晚期非小细胞肺癌患者血清载脂蛋白A-I水平及其临床意义分析

目的 探讨血清载脂蛋白A-I（ApoA-I）与晚期非小细胞肺癌（NSCLC）患者临床病理特征的关系及其对患者预后的影响。方法 回顾性分析2009年1月至2014年12月第二军医大学附属长海医院经病理组织学诊断的117例ⅢB～Ⅳ期NSCLC患者的临床资料，以治疗前ApoA-I基线值的中位数为截点分为高、低两组，分析ApoA-I水平与患者临床病理特征的关系，单因素及多因素生存分析评价ApoA-I对预后的影响。结果 低于治疗前ApoA-I基线值组（≤1.2 g／L）为50例（42.7％），高于治疗前ApoA-I基线值组（＞1.2 g／L）为67例（57.3％）；治疗前ApoA-I基线值与肿瘤直径、TNM分期、治疗前C反应蛋白值、血白蛋白及ECOG PS评分均有关（P＜0.05）。低于治疗前ApoA-I基线值组和高于治疗前ApoA-I基线值组患者的中位生存期（OS）分别为10.1个月和15.1个月，差异有统计学意义（P＜0.05）。单因素分析显示，吸烟指数、治疗前C反应蛋白值、血白蛋白、临床分期、淋巴结转移、ECOG PS评分及治疗前ApoA-I基线值均为影响患者预后的因素。Cox回归多因素分析显示，治疗前C反应蛋白值、临床分期、 ECOG PS评分及治疗前ApoA-I基线值为影响患者预后的独立危险因素。结论 血清ApoA-I水平低提示晚期NSCLC患者预后不良，ApoA-I可能是晚期NSCLC潜在的生物学标志物。

Level of serum apolipoprotein A-I in patients with advanced non-small cell lung cancer and its clinical significance

Objective To investigate the relationship between apolipoprotein A-I（ApoA-I） and clinicopathological features of patients with advanced non-small cell lung cancer（NSCLC）， as well as the effect of ApoA-I on the prognosis of advanced NSCLC. Methods Retrospective analysis was performed for 117 cases with histologically confirmed ⅢB and Ⅳ stage NSCLC patients in Changhai Hospital affiliated to Second Military Medical University from January 2009 to December 2014. All patients were classified into two groups based on the median value of baseline serum ApoA-I before treatment. The relationship between ApoA-I and clinicopathological features was studied. Univariate and multivariate analyses were performed to assess the prognostic effect of ApoA-I. Results All patients were divided into two groups： low serum ApoA-I levels before treatment（≤1.2 g／L， n=50） and high serum ApoA-I levels before treatment（＞1.2 g／L， n=67）. ApoA-I was correlated with greatest tumor diameter， clinical stage， serum C reactive protein before treatment， serum albumin and ECOG PS（P＜0.05）. The median overall survival（OS） of low and high ApoA-I levels patients were 10.1 months and 15.1 months with significant difference（P＜0.05）. Univariate analysis showed that the independent factors affecting the prognosis included smoking status， serum C reactive protein before treatment， serum albumin， clinical stage， N stage， ECOG PS and serum ApoA I level before treatment（P＜0.05）. Multivariate analysis by using Cox regression identified serum C reactive protein before treatment， clinical stage， ECOG PS and serum ApoA-I level before treatment as independent prognostic factors of all the patients. Conclusion A decreased serum ApoA-I level before treatment indicates poor prognosis in advanced NSCLC patients. ApoA-I could be a potential biological marker for advanced NSCLC patients.