代谢相关因素与肾癌发病风险的相关性研究

摘要

目的 探讨代谢相关因素与肾癌发病风险的相关性. 方法 回顾性分析2007年4月至2010年12月165例病理诊断的肾癌患者资料,以2007年北京市西城区调查数据库中330名无肾癌居民作为对照组.采集两组人群年龄、性别、身高、体质量、体质指数(BMI)、吸烟史、高血压病史、糖尿病史和血清甘油三酯、胆固醇、高密度脂蛋白胆固醇(H DL-c)、低密度脂蛋白胆固醇(LDL-c)等检验资料.应用条件Logistic回归分析方法分析资料,评估吸烟史、BMI、高血压病史、糖尿病史及血清甘油三酯、总胆固醇、HDL-c、LDL-c检验值与肾癌发病风险的相关性. 结果 条件Logistic回归分析结果显示:糖尿病史(HR=2.761,95％ CI=1.546 ～4.929)、高血压病史(HR=2.753,95％ CI=1.710～4.432)与肾癌发病风险呈正相关,吸烟史(HR=0.329,95％ CI=0.209 ～0.519)、血清甘油三酯(HR=0.585,95％ CI=0.374 ～0.913)、HDL-C(HR=0.024,95％ CI=0.008 ～0.073)、BMI水平(HR =0.916,95％CI=0.853 ～0.984)与肾癌发病风险呈负相关.按血脂及脂蛋白水平分组分析结果显示:高低密度脂蛋白胆固醇血症(HR=15.994,95％ CI=6.544 ～ 39.093)、低高密度脂蛋白胆固醇血症(HR=3.236,95％ CI=1.992 ～5.257)、糖尿病史(HR=3.234,95％ CI=1.789～5.848)、高血压病史(HR=2.614,95％CI=1.630～4.191)与肾癌风险呈正相关,吸烟史(HR=0.368,95％ CI=0.233 ～0.580)、高胆固醇血症(HR=0.144,95％ CI=0.068 ～0.304)呈负相关. 结论 肾癌发病可能与肥胖、高血压病、糖尿病、血脂及脂蛋白异常等代谢异常因素有关,高血压病、糖尿病、高低密度脂蛋白胆固醇血症、低高密度脂蛋白胆固醇血症可能是肾癌的危险因素,高胆固醇血症、血清甘油三酯、HDL-c水平升高可能是肾癌发病的保护因素.%Objective To investigate the associations between metabolic factors such as obesiy,hypertension,diabetes mellitus,dslipidemia and renal cell carcinoma (RCC).Methods From April 2007 to December 2010,we identified 165 patients with RCC undergoing surgical therapy at our institution.Three hundred and thirty normal physical examination people without RCC in a community in Beijing were recruited as control.We collected their history and metabolic index recorded before,including age,sex,height,weight,body mass index (BMI),history of smoking,hypertension,diabetes mellitus and levels of triglyceride,cholesterol,HDL-c,LDL-c.Conditional logistic regression was performed to investigate the association between smoking,BMI,hypertension,diabetes mellitus,triglyceride,cholesterol,HDL-c,LDL-c and RCC.Results Using the values of lipid and lipoprotein,multivariable logistic regression analysis showed that diabetes mellitus,hypertension were associated with an elevated risk of RCC (HR =2.761,95％ CI =1.546-4.929 ; HR =2.753,95％ CI =1.710-4.432) respectively,and smoking,levels of triglyceride,HDL-c and BMI were associated with an decrease risk of RCC (HR =0.329,95％ CI =0.209-0.519;HR =0.585,95％ CI=0.374-0.913; HR =0.024,95％ CI =0.008-0.073; HR =0.916,95％ CI =0.853-0.984) respectively.We separated lipid and lipoprotein into two groups by the normal value,and then analyze the factors by multivariable logistic regression analysis.High level of LDL-c,low level of HDL-c,diabetes mellitus,hypertension were associated with an elevated risk of RCC (HR =15.994,95％ CI =6.544-39.093; HR =3.236,95％ CI =1.992-5.257; HR =3.234,95％ CI =1.789-5.848; HR =2.614,95％ CI =1.630-4.191) respectively.Smoking and hypercholesterolemia were associated with an decrease risk of RCC (HR =0.368,95 ％ CI =0.233-0.580 ; HR =0.144,95 ％ CI =0.068-0.304) respectively.Conclusions Metabolic factors such as obesity,hypertension,diabetes mellitus,abnormal levels of lipid and lipoprotein may be associated with RCC.Hypertension,diabetes mellitus,low level of HDL-c,high level of LDL-c may be associated with increased RCC risk.Hypercholesterolemia,elevation of serum triglyceride and HDL-c may be protective factors of RCC.Elevation of BMI might slightly decrease the risk of RCC.