肺癌患者伴发静脉血栓栓塞症的风险预警及危险因素分析

Risk early warning and risk factors for venous thromboem-bolism in patients with lung cancer

目的分析Caprini模型预测肺癌患者伴发静脉血栓栓塞症(venous thromboem-bolism,VTE)的诊断效能,并探讨影响肺癌患者伴发VTE的相关危险因素。方法回顾性分析成都市第二人民医院2013年1月至2018年4月收治的673例肺癌患者的临床资料。按照患者VTE发生情况,将其分别纳入发生组(84例)和未发生组(589例),比较两组患者Caprini模型评分,计算Caprini评分预测肺癌患者伴发VTE的诊断效能。分析两组患者临床资料,采用多因素Logistic回归分析探讨肺癌患者伴发VTE的危险因素,寻求Caprini评分的优化策略。结果发生组患者Caprini评分[(5.17±0.49)分]显著高于未发生组[(1.21±0.33)分](t=5.089,P=0.001)。以Caprini评分≥3分为肺癌患者伴发VTE的诊断标准,其灵敏度为90.48%,特异度为88.62%。多因素Logistic回归分析显示,体质指数≥35 kg/m^2、腺癌、化疗、靶向治疗、血红蛋白水平<100 g/L均为肺癌患者伴发VTE的独立危险因素(P_均<0.05),临床分期Ⅰ～ⅢA期、血小板计数<350×10~9/L、D-二聚体水平<1.44 mg/L、可溶性P选择素水平<53.1μg/L均为其保护因素(P_均<0.05)。结论 Caprini评分能够为肺癌患者伴发VTE风险评估提供可靠参考,在此基础上,结合患者病理分型、临床分期评估其VTE发生风险,对于指导临床治疗方案的调整具有重要意义。

Objective To analyze the effectiveness of Caprini model in predicting venous thromboem-bolism(VTE) in patients with lung cancer, and to explore the risk factors associated with VTE in patients with lung cancer. Method 673 patients with lung cancer admitted to Chengdu Second People’s Hospital from January 2013 to April 2018 were analyzed retrospectively. According to the occurrence of VTE, the patients were divided into occurrence group(84 cases) and non-occurrence group(589 cases). The Caprini model scores of the two groups were compared. The Caprini score was calculated to predict the ef?cacy of VTE in lung cancer patients. In addition, the clinical data of the two groups were compared, and the risk factors of VTE in lung cancer patients were summarized by multivariate Logistic regression analysis, and the optimization strategy of Caprini score was sought. Result The score of Caprini in occurrence group [(5.17±0.49) points] was higher than that in non-occurrence group [(1.21±0.33) points](t = 5.089, P = 0.001). The sensitivity and speci?city of VTE for lung cancer patients with Caprini score ≥ 3 points were 90.48% and 88.62%, respectively. Multivariate Logistic regression analysis showed that body mass index ≥ 35 kg/m2, adenocarcinoma,chemotherapy, targeted therapy and hemoglobin < 100 g/L were independent risk factors for VTE in lung cancer patients(Pall< 0.05).Clinical stageⅠ~Ⅲ A, platelet count < 350×109/L, D-dimer level < 1.44 mg/L, soluble P-selectin < 53.1 μg/L were protective factors(Pall< 0.05). Conclusion Caprini score can provide a reliable reference for risk assessment of VTE in lung cancer patients.On this basis, it is also important to evaluate the risk of VTE in combination with pathological classi?cation and clinical stages for guiding the adjustment of clinical treatment.