肺癌合并静脉血栓的危险因素分析及预防性抗凝的重要性

Analysis on Risk Factors of Lung Cancer Complicated with Venous Thrombosis and Importance of Prophylactic Anticoagulation

目的分析肺癌合并静脉血栓栓塞症(venous thromboembolism,VTE)患者的临床特点及危险因素,观察预防性抗凝在肺癌患者中的应用情况,了解其早期应用的必要性。方法回顾性分析上海长海医院2012-06/2016-06月收治的肺癌患者,选取病历资料完整的50例合并VTE患者为VTE组,随机选取同期入院但未合并VTE的100例患者作为对照(非VTE组)。记录两组患者的一般情况、肿瘤相关情况及实验室检查,并对数据进行统计学处理,计量资料用t检验或非参数检验,计数资料通过χ~2检验,比较两组间有无统计学差异。结果单因素分析结果显示,VTE组D-二聚体、白细胞计数(white blood cell,WBC),凝血酶原时间(prothrombin time,PT)高于对照组,组间比较差异具有统计学意义(P<0.05);肺腺癌、晚期(Ⅲb-Ⅳ期)肺癌患者,接受了放疗、化疗的患者VTE发生率更高,组间比较差异有统计学意义(P<0.05)。而预防性抗凝能明显降低VTE发生率。多因素分析显示D-二聚体水平升高、肺腺癌、化疗是VTE的独立危险因素,而预防性抗凝是肺癌患者合并VTE的保护因素(P<0.05)。结论肺腺癌、D-二聚体升高、化疗是合并VTE的独立危险因素,预防性抗凝可以有效降低肺癌患者VTE发生率,临床上需对具有以上高危因素的患者提高警惕,积极给予预防性治疗,降低VTE发生率。

Objective To analyze the clinical characteristics and risk factors of lung cancer patients with venous thromboembolism （VTE）, observe the application of prophylactic anticoagulation and understand the necessity of its early application. Methods The lung cancer patients from June 2012 to June 2016 in Shanghai Changhai hospital were retro- spectively analyzed. Fifty VTE patients with complete medical record materials were collected into VTE group, and 100 patients without VTE over the same period were randomly selected as controls （non-VTE group）. The general data, tumor-related conditions and laboratory tests of two groups were recorded, and all data were done statistics. The meas- urement data were used t-test or non-parametric test, and enumeration data were used Z2 test. Two groups were com- pared. Results Univariate analysis showed that D-dimer, white blood cell （WBC）, and prothrombin time （PT） of VTE group were higher than these of control group （P〈0. 05）. The lung adenocarcinoma or advanced stage （ Ⅲh-lⅣ） lung cancer patients after radiotherapy and chemotherapy had higher incidence rate of VTE （P〈0. 05）, but prophylactic anti- coagulation significantly reduced the incidence rate of VTE. Multivariate analysis showed that higher I〉dimer levels, lung adenocarcinoma, and chemotherapy were independent risk factors for VTE, and prophylactic anticoagulation was a pro- tective factor for lung cancer patients with VTE （P〈0. 05）. Conclusion Lung adenocarcinoma, higher D-dimer, and chemotherapy are independent risk factors for VTE. Prophylactic anticoagulation can effectively reduce the incidence of VTE in lung cancer patients. Clinically, it is necessary to increase vigilance for patients with above high-risk factors, and actively provide preventive treatment to reduce the incidence of VTE.