肺癌病人发生肺栓塞的危险因素和风险列线图模型

Risk factors and risk nomogram model of pulmonary embolism in patients with lung cancer

目的探讨肺癌病人发生肺栓塞的危险因素,并建立相关列线图预测模型。方法回顾性分析2018年8月至2019年8月因肺癌于攀枝花市中心医院治疗的211例病人的临床资料,肺癌合并肺栓塞的病人有52例,未并发肺栓塞的有159例,分别设为合并肺栓塞组和单纯肺癌组。对影响肺癌病人发生肺栓塞的相关因素进行分析,并建立相关预测模型。结果单因素分析显示,两组病理类型[腺癌(51.92%)比(27.04%)]、TNM分期[Ⅲ~Ⅳ期(65.38%)比(40.25%)]、留置中心静脉导管[(15.38%)比(4.40%)]、化疗[(44.23%)比(22.01%)]、血红蛋白[≥140 g/L(63.46%)比(36.48%)]和D-二聚体[≥0.4 mg/L(53.85%)比(32.08%)]差异有统计学意义(P<0.05)。logistic回归分析可知,腺癌(OR=2.835,95%CI:1.355~5.931)、Ⅲ~Ⅳ期肺癌(OR=2.263,95%CI:1.087~4.710)、留置中心静脉导管(OR=5.065,95%CI:1.535~16.718)、化疗(OR=2.321,95%CI:1.095~4.920)、血红蛋白≥140 g/L(OR=3.282,95%CI:1.569~6.866)及D-二聚体≥0.4 mg/L(OR=2.772,95%CI:1.341~5.728)是肺癌病人发生肺栓塞的独立危险因素(P<0.05)。据此建立预测肺癌病人发生肺栓塞的列线图模型,模型验证结果显示,预测值同实测值基本一致,C-index为0.804(95%CI:0.769-0.839),表明模型具有良好的精准度和区分度。结论腺癌、Ⅲ~Ⅳ期肺癌、留置中心静脉导管、化疗、血红蛋白≥140 g/L及D-二聚体≥0.4 mg/L是肺癌病人发生肺栓塞的独立危险因素,本研究构建的列线图模型能够有效预测肺癌病人的肺栓塞发生风险。

Objective To explore the risk factors of pulmonary embolism in patients with lung cancer and establish a related nomogram prediction model.Methods The clinical data of 211 patients treated in Panzhihua City Central Hospital for lung cancer from August 2018 to August 2019 were retrospectively analyzed.There were 52 patients with lung cancer and pulmonary embolism,and 159 patients without pulmonary embolism.They were set as combined pulmonary embolism group and simple lung cancer group.The related factors that affect the occurrence of pulmonary embolism in patients with lung cancer were analyzed,and related predictive models were established.Results Univariate analysis showed that the pathological types of the two groups[adenocarcinoma(51.92%)vs.(27.04%)],TNM staging[StageⅢ-Ⅳ(65.38%)vs.(40.25%)],indwelling central venous catheter[(15.38%)vs.(4.40%)],chemotherapy[(44.23%)vs.(22.01%)],hemoglobin[≥140g/L(63.46%)vs.(36.48%)]and D-dimer[≥0.4 mg/L(53.85%)vs.(32.08%)]were significantly different(P<0.05).Logistic regression analysis showed that adenocarcinoma(OR=2.835,95%CI:1.355-5.931),stageⅢ-Ⅳlung cancer(OR=2.263,95%CI:1.087-4.710),Indwelling central venous catheter(OR=5.065,95%CI:1.535-16.718),chemotherapy(OR=2.321,95%CI:1.095-4.920),hemoglobin≥140g/L(OR=3.282,95%CI:1.569-6.866)and D-dimer≥0.4 mg/L(OR=2.772,95%CI:1.341-5.728)were independent risk factors for PTE in lung cancer patients(P<0.05).Based on this,a nomogram model for predicting pulmonary embolism in lung cancer patients was established.The verification of the model showed that the predicted value was basically the same as the measured value,with a C-index of 0.804(95%CI:0.769-0.839),indicating that the model had good accuracy and discrimination.Conclusions Adenocarcinoma,stageⅢ-Ⅳlung cancer,indwelling central venous catheter,chemotherapy,hemoglobin≥140 g/L and D-dimer≥0.4 mg/L are independent risk factors for pulmonary embolism in patients with lung cancer.The nomogram model constructed in this paper can effectively predict the risk of pulmonary embolism in patients with lung cancer.