恶性肿瘤化疗后肺部感染患者并发持续炎症-免疫抑制-分解代谢综合征的危险因素及预后分析  

Risk factors and prognosis of persistent inflammation-immunosuppressive catabolism syndrome in malignant tumor patients with lung infection after chemotherapy

作　　者：范思佳 孙霓[1] 张永飞[2] 张丽颖 李秀江[1] 张国兴[1] Fan Sijia;Sun Ni;Zhang Yongfei;Zhang Liying;Li Xiujiang;Zhang Guoxing(Department of ICU, Jilin Cancer Hospital, Changchun 130012, China;Department of Oncology, the First Affiliated Hospital of Jilin University, Changchun 130021, China)

机构地区：[1]吉林省肿瘤医院重症监护病房,长春130012 [2]吉林大学附属第一医院肿瘤科,长春130021

出　　处：《肿瘤研究与临床》2019年第3期172-175,共4页Cancer Research and Clinic

基　　金：吉林省自然科学基金(20160101170JC).

摘　　要：目的探讨化疗后肺部感染的恶性肿瘤患者并发持续炎症-免疫抑制-分解代谢综合征(PICS)的危险因素及预后。方法收集吉林省肿瘤医院2014年1月至2018年1月收治的化疗后肺部感染的恶性肿瘤患者128例,根据是否并发PICS将患者分为PICS组(44例)和对照组(84例)。比较两组患者临床特征和预后,并分析住院期间并发PICS的危险因素。结果与对照组比较,PICS组急性生理学与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分均增高[(18.6±3.8)分比(15.9±4.0)分,t=3.598,P=0.000;(4.8±1.5)分比(4.0±1.6)分,t=2.832,P=0.005]。与对照组比较,PICS组患者肺癌比例高[47.7%(21/44)比23.8%(20/84),χ^2=8.378,P=0.006]、清蛋白降低[(28.8±3.3)g/L比(30.8±2.9)g/L,t=3.695,P<0.01]、C反应蛋白增高[(60±8)mg/L比(45±8)mg/L,t=9.520,P<0.01]、住院时间延长[(33±7)d比(26±7)d,t=4.820,P<0.01]、院内死亡率增高[22.7%(10/44)比4.8%(4/84),χ^2=9.567,P=0.002]。多因素logistic回归分析显示,APACHEⅡ评分>20分、肺癌、清蛋白<30g/L是化疗后肺部感染的恶性肿瘤患者并发PICS的危险因素(均P<0.05)。结论化疗后肺部感染的恶性肿瘤患者PICS的发生率较高,APACHEⅡ评分>20分、肺癌、清蛋白<30g/L是患者预后不良的主要危险因素。Objective To investigate the risk factors and prognosis of persistent inflammation-immunosuppressive catabolism syndrome (PICS) in malignant tumor patients with lung infection after chemotherapy. Methods A total of 128 malignant tumor patients with pulmonary infection after chemotherapy from January 2014 to January 2018 in Jilin Cancer Hospital were collected. According to whether the patients were complicated with PICS, the patients were divided into the PICS group (44 cases) and the control group (84 cases). The clinical characteristics and prognosis of the two groups were compared, and the risk factors of PICS during hospitalization were analyzed. Results The acute physiology and chronic health evaluation (APACHE)Ⅱ score and sequential organ failure assessment (SOFA) score in the PICS group were higher than those in the control group [(18.6±3.8) vs.(15.9±4.0), t = 3.598, P < 0.01;(4.8±1.5) vs.(4.0±1.6), t = 2.832, P = 0.005]. When compared with the control group, the proportion of lung cancer in the PICS group was increased [47.7%(21/44) vs. 23.8%(20/84),χ^2 = 8.378, P = 0.006], and the albumin was decreased [(28.8±3.3) g/L vs.(30.8±2.9) g/L, t = 3.695, P < 0.01], the C reactive protein was increased [(60±8) mg/L vs.(45±8) mg/L, t = 9.520, P < 0.01], hospital duration was prolonged [(33±7) d vs.(26±7) d, t = 4.820, P < 0.01], hospital mortality was increased [22.7%(10/44) vs. 4.8%(4/84),χ^2 = 9.567, P = 0.002]. Multiple factor logistic regression analysis showed that the APACHE II score > 20, lung cancer and the albumin < 30 g/L were the risk factors for PICS in the malignant tumor patients with lung infection after chemotherapy (all P < 0.05). Conclusion The incidence of PICS in malignant tumor patients with pulmonary infection after chemotherapy is high, and the risk factors for the poor prognosis include APACHE Ⅱ score > 20, lung cancer and the albumin <30 g/L.

关 键 词：恶性肿瘤 药物疗法 联合 肺部感染 持续炎症-免疫抑制-分解代谢综合征 

分 类 号：R730.53[医药卫生—肿瘤] R563.1[医药卫生—临床医学]