老年晚期肺癌合并静脉血栓栓塞症现状及其危险因素

Status quo and risk factors of venous thromboembolism in elderly patients with advanced lung cancer

目的探讨老年晚期肺癌合并静脉血栓栓塞症(VTE)现状及其危险因素。方法选择空军军医大学第二附属医院2019年1月至2022年1月收治的270例老年晚期肺癌患者为研究对象,统计其VTE发生率及临床特征。采用SPSS 20.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用多因素logistic回归模型分析老年晚期肺癌患者VTE发生的影响因素。结果270例患者中,78例患者发生VTE(28.89%),其中单纯DVT患者占比最多[62(79.49%)],其位置多集中于下肢[52(66.67%)],多数患者在肺癌确诊6个月内发现VTE[71(91.02%)],患者临床表现多样,多采用注射低分子量肝素治疗[54(69.23%)]。多因素logistic回归分析结果显示,肺腺癌(OR=2.177,95%CI 1.515~3.129)、化疗(OR=11.531,95%CI 2.988~44.498)、中心静脉置管(OR=4.531,95%CI 1.524~13.474)、D-二聚体(OR=5.562,95%CI 2.796~11.067)及体能状况(PS)得分(OR=2.149,95%CI 1.301~3.549)是老年晚期肺癌患者发生VTE的危险因素,血清白蛋白(OR=0.430,95%CI 0.227~0.813)是其保护因素。结论老年晚期肺癌患者VTE发生率高,且缺乏特异性表现,肺癌确诊后6个月内是VTE发生的高峰时期。此外,肺腺癌、化疗、中心静脉置管及PS评分高将增加VTE的发生风险,而积极检测血浆D-二聚体、血清白蛋白水平,对于尽早诊断VTE,改善患者预后具有一定意义。

Objective To explore the status quo and risk factors of venous thromboembolism(VTE)in the elderly patients with advanced lung cancer.Methods A total of 270 elderly patients with advanced lung cancer admitted to the Second Hospital of Air Force Medical University between January 2019 and January 2022 were enrolled as the study subjects.The incidence rate and clinical characteristics of VTE were statistically analyzed.SPSS 20.0 was used for data analysis.According to the data type,t test orχ^(2) test was used for comparison between the groups.Multivariate logistic regression model was employed to analyze the influencing factors of the VTE occurrence in the elderly patients with advanced lung cancer.Results Among 270 elderly patients with advanced lung cancer,VTE occurred in 78(28.89%),among whom most[62(79.49%)]developed simple DVT,and most of them[52(66.67%)]were located in the lower extremities.VTE was found in most patients[71(91.02%)]within 6 months after the diagnosis of lung cancer,presenting various clinical manifestations.Most patients[54(69.23%)]were treated with low molecular weight heparin injection.Multivariate logistic regression analysis revealed that lung adenocarcinoma(OR=2.177,95%CI 1.515-3.129),chemotherapy(OR=11.531,95%CI 2.988-44.498),central venous catheterization(OR=4.531,95%CI 1.524-13.474),D-dimer(OR=5.562,95%CI 2.796-11.067)and performance status(PS)score(OR=2.149,95%CI 1.301-3.549)were risk factors affecting the VTE occurrence in the elderly patients with advanced lung cancer,and that serum albumin(OR=0.430,95%CI 0.227-0.813)was a protective factor.Conclusion The elderly patients with advanced lung cancer have a high incidence rate of VTE,presenting no specific manifestations.The VTE occurrences peak within 6 months after the diagnosis of lung cancer.In addition,lung adenocarcinoma,chemotherapy,central vein catheterization and high PS score increase the risk of VTE.Active detection of plasma D-dimer and serum albumin is significant in the early diagnosis of VTE and improved prognosis of the patients.