铜川市肺癌合并慢阻肺急性加重期的预后及危险因素分析

Prognosis and risk factors of lung cancer with acute exacerbation of COPD in Tongchuan City

目的 分析铜川市肺癌合并慢阻肺急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)的预后情况及危险因素,为改善肺癌合并AECOPD患者预后提供理论依据。方法 选取2021年1月至2022年8月铜川市人民医院收治的肺癌合并AECOPD患者280例,根据患者住院期间是否存活分为存活组和死亡组,比较两组血清CEA、CYFRA 21-1等肿瘤标志物水平;采用肺功能仪进行肺功能测定,对比两组FEV1、FVC、FEV1/FVC等肺功能指标水平;从病历系统收集患者临床资料,采用单因素分析和logistic回归分析影响肺癌合并AECOP患者预后的独立危险因素。结果 死亡组患者FEV1、FVC、 FEV1/FVC值显著低于生存组(P<0.05);血清CEA、CYFRA 21-1水平显著高于生存组(P<0.05);多因素logistic回归分析显示白蛋白水平<35 g/L(OR=2.728)、TNM分期Ⅲ~Ⅳ期(OR=2.416)、多重耐药菌感染(OR=2.982)、GOLD分级Ⅲ~Ⅳ级(OR=3.417)是铜川市肺癌合并AECOPD患者死亡的独立危险因素(P<0.05)。结论 铜川市肺癌合并AECOPD患者住院期间死亡风险较高,特别是TNM分期Ⅲ~Ⅳ期、GOLD分级Ⅲ~Ⅳ级的患者,应积极控制多重耐药菌感染,提高患者白蛋白水平,有助于患者预后。

Objective To analyse the prognosis and risk factors of lung cancer with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in Tongchuan City,and to provide a theoretical basis for improving the prognosis of patients with lung cancer complicated with AECOPD.Methods A total of 280 patients with lung cancer combined with AECOPD admitted to Tongchuan People′s Hospital from January 2021 to August 2022 were selected and divided into survival group and death group according to whether the patients survived during hospitalization.Serum carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYFRA 21-1)and other tumor markers were compared between the two groups.Lung function was measured by lung function instruments,and the levels of forced expiratory volume in one second(FEV1),forced vital capacity(FVC),FEV1/FVC and other lung function indicators were compared between the two groups.The patients′clinical data were collected from the medical record system,and univariate analysis and logistic regression were used to analyze the independent risk factors affecting the prognosis of patients with lung cancer complicated with AECOP.Results The values of FEV1,FVC and FEV1/FVC in the death group were significantly lower than those in the survival group(P<0.05).Serum CEA and CYFRA 21-1 levels in the death group were significantly higher than those in the survival group(P<0.05).Multiple logistic regression analysis showed that albumin level<35 g/L(OR=2.728),TNM stage III to IV(OR=2.416),multidrug-resistant bacterial infection(OR=2.982),and GOLD grade III to IV(OR=3.417)were independent risk factors for death in patients with lung cancer complicated with AECOPD in Tongchuan City(P<0.05).Conclusion Patients with lung cancer complicated with AECOPD in Tongchuan City have a high risk of death during hospitalization,especially patients with TNM stage III to IV and GOLD grade III to IV.Multi-drug resistant bacteria infection should be actively controlled to improve the albumin level of patients,which is conducive to the prognosis of patients.