肺癌患者肺部感染的相关临床危险因素分析  

Analysis of related clinical risk factors of lung infection in patients with lung cancer

作　　者：宋洋[1] 夏冰[1] 吴岳光 SONG Yang;XIA Bing;WU Yue-guang(Oncology Surgery,Hangzhou Cancer Hospital,Hangzhou,Zhejiang 310003,China)

机构地区：[1]杭州市肿瘤医院肿瘤外科,浙江杭州310003

出　　处：《中华全科医学》2021年第3期354-357,462,共5页Chinese Journal of General Practice

基　　金：国家自然科学基金资助项目(81301927)。

摘　　要：目的肺癌患者由于营养不良、放化疗等更容易发生感染,本文旨在对发生肺部感染的相关危险因素进行探究。方法回顾性研究2014年1月—2016年12月杭州市肿瘤医院收治的肺癌患者156例。肺部感染的定义为胸片显示存在新发的或正在进行的浸润性病变以及合并出现以下任何一项:新发化脓性痰、慢性痰液性质改变或发热。通过多变量Cox回归分析探究与肺部感染显著相关的危险因素。结果所有研究对象中60例(38.5%)出现肺部感染,直至随访结束,肺炎组患者的平均总生存率显著短于非肺炎组患者(48.5%vs.74.2%,P<0.05);既往吸烟(32.8%)与正在吸烟(19.6%)患者的总生存率低于从不吸烟者(75.4%),差异有统计学意义(P<0.001);多因素分析显示年龄(P=0.001)、临床Ⅳ期(P=0.045)、中性粒细胞减少症(P<0.001)、吸烟(P=0.020)是肺癌患者发生肺部感染的独立危险因素。接受化疗的患者亚组分析中显示年龄(P=0.006)、中性粒细胞减少症(P<0.001)和吸烟(P=0.030)、二线治疗(P=0.004)是肺炎发展的独立危险因素。结论对于肺癌患者,老年、吸烟和中性粒细胞减少症是影响其肺部感染的显著危险因素。Objective To explore the relevant risk factors for lung infection.Methods We conducted a retrospective study of 156 lung cancer patients admitted to Hangzhou Cancer Hospital from January 2014 to December 2016.Pulmonary infection was defined as a chest radiograph showing the presence of new or ongoing infiltrating lesions combined with any of the following:new purulent sputum,changes chronic sputum,or fever.Multivariate cox regression analysis was used to explore the risk factors that were significantly related to lung infection.Results A total of 60 cases(38.5%)of all study subjects developed pulmonary infections.Until the end of follow-up,the average overall survival rate of patients in the pneumonia group was significantly shorter than that of patients in the non-pneumonia group(48.5%vs.74.2%,P<0.05).The overall survival rate of smoking patients was significantly lower than that of never-smokers(32.8%vs.19.6%vs.75.4%,P<0.001).Multivariate analysis showed that age(P=0.001),clinical stageⅣ(P=0.045),neutropenia(P<0.001),and smoking(P=0.020)were independent risk factors for lung infection in patients with lung cancer.A subgroup analysis of patients receiving chemotherapy showed that age(P=0.006),neutral granulocytopenia(P<0.001),smoking(P=0.030),and second-line therapy(P=0.004)were independent risk factors for the development of pneumonia.Conclusion For lung cancer patients,old age,smoking,and neutropenia are significant risk factors affecting their lung infections.

关 键 词：肺癌 肺部感染 肺炎 危险因素 多因素分析 

分 类 号：R734.2[医药卫生—肿瘤] R563.1[医药卫生—临床医学]