目的 探讨中晚期鼻咽癌患者血清脂质水平与临床特征、生存预后的相关性。 方法 回顾性分析 2008 年 1 月至 2018 年 1 月于江南大学附属医院 238 例初诊Ⅲ~Ⅳ期鼻咽癌患者,收集血清脂质相关指标高密度脂蛋白胆固醇(HDL-C)、低密度 脂蛋白胆固醇(LDL-C)、载脂蛋白 A1(ApoA1)、载脂蛋白 B(ApoB)、载脂蛋白 E(ApoE)、胆固醇和甘油三酯,采用单因素和多 因素 Cox 回归模型分析、Kaplan-Meier 生存曲线和受试者操作特征(ROC) 曲线等进行统计分析和临床预后评价。 结果 年 龄≥55 岁鼻咽癌患者的 ApoA1 水平明显高于年龄<55 岁鼻咽癌患者(P= 0. 013)。 女性患者 HDL-C 水平明显高于男性患者 (P= 0. 001)。 单因素 Cox 回归模型分析结果显示,胆固醇与鼻咽癌患者总生存(OS)期差异有统计学意义(HR = 1. 626,95% CI = 1. 065~ 2. 482,P= 0. 024)。 进一步对 P<0. 1 的 ApoB、ApoE 和胆固醇纳入多因素 Cox 回归模型分析,结果显示高胆固醇是 鼻咽癌预后的危险因素(HR= 1. 613,95%CI = 1. 058~ 2. 460,P= 0. 026)。 不同基线胆固醇水平下,HDL-C(P = 0. 024)、LDL-C (P= 0. 001)和 ApoB(P= 0. 001)水平差异具有统计学意义。 低胆固醇患者的生存期比高胆固醇患者长,低胆固醇患者具有更 长的总生存期(P= 0. 025)。 ROC 曲线分析显示,胆固醇预测鼻咽癌预后的曲线下面积差异具有统计学意义,提示胆固醇对中 晚期鼻咽癌患者生存具有预测能力(AUC= 0. 581, 95%CI = 0. 505~ 0. 656,P= 0. 037)。 结论 中晚期鼻咽癌患者不同临床特征 间血脂存在明显差异;血清胆固醇是预测鼻咽癌患者预后的因素,且高胆固醇是鼻咽癌患者的危险因素,与患者不良预后 相关。

Objective To explore the correlation between serum lipid levels and clinical characteristics and survival prognosis of patients with middle- to late-stage nasopharyngeal carcinoma NPC . Method To retrospectively analyze 285 patients with NPC stage Ⅲ-Ⅳ in Affiliated Hospital of Jiangnan University and collect serum lipid-related indexes of high-density lipoprotein cholesterol HDL-C low-density lipoprotein cholesterol LDL-C apolipoprotein A1 ApoA1 apolipoprotein B ApoB apolipoprotein E ApoE cholesterol CHOL and triglyceride TG . Statistical analysis and clinical prognostic evaluation were performed using univariate and multivariate Cox regression Kaplan-Meier survival curves and ROC curves. Result ApoA1 was significantly higher in NPC patients aged ≥55 years than in NPC patients aged <55 years P= 0. 013 . Further grouped by gender the results showed that HDL-C was significantly higher in the female group than in the male group P= 0. 001 . The results of Cox one-way analysis showed that the difference in OS between high CHOL level and NPC patients was statistically significant HR = 1. 626 95% CI = 1. 065 - 2. 482 P= 0. 024 . Further ApoB ApoE and CHOL with P<0. 1 were included in a multifactorial Cox proportional risk analysis which showed that CHOL was a risk factor for NPC prognosis HR = 1. 613 95% CI = 1. 058-2. 460 P = 0. 026 . The differences in HDL-C P= 0. 024 LDL-C P = 0. 001 and ApoB P = 0. 001 were statistically significant at different baseline CHOL levels. Survival time was longer in the low CHOL group than in the high CHOL group and the low CHOL group had a higher overall survival time P= 0. 025 . ROC curve analysis showed that the area under the curve of CHOL predicting NPC prognosis AUC = 0. 581 95% CI = 0. 505-0. 656 P= 0. 037 . Conclusion Significant differences in serum lipids were found between the different clinical features of patients with middle and advanced NPC Serum CHOL emerged as an independent predictor of prognosis in patients with middle and advanced NPC and High cholesterol level is a risk factor for nasopharyngeal carcinoma patients and is associated with poor prognosis.