肺癌患者入院时下肢深静脉血栓的发生率及相关危险因素分析

Analysis of the Incidence of Lower Extremity Venous Thrombosis and Its Related Risk Factors in Admitted Patients with Lung Cancer

背景与目的静脉血栓栓塞症(venous thromboembolism, VTE)是一种公认的在肺癌患者中有较高发病率和死亡率的并发症。本研究目的是明确我们中心肺癌患者入院时下肢深静脉血栓(lower extremity venous thrombosis, LEDVT)的发生率,并揭示其入院时LEDVT发生的危险因素。方法选择天津医科大学总医院肺部肿瘤外科在2017年7月-2017年12月收治的231例肺癌患者,入院时即行双下肢静脉彩超检查,以分析肺癌患者LEDVT的发生率;同时,对肺良性疾病患者入院时LEDVT的发生率进行比较。在肺癌患者中,进一步分析LEDVT发生与其临床特征的关系,寻找LEDVT发生的可能危险因素;同时,亦分析这些患者的血浆D-二聚体(D-Dimmer)、纤维蛋白原(fibrinogen, FIB)、凝血酶时间(thrombin time, TT)、活化部分凝血酶时间(activated partial thrombin time,APTT)、凝血酶原时间(prothrombin time, PT)及血小板(platelet, PLT)之间的差异。结果在231例肺癌患者中,入院时发生LEDVT者12例,其发生率为5.2%(12/231);而77例肺良性疾病患者入院时均未查见LEDVT的发生,提示肺癌患者入院时LEDVT的发生率明显高于肺良性疾病(P<0.05)。在肺癌患者中进一步分析发现,伴有远处转移(包括N3淋巴结转移)的肺癌患者较不伴有转移者更易发生LEDVT(11.29%, 7/62 vs 2.96%, 5/169)(P<0.05)。肺癌LEDVT组患者入院时的D-Dimer的中位值为1,534mg/L(369 mg/L-10,000 mg/L),明显高于非LEDVT组患者(539 mg/L, 126 mg/L-1,000 mg/L)(P<0.05);而FIB、TT、APTT、PT和PLT在两组患者之间无明显统计学差异(P>0.05)。结论我们中心肺癌患者入院时LEDVT总体发生率约为5%,明显高于肺良性疾病患者。入院时伴有远处转移(包括N3淋巴结转移)的肺癌患者更易发生LEDVT,其中,D-Dimer值较高的患者应考虑到VTE事件发生的可能。

Background and objective Venous thromboembolism （VTE） is a recognized complication in lung cancer patients with higher morbidity and mortality. The purpose of this study is to determine the incidence of lower extremity venous thrombosis （LEDVT） in lung cancer patients and to reveal the risk factors for LEDVT during admission in our center. Methods We first connected 231 patients with lung cancer admitted to the Department of Lung Cancer Surgery, Tianjin Medi- cal University General Hospital from July 2017 to December 2017. All these patients underwent color ultrasound examina- tion of lower extremity vein on admission to analyze the incidence of LEDVT. At the same time, the incidence of LEDVT in patients with benign lung diseases on admission was used as control. In order to explore the possible risk factors for LEDVT in these patients with lung cancer, we further analyze the correlations between LEDVT and their clinical features. At the same time, we also analyze the relationship between LEDVT and Plasma D-Dimmer, fibrinogen （FIB）, thrombin time （XT）, acti- vated partial thrombin time （APTT）, prothrombin time （PT） and platelet （PLT） in these patients with lung cancer. Results Among 231 patients with lung cancer, the incidence rate of LEDVT on admission was 5.2% （12/231）, and in 77 patients with benign lung disease, there was none of patients with LEDVT on admission. This result indicated that the admitted incidence rate of LEDVT in patients with lung cancer was significantly higher than that in patients with benign lung disease （P〈0.05）. Further analysis in patients with lung cancer found that there was higher incidence rate of LEDVT in distant metastasis group （including N3 lymph node metastasis） compared to in non-distant metastasis group （11.29%, 7/62 vs 2.96%, 5/169） （P〈0.05）. In patients with lung cancer, the median value of D-Dimer in LEDVT group was 1,534 mg/L （369 mg/L- 10,000 mg/L）, which was significantly higher than that in the non-LEDVT group （539 mg/L, 126 mg/L-1,000 mg/L） （P〈0.05）. There was no statis- tically significant difference in FIB, TI？, APTI？, PT and PLT between these two groups （P〉0.05）. Conclusion The overall inci- dence of LEDVT in our central lung cancer patients was approximately 5%, significantly higher than that in patients with benign lung disease. Lung cancer patients with distant metastasis （including N3 lymph node metastasis） at admission were more likely to develop LEDVT, and these patients with higher D-Dimer values should be considered the oossibilitv of VTE events.