血清白蛋白及尿素氮水平与肺癌不同临床病理特征和预后的关系 |
您所在的位置：网站首页 › 人体血清白蛋白的价格 › 血清白蛋白及尿素氮水平与肺癌不同临床病理特征和预后的关系 |
| Zhongguo Fei Ai Za Zhi. 2017 Mar 20; 20(3): 175–186. Chinese. doi: 10.3779/j.issn.1009-3419.2017.03.06PMCID: PMC5973299PMID: 28302220 Language: Chinese | English 血清白蛋白及尿素氮水平与肺癌不同临床病理特征和预后的关系Relationships between Serum Albumin and Urea Level and the Clinical Pathological Characteristics and Survival Time in Patients with Lung Cancer李 亚伦, 李 镭, 张 立, and 李 为民*李 亚伦610041 成都，四川大学华西医院呼吸内科, Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China Find articles by 李 亚伦李 镭610041 成都，四川大学华西医院呼吸内科, Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China Find articles by 李 镭张 立610041 成都，四川大学华西医院呼吸内科, Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China Find articles by 张 立李 为民610041 成都，四川大学华西医院呼吸内科, Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China Find articles by 李 为民Author information Article notes Copyright and License information PMC Disclaimer 610041 成都，四川大学华西医院呼吸内科, Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China 李 为民: moc.361@300nimiew 李为民, Weimin LI, E-mail: moc.361@300nimiewReceived 2017 Jan 1; Revised 2017 Jan 26; Accepted 2017 Jan 28.Copyright 版权所有©《中国肺癌杂志》编辑部2017Copyright ©2017 Chinese Journal of Lung Cancer. All rights reserved.This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) License. See: https://creativecommons.org/licenses/by/3.0/Abstract背景与目的肺癌作为全球男女性中致死率最高的肿瘤之一，严重威胁着人类的健康。本研究旨在分析肺癌患者血清白蛋白及尿素氮水平与临床病理特征及生存期的关系。 方法收集2008年1月-2013年12月四川大学华西医院病理确诊原发性肺癌患者1, 098例，检测患者血清中白蛋白及尿素氮水平，按检测水平是否正常分为阳性组及阴性组，分别分析白蛋白及尿素氮水平与肺癌临床病理特征及生存期的相关性。 结果1, 098例患者的年龄、性别、病理学分型、肝转移、胸膜转移与血清白蛋白水平差异有统计学意义（P＜0.05）；312例鳞癌患者的年龄、肺内转移以及612例腺癌患者的年龄、性别、临床分期、胸膜转移与白蛋白水平差异有统计学意义（P＜0.05）。尿素水平与各临床特征均无统计学意义。不同病理学类型的肺癌患者血清白蛋白水平在阴性组与阳性组中位生存时间分别为鳞癌36个月和19个月，腺癌35个月和15个月，前者中位生存期明显高于后者。尿素氮水平与肺癌患者生存期无相关性。 结论多种影响因素与血清白蛋白阳性程度相关，血清白蛋白水平与肺癌的生存相关，其是肺癌患者预测预后的一个指标。 Keywords: 肺肿物, 血清白蛋白, 尿素氮, 预后AbstractBackground and objectiveLung cancer is the most common malignancy and is the leading cause of cancer-related death worldwide. Thus, this disease severely threatens human health. This study aims to identify the relationships between serum albumin and urea level and the clinical pathological characteristics and survival time in patients with lung cancer. MethodsA total of 1, 098 patients with lung cancer were diagnosed by pathology and tested the serum albumin and urea level in West China Hospital of Sichuan University during January 2008 to December 2013. According to the levels of albumin and urea, patients were divided into the normal level group(negative group) and abnormal level group(positive group). The differences of patients' clinical pathological characteristics and survival time in the two groups were analyzed. ResultsDifferences in age, sex, histological classification, liver metastasis and pleural metastasis were statistically significant between the two groups of serum albumin(P < 0.05). Differences in age, intrapulmonary metastasis of 312 patients of squamous cell carcinoma and differences in age, sex, stages, pleural metastasis of 612 patients of adenocarcinoma between the two groups of serum albumin(P < 0.05). There were no significant differences between the two groups of urea. In different histological classification between the two groups of serum albumin, the median survival period of squamous cell carcinoma was 36 months and 19 monthes, adenocarcinoma was 35 months and 15 monthes, the abnormal group were all significantly lower than those in the normal group. The median survival period was no significant difference between the two groups of urea. ConclusionThe level of serum albumin is an important indicator for prognosis. Keywords: Lung neoplasms, Albumin, Urea, Prognosis目前肺癌是全球发病率及致死率最高的肿瘤之一，非小细胞肺癌（non-small cell lung cancer, NSCLC）约占肺癌的80%，包括腺癌、鳞癌和大细胞癌；小细胞肺癌（small cell lung cancer, SCLC）约占20%，其恶性程度高，发展迅速，预后更差。尽管近些年治疗手段不断发展，但其5年生存率仅为17%[1]。世界卫生组织（World Health Organization, WHO）预测中国到2025年时每年新发肺癌病例将超过100万，成为世界肺癌第一大国[2]。 肺癌患者血清标志物监测对肺癌的诊断、治疗及预后有重要的临床意义。随着科技的进步，目前对肿瘤标志物的研究进展很快，临床多采用肿瘤标志物的联合检测。但在临床工作中，临床医师对血清中部分生化指标并不够重视。生化指标中血清白蛋白及尿素氮的测定值，可能会反应肺癌患者的预后。白蛋白主要在肝脏合成，其半衰期长，在体内广泛分布，以阻止体内营养状态的迅速改变。肺癌患者，尤其是疾病进展的患者，由于肿瘤代谢增强，能量消耗大，多数患者食欲下降，食物摄入量减少，白蛋白合成减少等因素，导致血清白蛋白水平下降。因此我们推测白蛋白水平不仅提示患者的营养水平，也和患者的预后有关。血清尿素氮是反应肾功能的主要指标之一，也是人体蛋白质代谢的主要终末产物。我们推测，血清尿素氮是否也和肺癌患者的预后等有相关性。因此本研究分析血清标志物中白蛋白及尿素氮指标与肺癌患者的临床特征及生存预后的差异。 1. 资料与方法1.1. 研究对象研究对象为2008年1月-2013年12月四川大学华西医院确诊原发性肺癌患者1, 098例，所有患者均随访24个月-36个月。纳入标准为初诊为原发性肺癌患者，所有患者均经病理学证实。排除标准为排除无病理学依据，临床资料不完整患者；以及合并其他肿瘤或肺癌复治的患者。收集资料包括肺癌患者年龄（＜45岁、45岁-60岁、＞60岁）、性别（男性、女性）、病理学分型（鳞癌、腺癌、小细胞癌）、临床分期（Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期）、吸烟史、淋巴结转移及远程转移（脑、骨、肝、肾上腺、肺内、胸膜、纵隔）情况。临床分期根据第七版美国癌症联合委员会（American Joint Committee on Cancer, AJCC）的肿瘤-淋巴结-转移（tumor -node-metastasis, TNM）分期[3]，病理类型及分化程度按1999年世界卫生组织（World Health Organization, WHO）肺癌组织学类型分类标准且由病理科医师确认[4]。 1.2. 分组按血清白蛋白及尿素氮指标水平正常与否进行分组，正常值范围：白蛋白40.0 g/L-55.0 g/L、尿素3.30 mmol/L-8.22 mmol/L。指标水平正常定义为阴性，低于正常范围定义为阳性。 1.3. 观察指标分析血清白蛋白及尿素氮指标水平阴性与阳性两组的年龄、性别、病理学类型、临床分期、吸烟史、淋巴结转移及远处转移的临床特征的差异；并分别分析不同病理学类型中，血清白蛋白及尿素氮指标水平阴性与阳性两组的年龄、性别、临床分期、吸烟史、淋巴结转移及远处转移的临床特征及生存曲线的差异；并对有意义的临床特征进行分析，观察其对患者生存预后的影响。 1.4. 统计学方法采用SPSS 19.0软件进行统计学分析，采用卡方检验，生存分析采用Kaplan-Meier法并进行Log-rank检验，采用GraphPad Prism进行图片制作。P＜0.05为差异有统计学意义。 2. 结果2.1. 一般情况如表 1和表 2所示，本研究总共纳入原发性肺癌患者1, 098例，年龄19岁-90岁，平均60.65岁。其中男性757例（占69.0%），女性341例（31.0%）。纳入患者中，病理类型以腺癌为主，612例（55.8%）；鳞癌312例（28.4%），小细胞癌174例（15.8%）。临床分期中，早期肺癌（Ⅰ期-Ⅱ期）207例（18.9%），中晚期891例（81.1%）。此外，647例（58.9%）肺癌患者在诊断时伴有淋巴结转移，所有患者中有吸烟史的625例（56.9%）。 1血清白蛋白水平与1, 098例肺癌患者临床病理特征的关系 The relationship between serum albumin level and clinicopathologic features of 1, 098 lung cancer patients ValueNegative(n=448)Positive(n=650)Total(n=1, 098)P SCLC: small cell lung cancer.Basic characteristics Age(yr)＜0.001 ＜4542(9.4%)48(7.4%)90 45-60194(43.3%)195(30.0%)389 ＞60212(47.3%)407(62.6%)619 Gender0.012 Male290(64.7%)467(71.8%)757 Female158(35.3%)183(28.2%)341 Histological classification＜0.01 Squamous98(21.8%)214(32.9%)312 Adenocarcinoma263(58.7%)349(53.7%)612 SCLC87(19.5%)87(13.4%)174 Stages0.001 Ⅰ61(13.6%)43(6.6%)104 Ⅱ45(10%)58(8.9%)103 Ⅲ111(24.8%)178(27.4%)289 Ⅳ231(51.6%)371(57.1%)602 Smoking status0.172 No204(45.5%)269(41.4%)473 Yes233(54.5%)381(58.6%)625Metastasis Brain0.036 No394(87.9%)583(89.7%)977 Yes54(12.2%)67(10.3%)121 Bone0.257 No368(82.1%)516(79.4%)884 Yes80(17.9%)134(20.6%)214 Liver0.036 No417(93.1%)581(89.4%)998 Yes31(6.9%)69(10.4%)100 Adrenal gland0.714 No423(94.4%)617(95.0%)1, 040 Yes25(5.6%)33(5.0%)58 Lymph node0.135 No196(48.7%)255(39.2%)451 Yes252(56.2%)395(60.8%)647 Intrapulmonary0.439 No401(89.5%)572(88.0%)973 Yes47(10.5%)78(12.0%)125 Pleural0.025 No396(88.4%)543(83.5%)939 Yes52(11.6%)107(16.5%)159 Mediastinal0.222 No439(98.0%)629(96.8%)1, 068 Yes9(2.0%)21(3.2%)30Open in a separate window2血尿素氮水平与1, 098例肺癌患者临床病理特征的关系 The relationship between serum urea level and clinicopathologic features of 1, 098 lung cancer patients ValueNegative(n=643)Positive(n=455) Total(n=1, 098)PBasic characteristics Age(yr)0.200 ＜4555(8.6%)35(7.7%)90 45-60240(37.3%)149(32.7%)389 ＞60348(54.1%)271(59.6%)619 Gender0.823 Male445(69.2%)312(68.6%)757 Female198(30.8%)143(31.4%)341 Histological classification0.925 Squamous185(28.8%)127(27.9%)312 Adenocarcinoma358(55.7%)254(55.8%)612 SCLC100(15.5%)74(16.3%)174 Stages0.145 Ⅰ58(9.0%)46(10.1%)104 Ⅱ55(8.6%)48(10.5%)103 Ⅲ185(28.8%)104(22.9%)289 Ⅳ345(53.6%)257(56.5%)602 Smoking status0.323 No269(41.8%)204(44.8%)473 Yes374(58.2%)251(55.2%)625Metastasis Brain0.576 No575(89.4%)402(88.4%)977 Yes68(10.6%)53(11.6%)121 Bone0.608 No521(81.0%)363(79.8%)884 Yes122(19.0%)92(20.2%)214 Liver0.331 No589(91.6%)409(89.9%)998 Yes54(8.4%)46(10.1%)100 Adrenal gland0.791 No610(94.9%)430(95.5%)1, 040 Yes33(5.1%)25(5.5%)58 Lymph node0.376 No257(40.0%)194(42.6%)451 Yes386(60.0%)261(57.4%)647 Intrapulmonary0.355 No565(87.9%)408(89.7%)973 Yes78(12.1%)47(10.3%)125 Pleural0.742 No548(85.2%)391(85.9%)939 Yes95(14.8%)64(14.1%)159 Mediastinal0.831 No626(97.4%)442(97.1%)1, 068 Yes17(2.6%)13(2.9%)30Open in a separate window2.2. 血清白蛋白及尿素氮水平与临床病理特征的关系血清白蛋白水平阴性和阳性两组中，年龄、性别、病理学分型、肝转移、胸膜转移方面差异有统计学意义（P＜0.05），其余无统计学差异（P＞0.05）（表 1）。血尿素氮水平阴性和阳性两组均无统计学差异（P＞0.05）（表 2）。 2.3. 肺癌不同病理分型中白蛋白水平与临床病理特征的关系312例鳞癌患者，血清白蛋白水平阴性和阳性两组，年龄和肺内转移方面差异有统计学意义（P＜0.05）（表 3）。612例腺癌患者中，年龄、性别、临床分期及胸膜转移方面差异有统计学意义（P＜0.05）（表 4）。174例小细胞癌患者中各临床特征均无统计学差异（P＞0.05）（表 5）。 3血清白蛋白水平与312例鳞癌患者临床病理特征的关系 The relationship between serum albumin level and clinicopathologic features of 312 patients of squamous cell carcinoma ValueNegative(n=98)Positive(n=214)Total(n=312)PBasic characteristics Age(yr)＜0.001 ＜455(5.1%)5(2.3%)10 45-6050(51.0%)67(31.3%)117 ＞6038(43.9%)14(66.4%)185 Gender0.861 Male89(90.8%)193(90.2%)282 Female158(35.3%)183(28.2%)30 Stages0.236 Ⅰ13(13.3%)15(7.0%)28 Ⅱ15(15.3%)26(12.1%)41 Ⅲ33(33.7%)84(39.3%)117 Ⅳ37(37.7%)89(41.6%)126 Smoking status0.430 No16(16.3%)43(20.1%)59 Yes82(83.7%)171(79.9%)253Metastasis Brain0.751 No91(92.9%)207(96.7%)298 Yes7(7.1%)7(3.3%)14 Bone0.751 No86(87.8%)185(86.4%)271 Yes12(12.2%)29(13.6%)41 Liver0.200 No93(94.9%)194(90.7%)287 Yes5(5.1%)20(9.3%)25 Adrenal gland0.424 No92(93.9%)207(96.7%)299 Yes6(6.1%)7(3.3%)13 Lymph node0.303 No45(45.9%)85(39.7%)130 Yes53(54.1%)129(60.3%)182 Intrapulmonary0.067 No93(94.9%)189(88.3%)282 Yes5(5.1%)25(11.7%)30 Pleural0.641 No90(91.8%)193(90.2%)283 Yes8(8.2%)21(9.8%)29 Mediastinal0.547 No96(98.0%)207(96.7%)303 Yes2(2.0%)7(3.3%)9Open in a separate window4血清白蛋白水平与612例腺癌患者临床病理特征的关系 The relationship between serum albumin level and clinicopathologic features of 612 patients of adenocarcinoma ValueNegative(n=263)Positive(n=349)Total(n=612)PBasic characteristics Age(yr)0.003 ＜4531(11.8%)36(10.3%)67 45-60101(38.4%)92(26.4%)193 ＞60131(49.8%)221(63.3%)352 Gender0.021 Male129(49.0%)204(58.5%)333 Female134(51.0%)145(41.5%)279 Stages0.001 Ⅰ42(16.0%)24(6.9%)66 Ⅱ27(10.2%)25(68%)52 Ⅲ47(17.9%)68(19.5%)115 Ⅳ147(55.9%)232(66.5%)379 Smoking status0.234 No164(62.4%)21(57.6%)365 Yes99(37.6%)148(42.4%)247Metastasis Brain0.886 No225(85.6%)300(90.8%)525 Yes38(14.4%)49(14.0%)87 Bone0.127 No207(78.7%)256(73.4%)463 Yes56(21.3%)93(26.6%)149 Liver0.222 No246(93.5%)317(90.8%)563 Yes17(6.5%)32(9.2%)49 Adrenal gland0.067 No256(97.3%)329(94.3%)585 Yes7(2.7%)20(5.7%)27 Lymph node0.160 No125(47.5%)146(41.8%)271 Yes138(52.5%)203(58.2%)341 Intrapulmonary0.673 No226(85.9%)304(87.1%)530 Yes37(14.1%)45(12.5%)82 Pleural0.019 No224(85.2%)271(77.7%)495 Yes39(14.8%)78(22.3%)117 Mediastinal0.069 No260(98.9%)337(96.6%)597 Yes3(1.1%)12(3.4%)15Open in a separate window5血清白蛋白水平与174例鳞癌患者临床病理特征的关系 The relationship between serum albumin level and clinicopathologic features of 174 small cell lung cancer patients ValueNegative(n=87)Positive(n=87)Total(n=174)PBasic characteristics Age(yr)0.567 ＜456(6.9%)7(8.0%)13 45-6043(49.4%)36(41.4%)79 ＞6038(43.7%)44(50.6%)82 Gender0.696 Male72(82.8%)70(80.5%)142 Female15(17.2%)17(19.5%)32 Stages0.470 Ⅰ6(6.9%)4(4.6%)10 Ⅱ3(3.4%)7(8.0%)10 Ⅲ31(35.6%)26(29.9%)57 Ⅳ47(54.1%)50(57.5%)97 Smoking status0.866 No24(27.6%)25(28.7%)49 Yes63(72.4%)62(71.3%)125Metastasis Brain0.886 No225(85.6%)300(90.8%)525 Yes38(14.4%)49(14.0%)87 Bone0.635 No78(89.7%)76(87.4%)154 Yes9(10.3%)11(12.6%)20 Liver0.089 No78(89.7%)70(80.5%)148 Yes9(10.3%)17(19.5%)26 Adrenal gland0.135 No75(86.2%)81(93.1%)156 Yes12(13.8%)6(6.9%)27 Lymph node0.738 No26(29.9%)24(27.6%)50 Yes61(70.1%)63(72.4%)124 Intrapulmonary No82(94.3%)79(90.8%)1610.387 Yes5(5.7%)8(9.2%)13 Pleural No82(94.3%)79(90.8%)1610.387 Yes5(5.7%)8(9.2%)13 Mediastinal0.406 No83(95.4%)85(97.7%)168 Yes4(4.6%)2(2.3%)6Open in a separate window2.4. 肺癌不同病理分型中血尿素氮水平与临床病理特征的关系312例鳞癌患者（表 6）及612例腺癌患者中（表 7），尿素水平阴性和阳性两组中各临床特征均无统计学差异（P＞0.05）；174例小细胞癌患者中仅年龄差异有统计学意义（P＜0.05）（表 8）。 6血尿素氮水平与312例鳞癌患者临床病理特征的关系 The relationship between serum urea level and clinicopathologic features of 312 patients of squamous cell carcinoma ValueNegative(n=185)Positive(n=127)Total(n=312)PBasic characteristics Age(yr)0.396 ＜458(4.3%)2(1.6%)10 45-6068(36.8%)49(38.6%)117 ＞60109(58.9%)76(59.8%)185 Gender0.636 Male166(89.7%)116(91.3%)282 Female19(10.3%)11(8.7%)30 Stages0.102 Ⅰ17(9.2%)11(8.7%)28 Ⅱ18(9.7%)23(18.1%)41 Ⅲ77(41..6%)40(31.5%)117 Ⅳ73(39.5%)53(41.7%)126 Smoking status0.559 No33(17.8%)26(20.5%)59 Yes152(82.2%)62(79.5%)253Metastasis Brain0.344 No175(94.6%)106(83.5%)298 Yes10(5.4%)21(3.1%)14 Bone0.141 No165(89.2%)106(83.5%)271 Yes20(10.8%)11(12.6%)41 Liver0.727 No171(92.4%)116(913%)287 Yes14(7.6%)11(8.7%)25 Adrenal gland0.456 No176(95.1%)123(96.9%)299 Yes9(4.9%)4(3.1%)13 Lymph node0.340 No73(39.5%)57(44.9%)130 Yes112(60.5%)70(55.1%)182 Intrapulmonary0.636 No166(89.7%)116(91.3%)282 Yes19(10.3%)11(8.7%)30 Pleural0.750 No167(90.3%)116(91.3%)283 Yes18(9.7%)11(9.7%)29 Mediastinal0.817 No180(97.3%)123(96.9%)303 Yes5(2.7%)4(3.1%)9Open in a separate window7血尿素氮水平与612例腺癌患者临床病理特征的关系 The relationship between serum urea level and clinicopathologic features of 612 patients of adenocarcinoma ValueNegative(n=358)Positive(n=254)Total(n=612)PBasic characteristics Age(yr)0.981 ＜4539(10.9%)28(11.0%)67 45-60114(31.8%)79(31.1%)193 ＞60205(57.3%)147(57.9%)352 Gender0.843 Male196(54.7%)137(53.9%)333 Female162(45.3%)117(46.1%)279 Stages0.272 Ⅰ34(9.5%)32(12.6%)66 Ⅱ32(8.9%)20(7.9%)52 Ⅲ75(21.0%)40(15.7%)115 Ⅳ217(60.6%)162(63.8%)379 Smoking status0.800 No212(59.2%)153(60.2%)365 Yes146(40.8%)101(39.8%)247Metastasis Brain0.166 No313(87.4%)212(83.5%)525 Yes45(12.6%)42(16.5%)87 Bone0.824 No272(76.0%)191(75.2%)463 Yes86(24.0%)63(24.8%)49 Liver0.421 No332(92.7%)231(90.9%)563 Yes26(7.3%)17(9.1%)49 Adrenal gland0.474 No344(96.1%)241(94.9%)585 Yes14(3.9%)13(5.1%)27 Lymph node0.455 No154(43.0%)117(46.1%)271 Yes204(57.0%)137(53.9%)341 Intrapulmonary0.331 No306(85.5%)224(88.2%)530 Yes52(14.5%)30(11.8%)82 Pleural0.927 No290(81.0%)205(80.7%)495 Yes68(19.0%)49(19.3%)117 Mediastinal0.516 No348(97.2%)249(98.0%)597 Yes10(2.8%)5(2.0%)15Open in a separate window8血尿素氮水平与174例鳞癌患者临床病理特征的关系 The relationship between serum urea level and clinicopathologic features of 174 small cell lung cancer patients ValueNegative(n=100)Positive(n=74)Total(n=174)PBasic characteristics Age(yr)＜0.001 ＜458(8.0%)5(6.7%)13 45-6058(58.0%)21(28.4%)79 ＞6034(34.0%)48(64.9%)82 Gender0.582 Male83(83.0%)59(79.7%)142 Female17(17.0%)15(20.3%)32 Stages0.826 Ⅰ7(7.0%)3(4.1%)10 Ⅱ5(5.0%)5(6.7%)10 Ⅲ33(33.0%)24(32.4%)57 Ⅳ55(55.0%)42(56.8%)97 Smoking status0.156 No24(24.0%)25(33.8%)49 Yes76(76.0%)49(66.2%)125Metastasis Brain0.469 No87(87.0%)67(90.5%)154 Yes13(13.0%)7(9.5%)20 Bone0.469 No84(84.0%)66(89.2%)154 Yes16(16.0%)8(10.8%)20 Liver0.685 No86(86.0%)62(83.8%)148 Yes14(14.0%)12(16.2%)26 Adrenal gland0.862 No90(90.0%)66(89.2%)156 Yes10(10.0%)8(10.8%)18 Lymph node0.668 No30(30.0%)20(27.0%)50 Yes70(70.0%)54(73.0%)124 Intrapulmonary0.373 No93(93.0%)68(91.9%)161 Yes7(7.0%)6(8.1%)13 Pleural0.373 No91(91.0%)70(94.6%)161 Yes9(9%)4(5.4%)13 Mediastinal0.224 No98(98.0%)70(94.6%)168 Yes2(2.0%)4(5.4%)6Open in a separate window2.5. 血清白蛋白水平与肺癌不同病理分型患者的预后对这1, 098例患者进行24个月-36个月的随访，最终仅565例患者获得生存资料。在不同病理分型肺癌患者中，对血清白蛋白水平阴性及阳性组的患者进行生存分析。鳞癌患者，血清白蛋白阴性组与阳性组中位生存时间分别为36个月和19个月，前者中位生存期明显高于后者，差异有统计学意义（P＜0.05）（图 1A）。腺癌患者，中位生存时间分别为35个月和15个月，前者中位生存期明显高于后者，差异有统计学意义（P＜0.05）（图 1B）。小细胞癌患者中，两组差异无统计学意义（P=0.234）（图 1C）。 Open in a separate window1生存曲线。A：鳞癌患者血清白蛋白水平阴性及阳性组；B：腺癌患者血清白蛋白水平阴性及阳性组；C：小细胞癌患者血清白蛋白水平阴性及阳性组；D：鳞癌患者血尿素氮水平阴性及阳性组；E：腺癌患者血尿素氮水平阴性及阳性组；F：小细胞癌患者血尿素氮水平阴性及阳性组。 The Kaplan-Meier curves. A: Squamous cell carcinoma in negative and positive of serum albumin level; B: Adenocarcinoma in negative and positive of serum albumin level; C: Small cell lung cancer in negative and positive of serum albumin level; D: Squamous cell carcinoma in negative and positive of serum urea level; E: Adenocarcinoma in negative and positive of serum urea level; F: Small cell lung cancer in negative and positive of serum urea level. 2.6. 血尿素氮水平与肺癌不同病理分型患者的预后在不同病理分型肺癌患者中，对血尿素氮水平阴性及阳性组的患者进行生存分析。鳞癌患者、腺癌患者及小细胞癌患者中，两组差异均无统计学意义，P值分别为0.795（图 1D）、0.0629（图 1E）、0.204（图 1F）。 3. 讨论近年来，随着环境恶化和人口老龄化的加剧，各类呼吸系统疾病的发生不断增加，肺癌是发生于支气管黏膜上皮的常见的呼吸系统恶性肿瘤，已成为危害人类生命安全的主要疾病之一[5]。 血清白蛋白是血清总蛋白的主要蛋白质成分，由肝脏合成，是血浆中含量最丰富的蛋白质，他具有结合和运输内源性与外源性物质，维持血液胶体渗透压、营养支持等方面均起着重要作用，在生命过程中有着重要意义。血尿素氮则是人体蛋白质代谢的主要终末产物。本研究发现尿素氮与肺癌患者的临床特征及预后无明显统计学差异，但血清白蛋白水平则与肺癌的生存相关，白蛋白水平低的患者中位生存期明显低于白蛋白水平正常的患者。这可能与血清白蛋白可以反应患者的营养状况，而营养状况可影响患者预后。 恶性肿瘤疾病是一种消耗性疾病，肺癌患者长期处于消耗状态，导致体重降低、营养不良。血清白蛋白是作为评价营养的生化指标，是反映内脏蛋白水平的最佳和最简易的参数[6]。29个肿瘤研究中心的临床流行病学调查显示：白蛋白水平是肿瘤患者存活的预示因子[7]；60岁以上住院患者的死亡率与低白蛋白水平有关[8]。而白蛋白的含量也是评价机体免疫力的重要指标，当白蛋白含量＜30 g/L时，机体可能无法抵抗外来病原菌的侵袭，导致肺部感染等发生，尤其是接受手术或联合多种化疗药物治疗的患者，更易导致体内大量白蛋白的丢失。有研究[9]显示，当血清白蛋白＜30 g/L时，患者发生肺部感染概率显著增高，且为独立危险因素。有研究[10]表明，肺癌患者可存在血清白蛋白水平降低，且外科手术或者放化疗可进一步导致其血清白蛋白水平降低，因此白蛋白可能与肺癌患者的病情相关，可能用于其预后。此外，有研究[11]发现，血清总蛋白和白蛋白降低是肺癌患者发生深静脉血栓的危险因素之一，这也可能是导致肺癌患者生存期缩短的原因。肺癌患者血清白蛋白可作为其预后评价的参考指标。早期关注肺癌患者的营养状态，尤其是接受手术或是接受放化疗的患者，加强营养及蛋白质的摄入，可能提高其预后。但患者血清白蛋白水平以及预后均可能受高血压、糖尿病等基础疾病的影响，因此明确患者血清白蛋白水平对其预后的评估价值需更大样本量和更全面的研究。 综上所述，肺癌患者血清白蛋白可作为患者预后的一个预测指标。但由于其受多种因素影响，故临床上可以采用多种指标以及肿瘤标志物联合，更好地预测患者的预后。 Funding Statement本研究受国家自然科学基金项目（No.81241068, No.81372504）资助 This study was supported by the grants from the National Natural Science Foundation of China(No.81241068 and No.81372504)(Both to Weimin LI) References1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30. doi: 10.3322/caac.v63.1. [PubMed] [CrossRef] [Google Scholar]2. World Health Organization. Cancer: fact sheet No. 297. World Health Organization website, 2011. http://www.who.int/mediacentre/factsheets/fs297/en/ Accessed September 10, 2011.3. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer stagin manual and future of TNM. Ann Surg Oncol. 2010;17(6):1471–1474. doi: 10.1245/s10434-010-0985-4. [PubMed] [CrossRef] [Google Scholar]4. Travis WD, Brambilla E, Riely GJ. New pathologic classification of lung cancer: relevance for clinical practice and clinical trials. J Clin Oncol. 2013;31(8):992–1001. doi: 10.1200/JCO.2012.46.9270. [PubMed] [CrossRef] [Google Scholar]5. Giatromanolaki A, Kalamida D, Siyridis E, et al. Increased expression of transcription factor EB(TFEB) is associated with autophagy, migratory phenotype and poor prognosis in non-small cell lung cancer. Lung Cancer. 2015;90(1):98–105. doi: 10.1016/j.lungcan.2015.07.008. [PubMed] [CrossRef] [Google Scholar]6. Piskorz L, Lesiak T, Brocki M, et al. Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer. http://www.ncbi.nlm.nih.gov/pubmed/22072348. Nutr Hosp. 2011;26(5):1025–1032. [PubMed] [Google Scholar]7. Gupta D, Vashi PG, Lammersfeld CA, et al. Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab. 2011;59(2-4):96–106. doi: 10.1159/000332914. [PubMed] [CrossRef] [Google Scholar]8. Hannan JL, Radwany SM, Albanese T. In-hospital mortality in patients older than 60 years with very low albumin levels. J Pain Symptom Manage. 2012;43(3):631–637. doi: 10.1016/j.jpainsymman.2011.04.009. [PubMed] [CrossRef] [Google Scholar]9. Lang MC, Li QH, Sang Y, et al. Analysis of pulmonary fungal infection in lung cancer patients after radiotherapy and chemotherapy. http://d.wanfangdata.com.cn/Periodical/zhyygrxzz201209025 Zhonghua Yi Yuan Gan Ran Xue Za Zhi. 2012;22(9):1815–1817. [Google Scholar]郎 梅春, 李 秋华, 桑 鹰, et al. 肺癌患者放化疗后合并肺部真菌感染分析 http://d.wanfangdata.com.cn/Periodical/zhyygrxzz201209025. 中华医院感染学杂志 2012;22(9):1815–1817. [Google Scholar]10. Wang MT, Zheng YL, Lin XX, et al. Changes and significance of serum albumin and lactic acid levels in patients with non small cell lung cancer undergoing video-assisted thoracoscopic surgery. http://d.wanfangdata.com.cn/Periodical/gdyx201608015 Guangdong Yi Xue. 2016;37(8):1157–1160. [Google Scholar]王 沐廷, 郑 滢丽, 林 晓旋, et al. 非小细胞肺癌胸腔镜手术围术期血清白蛋白和乳酸水平的变化及意义 http://d.wanfangdata.com.cn/Periodical/gdyx201608015 广东医学 2016;37(8):1157–1160. [Google Scholar]11. Hu NN, Cao LJ, Xia HL, et al. Clinical features and risk factors of lung cancer patients complicated with venous thromboembolis. http://d.wanfangdata.com.cn/Periodical/lcfkzz201609034 Lin Chuang Fei Ke Za Zhi. 2016;21(9):1671–1678. [Google Scholar]胡 娜娜, 操 乐杰, 夏 淮玲, et al. 肺癌合并静脉血栓栓塞症的临床特点及易患因素分析 http://d.wanfangdata.com.cn/Periodical/lcfkzz201609034. 临床肺科杂志 2016;21(9):1671–1678. [Google Scholar] |
今日新闻 |
点击排行 |
|
推荐新闻 |
图片新闻 |
|
专题文章 |
| CopyRight 2018-2019 实验室设备网 版权所有 win10的实时保护怎么永久关闭 |