原发性肺癌并发静脉血栓栓塞症临床特征及结局研究

Study on clinical characteristic and outcomes of primary lung cancer combined with venous thromboembolism

目的 探讨原发性肺癌患者并发静脉血栓栓塞症（VTE）的临床特征及预后.方法 选取原发性肺癌患者589例,根据是否发生VTE分为VTE组（n=49）和非VTE组（n =540）.将49例VTE患者分为肺血栓栓塞（PTE）组（n=15,包括单发PTE和PTE合并DVT）以及深静脉血栓形成（DVT）组（n=34）.采用单因素及Logistic多因素回归分析原发性肺癌患者并发VTE的影响因素.分析VTE患者的临床表现、发病时间及预后.结果 49例VTE患者中,单发FTE 10例（20.4％）,单发DVT 34例（69.4％）,PTE合并DVT 5例.（10.2％）.D-二聚体（OR=1.560,95％ CI=1.018 -2.392,χ^2=4.161,P=0.041）、白细胞介素-1（IL-1,OR=1.846,95％CI=1.054-3.234,χ^2=4.594,P=0.033）、肿瘤坏死因子（TNF,OR=1.486,95％CI=1.014-2.178,χ^2=4.126,P=0.042）、腺癌（OR=2.854,95％ CI=1.217-6.695,χ^2=5.812,P=0.016）、Ⅲ-Ⅳ期（OR =2.198,95％ CI=1.122 -4.305,χ^2=5.272,P=0.022）是原发性肺癌患者并发VTE的影响因素.胸闷、咳嗽、心率加快以及下肢肿痛是原发性肺癌患者并发VTE常见的临床表现.VTE多在原发性肺癌确诊后3个月内发病,PTE组与DVT组发病时间分布差异无统计学意义（P＞0.05）.截止2014年7月,49例VTE患者有31例（63.2％）死亡,12例（24.5％）存活,6例（12.2％）失访.49例VTE患者的中位生存时间为9.5个月,其中PTE组为5.8个月,DVT组为15.2个月,但两组差异无统计学意义（P＞0.05）.结论 D-二聚体升高、IL-1升高、TNF升高、腺癌、Ⅲ-Ⅳ期的原发性肺癌患者并发VTE的风险增高,多在肺癌确诊后3个月内发现,临床症状多不典型,病死率较高,需要采取辅助检查进行早期诊治.

Objective To observe the clinical characteristic and prognosis of primary lung cancer patients with venous thromboembolism （VTE）.Methods 589 primary lung cancer patients were selected and divided into VTE group（n =49） and non VTE group（n =540）.49 cases with VTE were divided into pulmonary thromboembolism （PTE） group（n =15）,including single PTE and PTE combined with deep venous thrombosis（DVT） and DVT group （n =34）.Single factor and multiple logistic regression analysis were performed to determine the factors influencing primary lung cancer patients with VTE.Clinical manifestation,time of onset and prognosis of patients with VTE were analyzed.Results 49 patients with VTE included 10 patients（20.4%） with single PTE,34 patients（69.4%） with single DVT and 5 PTE patients combined with DVT（10.2%）.D-dimer（OR =1.560,95% CI =1.018 - 2.392,χ^2=4.161,P =0.041）,interleukin-1 （IL-1,OR =1.846,95% CI =1.054-3.234,χ^2=4.594,P =0.033）,tumor necrosis factor （TNF OR =1.486,95% CI =1.014-2.178,χ^2=4.126,P =0.042）,adenocarcinoma （OR =2.854,95%CI=1.217-6.695,χ^2=5.812,P=0.016） and phase Ⅲ-Ⅳ（OR =2.198,95%CI=1.122-4.305,χ^2=5.272,P =0.022） were the factors influencing primary lung cancer patients with VTE.Chest tightness,coughing,accelerated heart rate,swelling and pain in lower limb were common clinical manifestations of primary lung cancer patients with VTE.Most patients with VTE occurred within 3 months after a diagnosis of primary lung cancer.There was no significant difference in the time of onset between PTE group and DVT group（P 〉0.05）.As of July 2014,31 cases （63.2%） died,12 cases （24.5 %） survived,and 6 cases （12.2%） lost in 49 patients with VTE.The median survival time of 49 patients with VTE was 9.5 months.The median survival time of PTE group was 5.8 months,while DVT group was 15.2 months,but no significant difference between them （P 〉 0.05）.Conclusion Increased D-dimer,increased IL-1,increased TNF,adenocarcinoma and phase Ⅲ-Ⅳ could increase the risk of primary lung cancer patients with VTE.There were little typical.clinical symptoms in most patients with VTE,which occurred with in 3 months after a diagnosis of primary lung cancer.They had high mortality and needed to take early diagnosis and treatment through auxiliary examination.