支气管镜管腔内活检出血风险与肺癌患者血脂水平的相关性研究

Plasma lipid levels are associated with the risk of endobronchial biopsy induced bleeding in patients with lung cancer

目的:探讨支气管镜管腔内活检(EBB)出血与肺癌患者血脂异常的关系。方法:收集2019年2月~2021年2月106例接受EBB诊断为原发性肺癌的患者为研究对象,分为出血组(n=41)和非出血组(n=65)。抽取患者入院第2天清晨空腹静脉血,比较两组患者的一般临床资料及生化指标。结果:非出血组患者血清低密度脂蛋白(LDL)和总胆固醇(CHOL)浓度均高于出血组患者(P<0.01)。多因素Logistic回归分析显示,CHOL升高(OR=0.161,95%CI:0.073~0.353)可能是EBB出血的保护因素(P<0.05)。利用广义可加模型评估显示,随着CHOL水平的增加,EBB期间出血的风险逐渐下降(P<0.01)。CHOL可作为EBB出血的预测因子,其截点值为3.45 mmol/L,ROC曲线下面积为0.83(95%CI:0.76~0.91),灵敏度为70.73%,特异度为75.38%。结论:肺癌患者血脂代谢异常与EBB出血密切相关,随着CHOL水平的增加,EBB期间出血的风险逐渐下降,CHOL是出血的保护因素。

Objective:To explore the relationship between hemorrhage from endobronchial biopsy(EBB)and plasma lipid level in patients with lung cancer.Methods:Patients of confirmed primary lung cancer undergone EBB were included from February 2019 to February 2021,and divided into bleeding group(n=41)or non-bleeding group(n=65).Fast venous blood was obtained in the early morning of the second day of admission.The general clinical data and biochemical indicators were compared between groups.Results:Patients in the non-bleeding group had higher levels of serum low density lipoprotein cholesterol(LDL)and total cholesterol(CHOL)than those in bleeding group(P<0.01).Multivariate Logistic regression analysis showed that elevated CHOL level was the potential factors to reduce hemorrhage from EBB(OR=0.161,95%CI:0.073-0.353).Estimation by generalized additive model showed that the risks of bleeding tended to decrease with elevated CHOL level(P<0.01),which suggested that CHOL level can be a predicting factor for bleeding during EBB(cutoff value:3.45 mmol/L).Receiver operating characteristic(ROC)curve analysis indicated that the area under ROC was 0.83(95%CI:0.76-0.91),and the sensitivity and specificity were 70.73%and 75.83%,respectively.Conclusion:Abnormal blood lipid metabolism is closely associated with bleeding in lung cancer patients undergoing EBB,and risks of EBB tends to decrease with elevated CHOL level,which suggests that CHOL is a protective factor for bleeding.