【作者】 张岩；

【导师】 杨兴无；

【作者基本信息】 大连医科大学 ， 外科学（专业学位）， 2019， 硕士

【摘要】 目的:探究结直肠癌患者血清总胆固醇(Total cholesterol,TC)、低密度脂蛋白(Low density lipoprotein,LDL)、高密度脂蛋白(High density lipoprotein,HDL)水平与肿瘤远处转移相关性,以及相关测定结果在结直肠癌患者的诊断与治疗过程中可能存在的临床价值。方法:本试验选取大连医科大学附属第二医院胃肠外科2016年10月至2018年12月期间收治的因结直肠恶性肿瘤行手术治疗的220例患者完整的临床资料进行回顾性研究。一般统计指标包括:性别、年龄、是否贫血(按照实际情况,结合既往研究资料,根据患者有无贫血及贫血程度,又可将纳入统计的病例分为无贫血组病例、轻-中度贫血组病例、重度贫血组病例)、是否存在高血压病。临床指标包括:TC(血清中总胆固醇计值)、LDL(血清中低密度脂蛋白计值)、HDL(血清中高密度脂蛋白计值)、Alb(血清中白蛋白计值,以35g/L为临界值,分为>35g/L病例组,≤35g/L病例组)。肿瘤特性相关指标包括:肿瘤的发生部位、肿瘤分化的程度、肿瘤的病理类型、脉管侵犯情况、淋巴结转移及远处转移情况。本研究中所有计量资料均采用均数±标准差的形式表示,数据处理运用SPSS17.0软件系统;研究结直肠癌远处转移与性别、年龄、是否贫血、是否存在高血压病、肿瘤的发生部位、肿瘤分化的程度、肿瘤的病理类型、脉管侵犯情况、淋巴结转移情况之间的关系采取卡方检验检测其相关性,以P<0.05为有统计学意义;针对结直肠癌有无远处转移的两组病例,其血清中脂质水平是否存在明显差异,组间比较采用T检验和秩和检验(Mann-Whitney test)的方法,以P<0.05为有统计学意义。探讨结直肠癌患者肿瘤远处转移与血清中低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、总胆固醇(TC)三者之间的关系采取Logistic多元回归方程,统计软件使用CHISS2004软件包。根据数据分析结果来探讨结直肠癌患者血清中TC、LDL、HDL水平与肿瘤远处转移的相关性,以及相关测定结果在结直肠癌患者的诊断与治疗过程中可能存在的相关临床价值。结果:1.有或者无远处转移的结直肠癌患者在性别(p=0.133)、年龄(p=0.938)、是否贫血(p=0.111)、是否存在高血压病(p=0.081)、血清中白蛋白水平(p=0.899)、肿瘤发生部位(p=0.477)、病理类型(p=0.577)等方面无差异;2.有远处转移的结直肠癌患者与无远处转移的结直肠癌患者相比,在肿瘤分化程度(p=0.038)、肿瘤是否有脉管侵犯(p=0.034)、肿瘤是否有癌结节(p=0.043)、肿瘤是否有淋巴结转移(p=0.029)、血清TC(p=0.003)、HDL(p=0.001)、LDL(p=0.003)等方面存在着差异;其中,有远处转移的结直肠癌患者相较无远处转移的结直肠癌患者血清中TC、LDL水平较高,但HDL水平较低。结论:1.结直肠癌是否存在远处转移与血清中的TC、LDL、HDL水平密切相关。2.有远处转移的结直肠癌患者血清中TC、LDL水平较高,而血清HDL水平低于无远处转移的患者。3.监测血脂水平对于结直肠癌的发现具有一定的参考意义。更多还原

【Abstract】 Objective: To explore the correlation between serum levels of Total cholesterol(TC),Low density lipoprotein(LDL)and High density lipoprotein(HDL)with distant metastasis in colorectal cancer patients,and the clinical value of the results in the diagnosis and treatment of colorectal cancer patients.Methods: In this study,a retrospective study was conducted on the complete clinical data of 220 patients who received surgical treatment for colorectal malignant tumors from October 2016 to December 2018 in gastrointestinal surgery department of the second affiliated hospital of dalian medical university.General statistical indicators include: gender,age,anemia(according to the actual situation,combined with previous research data,according to whether the patient has anemia and anemia degree,the included cases can be divided into no anemia group cases,mild to moderate anemia group cases,severe anemia group cases),whether there is hypertension.Clinical indicators include TC(total cholesterol in serum),LDL(low density lipoprotein in serum),HDL(high densitylipoprotein in serum)and Alb(albumin in serum).The patients were divided into the > 35g/L case group and the 35g/L case group with a critical value of 35g/L.Relevant indicators of tumor characteristics include: tumor location,degree of tumor differentiation,pathological type of tumor,vascular invasion,lymph node metastasis and distant metastasis.All measurement data in this study were expressed in the form of mean standard deviation,and SPSS17.0 software system was used for data processing.To study the relationship between distant metastasis of colorectal cancer and gender,age,anemia,hypertension,location of tumor,degree of tumor differentiation,pathological type of tumor,vascular invasion and lymph node metastasis,the chi-square test was used to detect the correlation.P < 0.05 was considered statistically significant.For the two groups with or without distant metastasis of colorectal cancer,there was a significant difference in serum lipid level between the two groups.T-test and mann-whitney test were used for comparison between the two groups,and P < 0.05 was considered statistically significant.To investigate the relationship between distant metastasis of colorectal cancer patients and serum low density lipoprotein(LDL),high density lipoprotein(HDL)and total cholesterol(TC).According to the data analysis results,the correlation between TC,LDL and HDL levels in serum and distant metastasis of colorectal cancer patients was discussed,and the clinical value of the results in the diagnosis and treatment ofcolorectal cancer patients.Results: 1.Colorectal cancer patients with or without distant metastasis showed no difference in gender(p=0.133),age(p= 0.938),anemia(p=0.111),hypertension(p=0.081),serum albumin level(p=0.899),tumor location(p=0.477),pathological type(p=0.577),etc.2.Patients with distant metastasis of colorectal cancer compared with patients with distant metastasis of colorectal cancer,the degree of tumor differentiation(p = 0.038),and whether tumor vascular invasion(p = 0.034),if there is a cancer tumor nodules(p = 0.043),and whether tumor with lymph node metastasis(p = 0.029),serum TC(p =0.003),HDL(p = 0.001),LDL(p = 0.003),differences exist;Among them,compared with patients without distant metastasis,patients with colorectal cancer have higher serum TC and LDL levels,but lower HDL levels.Conclusion: 1.The presence of distant metastasis in colorectal cancer is closely related to the levels of TC,LDL and HDL in serum.2.Serum TC and LDL levels were higher in colorectal cancer patients with distant metastasis,while serum HDL levels were lower in patients without distant metastasis.3.Monitoring blood lipid level has certain reference significance for the detection of colorectal cancer.更多还原