肺癌腔内位置对经支气管镜活检诱发出血风险的影响

Analysis of risk of endobronchial biopsy-induced bleeding in different locations of lung cancer

目的探讨肺癌不同腔内位置对经支气管镜活检诱发出血风险的影响。方法收集本院在2014年1月至2018年2月期间经支气管镜腔内活检并经病理确诊的643例肺癌患者资料;采用多因素回归分析比较不同位置肺癌腔内活检诱发出血风险的差异。结果在调整了性别、年龄、吸烟史、肿瘤病理类型和分期、合并症(慢性阻塞性肺疾病、高血压病、糖尿病和冠心病)、血小板计数、凝血酶原时间和活化部分凝血活酶时间后,多因素回归分析表明,与位于右下叶支气管肺癌活检诱发出血比较,其他腔内位置肺癌的活检出血比值比(95%可信区间)分别为:左主支气管5.24(2.23,12.31)、左上叶2.08(1.14,3.80)、左下叶1.93(1.01,3.67)、右主支气管2.92(1.14,7.47)、右上叶1.81(1.00,3.30)、右中间支气管4.91(1.94,12.45)、右中叶1.33(0.48,3.63)和气管2.19(0.58,8.30)。其中,与右下叶支气管病灶活检出血风险比较,左右主支气管、右中间支气管、左上下叶支气管差异均有统计学意义(P<0.05)。结论不同位置肺癌腔内活检诱发出血的风险存在差异。位于中央气道的肺癌较位于外周气道的肺癌更容易并发活检出血。而左主支气管、左上叶支气管分别是中央型气道、外周型气道肺癌中最容易并发活检出血的位置。

Objective To investigate risk of endobronchial biopsy(EBB)-induced bleeding in different locations of lung cancer.Methods The clinical data of 643 patients diagnosed with lung cancer were collected from January 2014 to February 2018.The association of lesions of location with the risk of EBB-induced bleeding was evaluated using multivariate regression analysis adjusted for demographics,tumor characteristics,and comorbidities.Results After adjusting for sex,age,smoking history,pathological type and stage of tumor,complications[chronic obstructive pulmonary disease(COPD),hypertension,diabetes and coronary heart disease],platelet count,prothrombin time and activated partial thromboplastin time,multivariate regression analysis showed that compared to incidence of EBB-induced bleeding in right lower bronchus,the odds ratio(95%confidence interval)of left main bronchus,left upper bronchus,left lower bronchus,right main bronchus,right upper bronchus,right middle bronchus,right middle lobar bronchus and the trachea were 5.24(2.23,12.31),2.08(1.14,3.80),1.93(1.01,3.67),2.92(1.14,7.47),1.81(1.00,3.30),4.91(1.94,12.45),1.33(0.48,3.63)and 2.19(0.58,8.30).Conclusions Patients with lung cancer located in the central airways were more likely to bleed upon EBB when compared lesions located in the peripheral bronchi.Lesions located in left main bronchus,left upper bronchus were the most likely to bleed upon EBB among the central airways and peripheral bronchi,respectively.