Huang Zhenhua, Liang Lining, Li Lingyu, Xu Miao, Li Xiang, Sun Hao, He Songwei, Lin Lilong, Zhang Yixin, Song Yancheng, Yang Man, Luo Yuling, Loh Horace H, Law Ping-Yee, Zheng Dayong, Zheng Hui
Department of Oncology, Nanfang Hospital, Southern Medical University, #1838 Guangzhou Ave. N, Guangzhou, 510515, China.
CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, A-131, #190 Kaiyuan Ave, Guangzhou, 510530, China.
Lipids Health Dis. 2016 Mar 8;15:47. doi: 10.1186/s12944-016-0212-9.
Pain management has been considered as significant contributor to broad quality-of-life improvement for cancer patients. Modulating serum cholesterol levels affects analgesia abilities of opioids, important pain killer for cancer patients, in mice system. Thus the correlation between opioids usages and cholesterol levels were investigated in human patients with lung cancer.
Medical records of 282 patients were selected with following criteria, 1) signed inform consent, 2) full medical records on total serum cholesterol levels and opioid administration, 3) opioid-naïve, 4) not received/receiving cancer-related or cholesterol lowering treatment, 5) pain level at level 5-8. The patients were divided into different groups basing on their gender and cholesterol levels. Since different opioids, morphine, oxycodone, and fentanyl, were all administrated at fixed low dose initially and increased gradually only if pain was not controlled, the percentages of patients in each group who did not respond to the initial doses of opioids and required higher doses for pain management were determined and compared.
Patients with relative low cholesterol levels have larger percentage (11 out of 28 in female and 31 out of 71 in male) to not respond to the initial dose of opioids than those with high cholesterol levels (0 out of 258 in female and 8 out of 74 in male). Similar differences were obtained when patients with different opioids were analyzed separately. After converting the doses of different opioids to equivalent doses of oxycodone, significant correlation between opioid usages and cholesterol levels was also observed.
Therefore, more attention should be taken to those cancer patients with low cholesterol levels because they may require higher doses of opioids as pain killer.
疼痛管理被认为是癌症患者生活质量全面改善的重要因素。在小鼠实验系统中，调节血清胆固醇水平会影响阿片类药物（癌症患者重要的止痛药物）的镇痛能力。因此，本研究调查了肺癌患者中阿片类药物使用与胆固醇水平之间的相关性。
选取282例患者的病历，入选标准如下：1）签署知情同意书；2）有关于总血清胆固醇水平和阿片类药物给药的完整病历；3）未使用过阿片类药物；4）未接受/正在接受癌症相关或降胆固醇治疗；5）疼痛程度为5-8级。根据患者的性别和胆固醇水平将其分为不同组。由于最初均以固定低剂量给予不同的阿片类药物（吗啡、羟考酮和芬太尼），仅在疼痛未得到控制时才逐渐增加剂量，因此确定并比较了每组中对初始剂量阿片类药物无反应且需要更高剂量进行疼痛管理的患者百分比。
胆固醇水平相对较低的患者对初始剂量阿片类药物无反应的百分比（女性28例中有11例，男性71例中有31例）高于胆固醇水平高的患者（女性258例中无，男性74例中有8例）。分别分析使用不同阿片类药物的患者时也得到了类似差异。将不同阿片类药物的剂量换算为等效的羟考酮剂量后，还观察到阿片类药物使用与胆固醇水平之间存在显著相关性。
因此，对于胆固醇水平低的癌症患者应给予更多关注，因为他们可能需要更高剂量的阿片类药物作为止痛剂。
