老年消化道恶性肿瘤并发急性肺血栓栓塞患者的临床特点和预后分析  

Clinical characteristics and prognosis of digestive system tumors in elderly patients complicated with acute pulmonary thromboemholism

作　　者：别志欣[1] 王晖[2] 胡雪晴[2] 张子瑾[2] 赵赟博[1] 李琳[1] Bie Zhixin;Wang Hui;Hu Xueqing;Zhang Zijin;Zhao Yunbo;Li Lin(Minimally Invasive Tumor Therapies Center, 13eijing Hospital, National Center of Gerontology, Beijing 100730, China;Department of Oncology , Beijing Hospital, National Center of Gerontology ,Beijing 100730 ,China)

机构地区：[1]北京医院国家老年医学中心肿瘤微创治疗中心,100730 [2]北京医院肿瘤科,100730

出　　处：《中华老年医学杂志》2018年第7期788-792,共5页Chinese Journal of Geriatrics

基　　金：北京医院院内课题（bj-2018-017）

摘　　要：目的分析老年消化道恶性肿瘤患者并发急性肺血栓栓塞（PTE）的临床特点、预后及影响预后的危险因素，探讨相应的预防措施。方法本研究为回顾性队列研究，回顾性选择北京医院肿瘤科自2007年1月至2018年1月收治的41例消化道恶性肿瘤并发PTE的老年患者为PTE组，同期选择基础情况相似且未发生PTE的45例消化道恶性肿瘤老年患者为非PTE组，比较两组的临床资料，KaplanMeier生存分析比较两组的预后情况，Cox回归分析影响预后的危险因素。结果86例老年患者中，男56例，女30例，年龄60～92岁。平均（75．8±13．7）岁。两组基线D-二聚体水平差异有统计学意义（P〈0．05）；PTE患者的主要症状为呼吸困难（78．0％，67例）。在所有并发PTE的原发肿瘤构成比中，结直肠肿瘤最多（56．1％，23例），其次为胃癌（31．7％，13例）。PTE组患者中23例（56．1％）合并深静脉血栓，多位于下肢（56．5％，23例）；90．2％（37例）的患者在化疗和随访时出现PTE。随访中67例患者（77．9％）死亡，两组间全因死亡率和PTE归因病死率比较差异有统计学意义（P〈0．05）。Kaplan—Meier生存分析结果显示，两组的中位生存时间存在差异有统计学意义（3．7个月比8．5个月，P〈0．05）。多元Cox回归分析结果显示，年龄、PTE和肿瘤远处转移是影响中位生存时间的危险因素（均P〈0．05）。结论老年消化道恶性肿瘤并发PTE患者临床表现无特异性，且增加归因死亡风险，需对疑似PTE患者早期诊断和治疗以改善患者预后。Objective To investigate the clinical characteristics, prognosis, and influencing factors of digestive system tumors in elderly patients complicated with acute pulmonary thromboembolism（PTE）. Methods In this retrospective cohort study, we analyzed data from 86 elderly patients with digestive system tumors from the Oncology Department of Beijing Hospital from January 2007 to January 2017. Forty-one elderly patients who had digestive system tumors with PTE were assigned into an observation group and forty-five without PTE into a control group. We analyzed the clinical characteristics of the two groups. Kaplan-Meier survival analysis was used to assess the median survivaJ time; and Cox regression analysis was used to evaluate the influencing factors for prognosis. Results Eighty-six elderly patients with a mean age of（75.8 ± 13.7）years ranging from 60 to 92 years were enrolled. There was a statistically significant difference in the D-dimer level between the groups at baseline （P 〈 0. 05）. In the observation group, the primary symptom was dyspnea（78.0%, n= 67）. Of all primary tumors complicated with PTE, eoloreetal cancers had the highest prevalence,accounting for 56.1 G （n = 23 ）, followed by gastric cancers, representing 31.7 （n= 13）. Twenty-three patients in the observation group were complicated with deep venous thrombosis（56.1G,n= 23）, which mostly located in the lower limbs（56.5%, n= 23）. Meanwhile, 90.2 % of PTE（n= 37）occurred during chemotherapy or follow-up. Sixty seven patients （77.9 % ）died during the follow-up, and the difference in mortality between the two groups was statistically significant（P 〈 0.05）. Kaplan-Meier survival analysis showed a significant difference in median survival time between the two groups （3.7 vs. 8.5 months, P 〈 0.05） . Cox regression analysis indicated that age, PTE, and metastasis were risk factors for median survival time（all P 〈0.05） Conclusions Elderly patients with digestive system tumors complicated with acute

关 键 词：消化系统肿瘤 肺栓塞 预后 

分 类 号：R563.5[医药卫生—呼吸系统] R735[医药卫生—内科学]