Relationship between high density lipoprotein and prognosis of patients with myelodysplastic syndrome
-
摘要: 目的 探讨高密度脂蛋白(HDL)与骨髓增生异常综合征(MDS)预后的关系。方法 收集2013年1月—2019年1月224例初诊MDS患者的临床资料并进行统计分析。结果 全部患者分为HDL≥1 mmol/L组(121例)和HDL＜1 mmol/L组(103例)。HDL≥1 mmol/L组患者的中位总生存时间为86个月(95%CI44~127)，HDL＜1 mmol/L组患者的中位总生存时间为19个月(95%CI3~34)，2组比较差异有统计学意义(P＜0.001)。HDL＜1 mmol/L组中IPSS-R中危/高危/极高危患者比例明显高于HDL≥1 mmol/L组(82.5% vs 68.6%，P=0.016)。Cox多因素分析显示，HDL＜1 mmol/L为原始细胞＜5%的MDS患者的预后不良因素(HR＝2.17，95%CI1.16~4.08，P＝0.016)。结论 在MDS患者中，低水平的HDL与更差的IPSS-R预后分层相关，低水平的HDL可以作为评估成人初诊原始细胞＜5%的MDS患者预后的危险因素。Abstract: Objective To explore the relationship between high density lipoprotein(HDL) and the prognosis of myelodysplastic syndrome(MDS).Methods The clinical data of 224 newly diagnosed patients with MDS from January 2013 to January 2019 were collected and analyzed.Results All patients were divided into HDL≥1 mmol/L group(121 cases) and HDL < 1 mmol/L group(103 cases). The median overall survival time of patients with HDL≥1 mmol/L was 86 months(95%CI44-127), and that of patients with HDL < 1 mmol/L was 19 months(95%CI3-34). There was significant difference between the two groups(P< 0.001). The proportions of IPSS-R intermediate/high/very high risks in HDL < 1 mmol/L group was significanlty higher than that in HDL≥1 mmol/L group(82.5% vs 68.6%,P=0.016). Cox multivariate analysis showed that HDL < 1 mmol/L was a poor prognostic factor in MDS patients with bone marrow blasts < 5%(HR=2.17, 95%CI1.16-4.08,P＝0.016).Conclusion In MDS patients, low level of HDL is associated with more advanced IPSS-R prognostic risk categories. Low level of HDL can be used as a risk factor to evaluate the prognosis of adult newly diagnosed MDS patients with bone marrow blasts < 5%.
-
Key words:
- myelodysplastic syndrome /
- prognosis /
- high density lipoprotein
-
-
表 1 HDL＜1 mmol/L组和HDL≥1 mmol/L组患者临床特征比较
临床特征 HDL≥1 mmol/L组(121例) HDL＜1 mmol/L组(103例) P 男性/例(%) 66(54.5) 64(62.1) 0.251 年龄/岁 56(22~87) 58(19~88) 0.479 血红蛋白/(g·L-1) 75(26~143) 73(32~147) 0.436 中性粒细胞计数/(×109·L-1) 1.61(0.12~10.50) 1.48(0.04~8.38) 0.574 血小板计数/(×109·L-1) 92(2~436) 77(5~370) 0.167 骨髓原始细胞计数/例(%) 0.022 ≥5% 35(28.9) 45(43.7) ＜5% 86(71.1) 58(56.3) IPSS-R染色体核型/例(%) 0.051 极好/好 90(74.4) 61(59.2) 中等 15(12.4) 21(20.4) 差 7(5.8) 14(13.6) 极差 9(7.4) 7(6.8) IPSS-R预后分组/例(%) 0.016 极低危/低危 38(31.4) 18(17.5) 中危/高危/极高危 83(68.6) 85(82.5) 
下载: 导出CSV
表 2 144例骨髓原始细胞＜5%患者OS的单因素及多因素分析
参数 单因素分析 多因素分析 HR 95%CI P HR 95%CI P 年龄≥60岁 1.78 1.01~3.16 0.048 1.68 0.86~3.28 0.131 HDL＜1 mmol/L 2.25 1.29~3.92 0.004 2.17 1.16~4.08 0.016 血红蛋白/(g·L-1) ≥100 参照 参照 80~100 1.31 0.38~4.48 0.667 1.04 0.28~3.84 0.949 ＜80 3.52 1.26~9.86 0.017 1.88 0.63~5.62 0.257 中性粒细胞计数＜0.8×109/L 2.37 1.35~4.17 0.003 2.27 1.24~4.15 0.008 血小板计数/(×109·L-1) ≥100 参照 参照 50~100 0.95 0.39~2.31 0.912 0.72 0.27~1.89 0.500 ＜50 2.79 1.41~5.52 0.003 2.00 0.99~4.06 0.050 IPSS-R染色体核型 很好/好 参照 参照 中等 1.75 0.72~4.27 0.218 1.42 0.55~3.68 0.466 差 5.99 2.62~13.71 ＜0.001 3.71 1.49~9.21 0.005 极差 14.51 6.24~33.72 ＜0.001 8.00 3.10~20.68 ＜0.001
下载: 导出CSV
-
[1] Pedersen KM, Colak Y, Bojesen SE, et al. Low high-density lipoprotein and increased risk of several cancers: 2 population-based cohort studies including 116, 728 individuals[J]. J Hematol Oncol, 2020, 13(1): 1-11. doi: 10.1186/s13045-019-0838-y
[2] Adorni MP, Ronda N, Bernini F, et al. High Density Lipoprotein Cholesterol Efflux Capacity and Atherosclerosis in Cardiovascular Disease: Pathophysiological Aspects and Pharmacological Perspectives[J]. Cells, 2021, 10(3): 574. doi: 10.3390/cells10030574
[3] Yvan-Charvet L, Pagler T, Gautier EL, et al. ATP-binding cassette transporters and HDL suppress hematopoietic stem cell proliferation[J]. Science, 2010, 328(5986): 1689-1693. doi: 10.1126/science.1189731
[4] Franczyk B, Rysz J, Ławiński J, et al. Is a High HDL-Cholesterol Level Always Beneficial?[J]. Biomedicines, 2021, 9(9): 1083. doi: 10.3390/biomedicines9091083
[5] Choi T, Choi IY, Han K, et al. Lipid Level, Lipid Variability, and Risk of Multiple Myeloma: A Nationwide Population-Based Study of 3, 527, 776 Subjects[J]. Cancers, 2021, 13(3): 540. doi: 10.3390/cancers13030540
[6] Pirro M, Ricciuti B, Rader DJ, et al. High density lipoprotein cholesterol and cancer: marker or causative?[J]. Prog Lipid Res, 2018, 71: 54-69. doi: 10.1016/j.plipres.2018.06.001
[7] Pih GY, Gong EJ, Choi JY, et al. Associations of Serum Lipid Level with Gastric Cancer Risk, Pathology, and Prognosis[J]. Cancer Res Treat, 2021, 53(2): 445-456. doi: 10.4143/crt.2020.599
[8] Yang C, Tian G, Mi J, et al. Causal relevance of circulating high-density lipoprotein cholesterol with cancer: a Mendelian randomization meta-analysis[J]. Sci Rep, 2015, 5(1): 1-7.
[9] 曹蓝, 洪鸣. 骨髓增生异常综合征/骨髓增殖性肿瘤的治疗进展[J]. 临床血液学杂志, 2021, 34(9): 680-683. http://lcxz.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=e1f4c1de-e301-4525-9975-162f46f026f6
[10] Kuliszkiewicz-Janus M, Malecki R, Mohamed A. Lipid changes occuring in the course of hematological cancers[J]. Cell Mol Biol Lett, 2008, 13(3): 465-474.
[11] 刘虹宏, 张冬花, 程宇彤, 等. ApoE基因多态性与血清脂质水平及冠状动脉狭窄严重程度的相关性研究[J]. 临床心血管病杂志, 2021, 37(5): 478-484. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202105017.htm
[12] 吴祖飞, 陈诗, 刘叶红, 等. 不同血脂成分与冠状动脉病变相关性的初步探讨[J]. 临床心血管病杂志, 2021, 37(9): 816-824. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202109008.htm
[13] Greenberg PL, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes[J]. Blood, 2012, 120(12): 2454-2465. doi: 10.1182/blood-2012-03-420489
[14] Jeong SM, Choi T, Kim D, et al. Association between high-density lipoprotein cholesterol level and risk of hematologic malignancy[J]. Leukemia, 2021, 35(5): 1356-1364. doi: 10.1038/s41375-020-01081-5
[15] Bousounis P, Bergo V, Trompouki E, et al. Inflammation, Aging and Hematopoiesis: A Complex Relationship[J]. Cells, 2021, 10(6): 1386. doi: 10.3390/cells10061386
[16] Kothari V, Tang J, He Y, et al. ADAM17 Boosts Cholesterol Efflux and Downstream Effects of High-Density Lipoprotein on Inflammatory Pathways in Macrophages[J]. Arterioscler Thromb Vasc Biol, 2021, 41(6): 1854-1873. doi: 10.1161/ATVBAHA.121.315145
[17] Ouweneel AB, Thomas MJ, Sorci-Thomas MG, et al. The ins and outs of lipid rafts: functions in intracellular cholesterol homeostasis, microparticles, and cell membranes: Thematic Review Series: Biology of Lipid Rafts[J]. J Lipid Res, 2020, 61(5): 676-686. doi: 10.1194/jlr.TR119000383
[18] Gao M, Zhao D, Schouteden S, et al. Regulation of high-density lipoprotein on hematopoietic stem/progenitor cells in atherosclerosis requires scavenger receptor type BI expression[J]. Arterioscler Thromb Vasc Biol, 2014, 34(9): 1900-1909. doi: 10.1161/ATVBAHA.114.304006
[19] 杨倩, 聂淑敏, 黄俊霞, 等. 地西他滨为主方案治疗中高危骨髓增生异常综合征患者的病态造血变化及预后价值分析[J]. 临床血液学杂志, 2020, 33(3): 191-194. http://lcxz.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=2b614d9b-969f-48a0-aa28-e9ad4fd20e18
-
图(3)
表(2)
计量
- 文章访问数: 1296
- PDF下载数: 567
- 施引文献: 0