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目的:探讨肾细胞癌患者代谢相关因素与分级、分期等肿瘤病理学特征的相关性。方法:回顾性分析2009年1月至2015年1月期间在北京大学人民医院泌尿外科经手术后病理确诊的382例肾癌患者的病历资料,采用t检验、秩和检验和Logistic回归分析等多种统计学方法,分析常用代谢相关指标(体重、体质指数、腰围、血压、血糖、血清甘油三酯、胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇)与肾癌分级、分期及肿瘤直径的相关性。结果:382例患者中80例(20.94%)为高级别肿瘤,63例(16.49%)为进展性肿瘤,153例(40.05%)肿瘤直径>4 cm。与低级别肿瘤组相比,高级别肿瘤组患者的高密度脂蛋白胆固醇水平较低(P=0.015);进展性肿瘤患者与局限性患者相比具有较低的体质指数(P=0.022)、血清胆固醇(P=0.005)和高密度脂蛋白胆固醇(P=0.006);肿瘤直径>4 cm组的患者则具有较低的低密度脂蛋白胆固醇水平(P=0.030)。Logistic回归分析显示,体质指数(OR=0.906,95%CI:0.852~0.986,P=0.023)、血清胆固醇(OR=0.660,95%CI:0.492~0.884,P=0.005)与肿瘤分期相关,高密度脂蛋白胆固醇与肿瘤分级(OR=0.293,95%CI:0.108~0.797,P=0.016)和分期(OR=0.204,95%CI:0.065~0.635,P=0.006)均相关,低密度脂蛋白胆固醇与肿瘤直径相关(OR=0.756,95%CI:0.586~0.975,P=0.031)。结论:代谢相关因素尤其是肥胖和血脂水平与肾癌分级、分期等组织病理学特征关系密切。
OBJECTIVE: To investigate the correlation between the metabolic pathological features of patients with renal cell carcinoma and the pathological features such as grading and staging. Methods: The clinical data of 382 patients with renal cell carcinoma diagnosed postoperatively from January 2009 to January 2015 in Department of Urology, Peking University People’s Hospital were retrospectively analyzed. The results of t test, rank sum test and Logistic regression analysis Statistical methods were used to analyze the relationship between common metabolic parameters (body weight, body mass index, waist circumference, blood pressure, blood glucose, serum triglycerides, cholesterol, LDL cholesterol and HDL cholesterol) Relevance. Results: Among 382 patients, 80 (20.94%) were high grade tumors, 63 (16.49%) were advanced tumors and 153 (40.05%) were> 4 cm in diameter. High-density lipoprotein cholesterol was lower (P = 0.015) in patients with high-grade tumors compared with those in low-grade tumors; patients with progressive tumors had a lower body mass index (P = 0.022) than patients with limited disease, Serum cholesterol (P = 0.005) and HDL cholesterol (P = 0.006); patients with tumors> 4 cm had lower LDL cholesterol (P = .030). Logistic regression analysis showed that body mass index (OR = 0.906, 95% CI: 0.852-0.986, P = 0.023), serum cholesterol (OR = 0.660,95% CI: 0.492-0.884, P = 0.005) Compared with tumor grade (OR = 0.293, 95% CI: 0.108-0.797, P = 0.016) and stage (OR = 0.204, 95% CI: 0.065-0.635, P = 0.006) Cholesterol was correlated with tumor diameter (OR = 0.756, 95% CI: 0.586-0.975, P = 0.031). Conclusion: Metabolic related factors, especially obesity and lipid levels, are closely related to histopathological features such as grade and stage of renal cell carcinoma.