临床指标在小细胞肺癌合并低钠血症患者中的临床意义

Clinical significance of clinical indicators in patients with small cell lung cancer complicated with hyponatremia

目的探讨临床指标联合检测在小细胞肺癌(SCLC)合并低钠血症中的临床意义,进一步指导SCLC合并低钠血症的治疗和预防。方法选取山西省肿瘤医院2015年1月至2019年1月经组织病理初次确诊且未经治疗的500例SCLC患者为研究对象,随访至2020年1月,获得完整随访者465例。按确诊SCLC时的基线血清钠值将465例患者分为低钠组(n=232)和对照组(n=233);根据病程中最低血钠值分成血钠正常组(n=181)、轻度低钠组(n=113)、中度低钠组(n=80)、重度低钠组(n=91);经过一线化疗一周期后再分为钠纠正组(n=77)及钠未纠正组(n=388)。统计患者一般临床资料及相关临床化验指标,对低钠组与对照组、低钠血症各严重程度组(正常、轻、中、重四个亚组)、治疗后钠纠正组与未纠正组之间临床指标的差异采用IBM SPSS 25.0进行统计学分析,组间比较采用Man-Whitney秩和检验、KWH秩和检验、卡方检验,用二元Logistic回归分析各临床指标与SCLC合并低钠血症之间的相关关系,以双侧P<0.05认为差异有统计学意义。结果低钠组在神经元特异性烯醇化酶(NSE)、胃泌素释放肽前体(Pro GRP)、中性粒细胞百分比(NEUT%)、血红蛋白(Hb)、天冬氨酸氨基转移酶(AST)、L-γ谷氨酸氨基转移酶(GGT)、碱性磷酸酶(ALP)、肌酐(Cr)、尿酸(UA)、有无胸腔积液方面均高于对照组,差异有统计学意义(P<0.05)。低钠血症各严重程度组(正常、轻、中、重四个亚组)在性别、是否吸烟、NSE、Pro GRP、NEUT%、Hb、乳酸脱氢酶(LDH)、Cr、UA、有无胸腔积液方面差异有统计学意义(P<0.05)。一线化疗后,在NEUT%、Cr、UA方面,钠纠正组与钠未纠正组比较,差异有统计学意义(P<0.05)。Logistic回归分析得出:NSE、NEUT%、丙氨酸氨基转移酶(ALT)、AST、LDH、UA、胸腔积液是SCLC合并低钠血症的独立影响因素。结论NSE、NEUT%、ALT、AST、LDH、UA、胸腔积液是SCLC合并低钠血症患者的独立影响因素,应加强临床监测,及时识别并治疗低钠血症,以优化SCLC合并低钠血症患者的预后。

Objective To explore the clinical significance of combined clinical indicators in small cell lung cancer(SCLC)complicated with hyponatremia,and to further guide the treatment and prevention of SCLC complicated with hyponatremia.Methods A total of 500 patients with SCLC who were initially diagnosed but not treated in Shanxi Provincial Cancer Hospital from January 2015 to January 2019 were selected as the research subjects.The follow-up period was up to January 2020,and 465 patients with intact follow-up were obtained.According to the baseline serum sodium value at the diagnosis of SCLC,465 patients were divided into low sodium group(n=232)and control group(n=233).According to the lowest serum sodium value during the course of disease,the patients were divided into four subgroups:normal group(n=181),mild hyposodium group(n=113),moderate hyposodium group(n=80)and severe hyposodium group(n=91).After one cycle of first-line chemotherapy,the patients were divided into two subgroups:sodium corrected group(n=77)and sodium uncorrected group(n=388).General clinical data and related clinical indexes were recorded and compared between low sodium group and control group,between different sodium groups(normal,light,medium,heavy),between sodium corrected group and sodium uncorrected group using the IBM SPSS 25.0 by Man-Whitney test,KWH rank and inspection,and Chi-square test.Binary Logistic regression was used to analyze the relationships between SCLC complicated with hyponatremia and clinical indicators,with a double side P<0.05 as statistical significance.Results The levels of neuron-specific enolase(NSE)and progastrin-releasing peptide(ProGRP),the neutrophil percentage(NEUT%),the contents of hemoglobin(Hb),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),creatinine(Cr)and uric acid(UA),and the incidence of pleural effusion were higher in low sodium group than in control group(P<0.05).There was statistically significant difference in gender,smoking,NSE,Pro GRP,NEUT%,Hb,lactate dehydrogenase(LDH),Cr,UA and pleural effusion among different sodium groups(P<0.05).After first-line chemotherapy,there was statistically significant difference in NEUT%,Cr and UA between sodium correct-ed group and sodium uncorrected group(P<0.05).Logistic regression analysis showed that NSE,NEUT%,alanine aminotransferase(ALT),AST,LDH,UA and pleural effusion were independent influencing factors for SCLC complicated with hyponatremia.Conclusion NSE,NEUT%,ALT,AST,LDH,UA and pleural effusion are independent influencing factors for patients with SCLC complicated with hyponatremia.Clinical monitoring should be strengthened to identify and treat hyponatremia in time,so as to optimize the prognosis of patients with SCLC complicated with hyponatremia.