MHR、D-二聚体联合COMPASS-CAT评分对肺癌合并偶然检出肺栓塞的诊断价值

Diagnostic potential of MHR and D-D combined with the COMPASS-CAT score in the incidental pulmonary embolism in lung cancer

目的探讨单核细胞计数/高密度脂蛋白胆固醇比值(MHR)、D-二聚体联合COMPASS-CAT评分对肺癌合并偶然检出肺栓塞(IPE)的诊断价值。方法本研究为病例对照研究。依据肺栓塞诊断经过,采用目的抽样法选取2018年1月至2023年12月期间秦皇岛市第一医院收治的54例肺癌合并IPE患者为研究对象(IPE组);选取同期肺癌非合并肺栓塞患者108例为非IPE组。比较2组一般资料、实验室指标和治疗方式。采用单因素和多因素logistic回归分析肺癌合并IPE的危险因素。绘制受试者操作特征曲线评估MHR、D-二聚体、COMPASS-CAT评分及三者联合对肺癌合并IPE的诊断价值。结果IPE组共54例,其中男36例(66.7%),女18例(33.3%);年龄(65.94±4.64)岁,年龄范围为48~73岁。非IPE组共108例,其中男74例(68.5%),女34例(31.5%);年龄(61.02±7.19)岁,年龄范围为48~80岁。2组间年龄、呼吸困难、腺癌、肿瘤Ⅲ/Ⅳ期、手术治疗、MHR、D-二聚体、血浆白蛋白、总胆固醇、癌胚抗原、COMPASS-CAT评分的比较差异均有统计学意义(均P<0.05);2组间性别、吸烟史、身体质量指数、体力状况评分、腺癌外其他病理类型、基因突变、白细胞计数、血红蛋白、中性粒细胞/淋巴细胞比值、纤维蛋白原、甘油三酯、低密度脂蛋白、同型半胱氨酸、铁蛋白、血小板计数的比较差异均无统计学意义(均P>0.05)。单因素logistic回归分析显示:年龄、肿瘤Ⅲ/Ⅳ期、MHR、D-二聚体、血浆白蛋白、总胆固醇、癌胚抗原、COMPASS-CAT评分是肺癌合并IPE的影响因素(均P<0.05)。多因素logistic回归分析显示:MHR、D-二聚体、总胆固醇和COMPASS-CAT评分升高是肺癌合并IPE的独立危险因素(均P<0.05)。受试者操作特征曲线分析MHR、D-二聚体、COMPASS-CAT评分预测肺癌合并IPE的曲线下面积分别为0.859、0.756、0.935,敏感度分别为70.37%、68.52%、87.04%,特异度分别为89.81%、91.67%、95.31%;三项联合的曲线下面积为0.959,敏感度为88.89%,特异度为95.37%。结论MHR、D-二聚体联合COMPASS-CAT评分对肺癌合并IPE具有较好的预测效能。

ObjectiveTo evaluate the value of monocyte count/high-density lipoprotein cholesterol ratio(MHR)and D-dimer(D-D)combined with the COMPASS-CAT score in the diagnosis of incidental pulmonary embolism(IPE)in lung cancer.MethodsThis was a case-control study.According to the diagnosis of pulmonary embolism,54 lung cancer patients complicated with IPE admitted to the First Hospital of Qinhuangdao from January 2018 to December 2023 were included in the IPE group using purposive sampling method.During the same period,108 lung cancer patients without pulmonary embolism were selected as the control group(non-IPE group).General data,laboratory parameters,and treatment methods were compared between the two groups.Univariate and multivariate logistic regression analyses were performed to identify risk factors for IPE in lung cancer.The value of MHR,D-dimer,and COMPASS-CAT scores and their combination in the diagnosis of IPE in lung cancer was evaluated by drawing a receiver operating characteristic(ROC)curve.ResultsThere were 54 patients in the IPE group,including 36 males(66.7%)and 18 females(33.3%),with a mean age of 65.94±4.64(48-73)years.There were 108 patients in the non-IPE group,including 74 males(68.5%)and 34 females(31.5%),with a mean age of 61.02±7.19(48-80)years.There were significant differences in age,dyspnea,adenocarcinoma,tumor stageⅢ/Ⅳ,surgical treatment,MHR,D-D,plasma albumin(ALB),total cholesterol(TC),carcinoembryonic antigen(CEA),and COMPASS-CAT score between the two groups(all P<0.05).There were no significant differences in gender,smoking history,body mass index(BMI),physical condition score,other pathological types other than adenocarcinomas,gene mutations,white blood cell count,hemoglobin,neutrophil/lymphocyte ratio,fibrinogen,triglycerides,low-density lipoprotein,homocysteine,ferritin,and platelet count between the two groups(all P>0.05).Univariate logistic regression analysis showed that age,tumor stageⅢ/Ⅳ,MHR,D-D,ALB,TC,CEA,and COMPASS-CAT score were significantly correlated with IPE in lung cancer(all P<0.05).Multivariate logistic regression analysis showed that elevated MHR,D-D,TC,and the COMPASS-CAT scores were independent risk factors for IPE in lung cancer(all P<0.05).ROC curve showed that the area under the curve(AUC)of MHR,D-D,and the COMPASS-CAT scores in predicting IPE in lung cancer was 0.859,0.756,and 0.935,respectively;the sensitivity was 70.37%,68.52%,and 87.04%,respectively;and the specificity was 89.81%,91.67%,and 95.31%,respectively.The AUC,sensitivity and specificity of MHR and D-D combined with the COMPASS-CAT score in predicting IPE in lung cancer were 0.959,88.89%,and 95.37%,respectively.ConclusionMHR and D-D combined with the COMPASS-CAT scores have a good predictive power for lung cancer complicated with IPE.