Huang Chung-I, Lin Li-Ching, Tien Hung-Cheng, Que Jenny, Ting Wei Chen, Chen Po-Chun, Wu Hsin-Min, Ho Chung-Han, Wang Jhi-Joung, Wang Ren-Hong, Yang Ching-Chieh
Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.
PLoS One. 2017 Mar 31;12(3):e0174574. doi: 10.1371/journal.pone.0174574. eCollection 2017.
Anxiety/depression is common among patients with head and neck cancer (HNC), and can negatively affect treatment compliance and outcome. The aim of this study was to assess the association between hyperlipidemia and the risk of new-onset anxiety/depression after the diagnosis of HNC and the influence of administering statins.
A matched longitudinal cohort study of 1632 subjects (408 HNC patients with preexisting hyperlipidemia and 1224 age- and sex-matched HNC patients without hyperlipidemia) was included and analyzed by using data from Taiwan's National Health Insurance Research Database from January 1996 to December 2012. The incidence and hazard ratios (HRs) for the development of new-onset anxiety/depression were examined between the two groups. Cox proportional hazard regression was applied to estimate the relative risks of anxiety/depressive disorders adjusted for potential confounding factors. To estimate the risks of anxiety/depression in different sub-groups, a stratified analysis was also used.
HNC patients with preexisting hyperlipidemia had a higher risk for comorbidities such as hypertension, diabetes mellitus, and cardiovascular disease (P <0.001). The incidence rate of anxiety/depression in the HNC patients with preexisting hyperlipidemia was also significantly higher than that among patients without hyperlipidemia (10.78% vs 7.27%, respectively; P = 0.03). A Cox regression model revealed that preexisting hyperlipidemia was an independent risk factor for anxiety/depression (aHR, 1.96; 95% CI, 1.30-2.94). Statins use was protective against anxiety/depression among HNC patients with hyperlipidemia (aHR, 0.85; 95% CI, 0.46-1.57), especially for individuals older than 65 years and for females.
Preexisting hyperlipidemia was associated with increased risk of new-onset anxiety/depression in the HNC patients. Statins use for HNC patients with hyperlipidemia could decrease the risk of anxiety/depression, especially for those older than 65 years and for female patients.
焦虑/抑郁在头颈癌（HNC）患者中很常见，并且会对治疗依从性和治疗结果产生负面影响。本研究的目的是评估高脂血症与HNC诊断后新发焦虑/抑郁风险之间的关联以及服用他汀类药物的影响。
纳入一项对1632名受试者（408名患有高脂血症的HNC患者和1224名年龄及性别匹配的无高脂血症的HNC患者）进行的匹配纵向队列研究，并利用1996年1月至2012年12月台湾国民健康保险研究数据库的数据进行分析。检查两组之间新发焦虑/抑郁的发生率和风险比（HRs）。采用Cox比例风险回归来估计经潜在混杂因素调整后的焦虑/抑郁障碍的相对风险。为了估计不同亚组中焦虑/抑郁的风险，还进行了分层分析。
患有高脂血症的HNC患者患高血压、糖尿病和心血管疾病等合并症的风险更高（P<0.001）。患有高脂血症的HNC患者中焦虑/抑郁的发生率也显著高于无高脂血症的患者（分别为10.78%和7.27%；P = 0.03）。Cox回归模型显示，既往高脂血症是焦虑/抑郁的独立危险因素（校正后HR，1.96；95%置信区间，1.30 - 2.94）。服用他汀类药物对患有高脂血症的HNC患者的焦虑/抑郁有保护作用（校正后HR，0.85；95%置信区间，0.46 - 1.57），尤其是对65岁以上的个体和女性。
既往高脂血症与HNC患者新发焦虑/抑郁风险增加有关。对患有高脂血症的HNC患者使用他汀类药物可降低焦虑/抑郁的风险，尤其是对65岁以上的患者和女性患者。
