賀爾蒙輔助療法對台灣女性乳癌病患在血脂的影響

Effects of Adjuvant Endocrine Therapy on Lipid Profiles in Taiwanese Women with Breast Cancer

陳慶鴻(Ching-Hung Chen)

指導教授 ： 林双金

高雄醫學大學/藥學院/臨床藥學研究所/碩士(2010年)

摘要

背景
本研究旨在評估服用安美達（anastrozole）或泰莫西芬（tamoxifen）對於台灣女性早期乳癌病患在血脂方面的影響。血脂檢測項目包括總膽固醇（total cholesterol, TC），三酸甘油脂（triglycerides, TG），高密度脂蛋白（high-density lipoprotein-cholesterol, HDL-C），低密度脂蛋白（low-density lipoprotein-cholesterol, LDL-C），載脂蛋白A-1（apolipoprotein A-1, ApoA-1），載脂蛋白B （apolipoprotein B, ApoB），總膽固醇與高密度脂蛋白之比值（TC/HDL-C ratio），低密度脂蛋白與高密度脂蛋白之比值（LDL-C/HDL-C ratio）及載脂蛋白B與載脂蛋白A-1之比值（ApoB/ApoA-1 ratio）。
方法
本研究是前瞻性世代研究，研究期間為2009年2月至2010年4月。在本研究中，所有病患已接受過手術、化學治療、及（或）放射治療，且第一次服用安美達（每日1次，每次1毫克）或泰莫西芬（每日2次，每次10毫克）。經病患簽署受試者同意書之後，於病患未服藥前（基準值）、12週、24週、36週及48週時，經隔夜空腹後抽血檢測血脂相關項目。
結果
本研究共納入68位患者。經由混合效應模式分析結果，並調整干擾因子以避免干擾效應；這些干擾因子包括有病患年齡、身體質量指數、未服藥前各血脂基準值及相較於基準值其身體質量指數變化值。在總膽固醇與低密度脂蛋白的檢測值，服用安美達這組的病患相較於泰莫西芬者，與未服藥前基準值相比增加較多，且增加值在24週後其統計值具有意義（分別增加18.5 mg/dL與22.3 mg/dL）。然而在安美達這組的病患相較於泰莫西芬者，在12週後其載脂蛋白A-1與未服藥前基準值相比降低16.3 mg/dL且達統計顯著差異。而總膽固醇與高密度脂蛋白之比值、低密度脂蛋白與高密度脂蛋白之比值及載脂蛋白B與載脂蛋白A-1之比值，服用安美達這組的病患相較於泰莫西芬者，在24週時與未服藥前基準值相比增加較多（分別增加0.73、0.70與0.12），且增加值在統計上具有意義。
結論
從本研究結果顯示，對於服用安美達的台灣女性病患，在服藥24週後，總膽固醇及低密度脂蛋白其血中濃度上升且載脂蛋白A-1血中濃度下降。服用安美達將會對於心血管危險因子有不良的影響。依據本研究結果建議對於有心血管疾病高風險之病患，在服用安美達期間需定期檢測血脂項目。

關鍵字

乳癌 ； 安美達 ； 泰莫西芬 ； 總膽固醇 ； 低密度脂蛋白 ； 載脂蛋白A-1 ； 心血管危險因子 ； 混合效應模式

並列摘要

Background
This study intended to evaluate changes in serum lipid profiles in Taiwanese women receiving anastrozole or tamoxifen for early stage breast cancer. The serum lipid profiles included total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A-1 (ApoA-1), apolipoprotein B (ApoB), TC/HDL-C ratio, LDL-C/HDL-C ratio and ApoB/ApoA-1 ratio.
Methods
It was a prospective cohort study between February 2009 and April 2010. All patients had completed surgery, chemotherapy, and/or radiotherapy and were initially taking 1 mg of anastrozole once daily, or tamoxifen 10 mg twice daily. Patients consenting to participate in this study had blood drawn after overnight fasting and lipid profiles evaluated at baseline, 12 weeks, 24 weeks, 36 weeks and 48 weeks.
Results
Sixty-eight women were enrolled in the study. The study was analyzed by a Mixed-effects model and adjusted for differences by factors to prevent confounding effects. The factors measured at baseline included age, body-mass-index (BMI), each parameter self and BMI differential value compared with baseline. In TC and LDL-C levels, the anastrozole group increased more than the tamoxifen group, and difference in the change from baseline after 24 weeks was significant (18.5 mg/dL; 22.3 mg/dL respectively). However, the anastrozole group decreased ApoA-1 by 16.3 mg/dL more than the tamoxifen group and showed significant difference in the change from baseline after 12 weeks. TC/HDL-C, LDL-C/HDL-C and ApoB/ApoA-1 ratios increased in the anastrozole group more than the tamoxifen group (0.73; 0.70; 0.12 respectively) and difference in the change from baseline at 24 weeks was significant.
Conclusion
This study indicates that anastrozole significantly elevates the levels of TC, LDL-C and decreases the level of ApoA-1 in Taiwanese women with breast cancer after 24 weeks of treatments. Anastrozole had a detrimental effect on cardiovascular risk factors. Patients taking anastrozole need to check lipid profiles routinely if they have risks of cardiovascular disease.

並列關鍵字

Breast cancer ； Anastrozole ； Tamoxifen ； Total cholesterol ； Low-density lipoprotein-cholesterol ； Apolipoprotein A-1 ； Cardiovascular risk factors ； Mixed-effects model

參考文獻

參考文獻

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