yixin, Guan Yinan, Zhang Yin, Shi Xianbiao, Yao Yongzhong. Relationships between serum lipids, CA153 level and breast cancer incidence and clinicopathological features of patients[J]. Journal of International Oncology, 2020, 47(2): 70-76.

图/表6

临床特征	病例组 (n=198)	对照组 (n=198)	t值	P值
年龄(岁)	51.89±9.62	52.01±9.68	-0.115	0.909
身高(cm)	159.33±5.66	159.74±5.21	-0.744	0.457
体重(kg)	60.79±8.78	59.60±7.74	1.431	0.153
BMI(kg/m²)	23.94±3.16	23.37±2.99	1.825	0.069
TG(mmol/L)	1.22±0.73	1.06±0.52	2.559	0.011
TC(mmol/L)	4.47±0.86	4.99±0.80	-6.228	<0.001
HDL-C(mmol/L)	1.32±0.34	1.53±0.38	-5.913	<0.001
LDL-C(mmol/L)	2.65±0.68	2.62±0.61	0.466	0.642

表1

表2

198例乳腺癌患者发病风险的单因素logistic回归分析"

变量	OR值	95%CI	P值
TG(mmol/L)
≥1.240	1.585	1.038~2.421	0.033
<1.240	参考
TC(mmol/L)
≥4.775	0.332	0.220~0.500	<0.001
<4.775	参考
HDL-C(mmol/L)
≥1.325	0.388	0.256~0.588	<0.001
<1.325	参考
LDL-C(mmol/L)
≥3.275	1.429	0.844~2.421	0.184
<3.275	参考
月经状态
已绝经	1.224	0.825~1.816	0.315
未绝经	参考
年龄	0.999	0.979~1.019	0.909
BMI	1.062	0.995~1.133	0.070

表2

表3

表4

165例未接受新辅助化疗的乳腺癌患者临床病理特征"

临床病理特征	例数	百分比(%)
肿瘤大小
T₁	51	30.9
T₂	105	63.6
T₃	9	5.5
淋巴结分期
N₀	95	57.6
N₁	50	30.3
N₂	12	7.3
N₃	8	4.8
临床分期
Ⅰ	31	18.8
Ⅱ	111	67.3
Ⅲ	23	13.9
分子分型
Luminal A型	9	5.5
Luminal B型	97	58.8
Her-2过表达型	29	17.6
三阴性	30	18.2

表4

表5

血脂、CA153水平与165例未接受新辅助化疗的乳腺癌患者临床病理特征之间的关系(xˉ±s)"

临床病理特征	淋巴结转移		t值	P值	临床分期		t值	P值
临床病理特征	阳性(n=70)	阴性(n=95)	t值	P值	Ⅰ期(n=31)	Ⅱ、Ⅲ期(n=134)	t值	P值
TG(mmol/L)	1.27±0.81	1.17±0.71	0.784	0.434	1.19±0.65	1.22±0.78	-0.217	0.828
TC(mmol/L)	4.36±0.73	4.67±0.83	-2.518	0.013	4.90±0.89	4.46±0.76	2.855	0.005
HDL-C(mmol/L)	1.28±0.32	1.38±0.35	-1.763	0.080	1.41±0.29	1.32±0.35	1.327	0.186
LDL-C(mmol/L)	2.53±0.58	2.77±0.70	-2.312	0.022	2.95±0.71	2.60±0.63	2.705	0.008
CA153(U/ml)	12.57±6.68	12.46±6.11	0.105	0.916	11.86±5.58	12.66±6.52	-0.629	0.530
临床病理特征	分子分型		t值	P值	肿瘤大小		t值	P值
临床病理特征	三阴性(n=30)	非三阴性(n=135)	t值	P值	T₁(n=51)	T₂、T₃(n=114)	t值	P值
TG(mmol/L)	1.20±0.64	1.22±0.78	-0.137	0.892	1.21±0.65	1.21±0.80	0.006	0.996
TC(mmol/L)	4.68±0.86	4.51±0.79	1.073	0.285	4.66±0.92	4.48±0.74	1.327	0.186
HDL-C(mmol/L)	1.28±0.36	1.35±0.34	-0.953	0.342	1.36±0.32	1.33±0.35	0.521	0.603
LDL-C(mmol/L)	2.84±0.73	2.63±0.64	1.530	0.128	2.77±0.71	2.62±0.64	1.335	0.184
CA153(U/ml)	14.94±7.45	11.96±5.96	2.359	0.020	12.36±6.34	12.57±6.37	-0.202	0.840

表5

变量	CA153水平
年龄	0.025	0.752
BMI	0.150	0.055
TG	0.167	0.032
TC	0.010	0.896
HDL-C	-0.149	0.056
LDL-C	0.013	0.869

表6

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