肺癌合并静脉血栓栓塞症89例临床分析

Venous thromboembolism in 89 patients with lung cancer:clinical analysis

目的:本研究旨在探讨肺癌合并静脉血栓栓塞症(venous thromboembolism,VTE)患者的临床相关因素,为肺癌合并VTE的预防及治疗提供依据。方法:对2008年7月-2010年6月收治的经细胞学或病理学确诊的2053例肺癌病例进行回顾性分析。采用螺旋CT、肺动脉造影及彩色多普勒超声检查明确VTE诊断。将年龄、性别、病理类型、肺癌分期、手术、体质量指数、基础疾病、治疗前血小板计数、D-二聚体、白细胞介素1和肿瘤坏死因子作为临床相关因素。结果:2053例肺癌患者中,89例(4.34%)患者合并VTE。腺癌患者的VTE发生率为5.65%(58/1027),非腺癌患者为3.02%(31/1026),差异有统计学意义(P=0.003);Ⅰ～ⅢA期患者的VTE发生率为1.48%(10/677),ⅢB～Ⅳ期患者的VTE发生率为5.74%(79/1376),差异有统计学意义(P<0.001);Ⅰ～ⅢA期接受手术治疗患者的VTE发生率为1.55%(10/645),未行手术治疗患者的VTE发生率为0%(0/32),差异有统计学意义(P=0.044);无基础疾病患者的VTE发生率为2.70%(33/1221),伴随基础疾病患者的VTE发生率为6.73%(56/832),差异有统计学意义(P<0.001)。治疗前,血小板计数、D-二聚体、白细胞介素1和肿瘤坏死因子水平正常者的VTE发生率分别为3.72%、0.31%、2.44%和3.27%,而水平升高者的VTE发生率分别为6.26%、19.91%、10.26%和7.74%,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,腺癌、手术、基础疾病以及D-二聚体、白细胞介素1和肿瘤坏死因子水平升高是肺癌患者发生VTE的相关临床因素(P<0.05)。结论:肺癌合并VTE患者中,腺癌是最常见的病理类型。手术、基础疾病以及D-二聚体、白细胞介素1和肿瘤坏死因子水平升高是肺癌患者发生VTE的危险因素。

Objective： The aim of this study is to investigate the clinical factors in association with venous thromboembolism （VTE） in patients with lung cancer, and to provide evidence for prevention and therapy of VTE. Methods： Clinical information of 2 053 patients with lung cancer definitely diagnosed by cytology or pathology between July 2008 and June 2010 was retrospectively analyzed. VTE was confirmed by chest spiral computed tomography （CT）, pulmonary arteriography and colorful Doppler ultrasound. The clinical factors including age, gender, pathological type, operation, clinical stage, body mass index, co-morbidity and platelet count as well as D-dimer, interleukin-1 （IL-1） and tumor necrosis factor （TNF） were considered as the potential VTE-related factors. Results： Of 2 053 patients, 89 （4.34%） were confirmed with VTE. The incidence rates of VTE in patients with adenocarcinoma and non-adenocarcinoma were 5.65% （58/1 027） and 3.02% （31/1 026）, respectively, and the difference was statistically significant （P=0.003）. The incidence rate of VTE in stage Ⅰ -ⅢA lung cancer patients was significantly lower than that in stage ⅢB-Ⅳ lung cancer patients [1.48% （10/677） vs 5.74% （79/1 376）; P〈0.001]. In patients with stage Ⅰ-ⅢA undergoing surgical operation or not, the incidence rates of VTE were 1.55% （10/645） and 0% （0/32）, respectively （P=0.044）. Significant difference of incidence rate of VTE was also found between the patients with and without co-morbidity [6.73% （56/832） vs 2.70% （33/ 1 221）; P〈0.001]. The incidence rates of VTE in patients with normal levels of platelet count, D-dimer,IL-1 and TNF were 3.72%, 0.31%, 2.44% and 3.27%, respectively; whereas, the incidence rates in patients with increased levels of these measurements were 6.26%, 19.91%, 10.26% and 7.74%, respectively; the differences between two groups were all significant （P〈0.05）. Logistic multivariant regression analysis revealed that the clinical factors of adenocarcinoma, operation, co-morbidy and high levels of D-dimer, IL-1 and TNF in blood were associated with increased risk of VTE （P〈O.05）. Conclusion： Adenocarcinoma is the most common pathological type in lung cancer patients with VTE. The risk factors of VTE include operation, co-morbidity and high levels of D-dimer, IL-1 and TNF in blood.