肺癌患者发生肺栓塞的相关危险因素分析

Analysis of risk factors for pulmonary embolism in patients with lung cancer

目的探讨肺癌患者发生肺栓塞的独立危险因素。方法本研究采用回顾性队列研究,收集2016年1月至2018年12月入住我科的肺癌患者共238例,依据住院期间是否发生肺栓塞(Pulmonary embolism,PE)分为研究组(38例)和对照组(200例),分析记录两组患者的一般临床资料,包括年龄、性别、身体质量指数(Body Mass Index,BMI)、吸烟史、饮酒史、合并基础疾病、是否留置中心静脉导管,肿瘤相关情况包括病理类型、TNM分期,生化及凝血指标,包括白蛋白(Albumin,ALB)、D-二聚体(D-dimer,D-D),血常规相关指标,包括白细胞计数(White blood cells,WBC)、中性粒细胞-淋巴细胞比率(Neutrophil to lymphocyte ratio,NLR)、单核细胞-淋巴细胞比率(monocyte to lymphocyte ratio,MLR)、血小板-淋巴细胞比率(platelet to lymphocyte ratio,PLR)。肺癌合并PE的独立危险因素分析采用多因素Logistic回归分析,采用Kaplan-Meier分析两组的生存状况。结果两组患者在年龄(t=1.56,P=0.17)、性别(χ~2=0.45,P=0.50)、吸烟史(χ~2=1.34,P=0.24)、饮酒史(χ~2=1.23,P=0.26)、BMI(χ~2=1.31,P=0.23)合并基础疾病(χ~2=3.61,P=0.06)、肿瘤病理类型(χ~2=0.10,P=0.92)、肿瘤分期(χ~2=0.93,P=0.79)、PLR(t=0.85,P=0.42)方面差异无统计学差异,但在留置中心静脉导管(χ~2=12.26,P=0.00)、ALB(t=13.40,P=0.00)、D-二聚体(t=12.86,P<0.001)、WBC(t=15.78,P<0.001)、NLR(t=19.96,P<0.001、MLR(t=22.01,P<0.001)的差异具有统计学意义,进一步进行多因素logistic回归分析,发现D-二聚体、WBC、NLR、MLR是肺癌患者合并PE的独立危险因素,研究组中位生存期明显低于对照组(11.60月vs17.47月),且差异有统计学意义(χ~2=4.21,P=0.04)。结论D-二聚体、WBC、NLR、MLR是肺癌患者合并PE的独立危险因素。

Objective To investigate the risk factors for pulmonary embolism in patients with lung cancer.Methods The clinical data of 238 patients with lung cancer in our hospital from Jan.2016 to Dec.2018 were retrospectively reviewed,including 38 patients with PE(the study group)and 200 patients without PE(the control group).The related risk factors were analyzed by multi-factor logistic regression analysis.The survival of these patients was compared with that of the control subjects by Kaplan-Meier analysis.Results Single factor analysis showed that indwelling central venous catheter(χ~2=12.26,P<0.001),ALB(t=13.40,P<0.001),D-dimer(t=12.86,P<0.001),WBC(t=15.78,P<0.001),NLR(t=19.96,P<0.001),and MLR(t=22.01,P<0.001)were significantly higher in the study group than those in the control group(P<0.05).There was no significantly difference in age(t=1.56,P=0.17),sex(χ~2=0.45,P=0.50),smoking history(χ~2=1.34,P=0.24),drinking history(χ~2=1.23,P=0.26),BMI(χ~2=1.31,P=0.23),combined with basic diseases(χ~2=3.61,P=0.06),tumor pathological type(χ~2=0.10,P=0.92),TNM stage(χ~2=0.93,P=0.79),and PLR(t=0.85,P=0.42)between the study group and the control group.Multi-factor logistic regression analysis showed that D-dimer,WBC,NLR,MLR were the main risk factors for pulmonary embolism in patients with lung cancer.The median survival time of patients with lung cancer and PE was 11.6 months,which was significantly lower than that of patients with lung cancer only(χ2=4.21,P=0.04).Conclusion D-dimer,WBC,NLR and MLR are the main risk factors for pulmonary embolism in patients with lung cancer.