肺腺癌合并肺栓塞患者临床特征分析

Clinical features analysis in lung adenocarcinoma patients complicated with pulmonary thromboembolism

目的分析肺腺癌并发肺栓塞患者的临床特征，提高临床诊治水平。方法采用1：1配比设计回顾性对照研究方法，将广州医科大学附属第一医院广州呼吸疾病研究所2013年6月至2016年3月收治的41例肺腺癌并发肺栓塞患者作为病例组；以性别、年龄（±4岁）、治疗方式、基础疾病匹配的41例同期住院的单纯肺腺癌患者作为对照组。单因素分析后，对有统计学意义的因素再行条件logistic回归分析，明确肺栓塞相关危险因素。结果2组患者主要临床症状包括：咳嗽、呼吸困难、胸痛、咯血，2组比较差异均无统计学意义。病例组下肢肿痛的比例高于对照组（Х^2=6．474，P〈0．05）。肿瘤分期中，病例组Ⅲ＋Ⅳ期的比例高于对照组（Х^2=8．002，P〈0．05）。病例组白细胞计数、D-二聚体、神经元特异性烯醇化酶、癌胚抗原、糖类抗原125、糖类抗原15—3浓度及表皮生长因子受体（EGFR）21外显子突变率均高于对照组（P值均〈0．05）。将上述差异有统计学意义的参数行logistic回归分析，结果显示D-二聚体、EGFR21外显子突变是肺腺癌并发肺栓塞的危险因素。结论D-二聚体、EGFR21外显子突变对肺腺癌患者合并肺栓塞有预警作用。

Objective To analyze the clinical characteristics of lung adenocarcinoma complicated with pulmonary thromboembolism in order to improve the clinical management. Methods A 1 ： 1 matched and retrospective study was conducted. 41 patients with lung adenocarcinoma complicated with pulmonary thromboembolism admitted to the First Affiliated Hospital of Guangzhou Medical University/ Guangzhou Institute of Respiratory Disease from June 2013 to March 2016 were identified as study group. Another 41 patients with simple lung adenocarcinoma matched sex, age （± four years old）, therapy and baseline diseases with study group in the same study period were selected as control group. Univariate analysis and logistic analysis were used to identify the risk factors of pulmonary thromboembolism. Results There was no significant difference between two groups in the incidences of the primary clinical symptoms including cough, dyspnea, chest pain and hemoptysis. Compared with the control group, incidence of swelling and pain in lower limbs was higher in the study group （ Х^2=6.474, P 〈0.05）, the proportion of patients in stage Ⅲ and Ⅳ was significantly higher in the study group （ Х^2=8. 002, P〈0.05 ）. The white blood cell count, D-dimer, neuron specific enolase, careinoembryonic antigen, carbohydrate antigen 125, and carbohydrate antigen 15-3 and L858R EGFR mutation rate in the study group were statistically higher than those in the control group （all P 〈0.05）. Logistic regression analysis revealed that only D-dimer and L858R EGFR mutation were risk factors for pulmonary embolism in lung adenoearcinoma. Conclusions D-dimer and L858R EGFR mutation are the risk factors for pulmonary embolism in lung adenocarcinoma.