肺癌并发肺栓塞的危险因素及预后分析  

Analysis on the risk factors and prognosis of lung cancer complicated with pulmonary embolism

作　　者：罗水妹 黄颂平[1] 许白兰[1] 沈冰寒[1] LUO Shuimei;HUANG Songping;XU Bailan;SHEN Binghan(Department of Respiratory and Critical Care Medicine,Quanzhou First Hospital,Quanzhou 362000,China)

机构地区：[1]泉州市第一医院呼吸与危重症医学科,泉州362000

出　　处：《广州医药》2021年第2期40-45,共6页Guangzhou Medical Journal

基　　金：泉州市科技计划项目(2018N048S)。

摘　　要：目的本研究旨在探讨肺癌合并肺栓塞的相关危险因素及肺栓塞对肺癌患者预后的影响。方法检索2000年1月-2020年3月万方、中国知网、维普期刊、Medline Pubmed及EMBASE数据库中所有相关文献,并使用RevMan 5.3软件进行统计分析。结果9项临床病例对照研究共1179例患者纳入本研究。分析结果显示肺癌合并肺栓塞患者的中位生存时间明显低于单纯肺癌患者(HR=2.82,95%CI[2.06,3.87],P<0.0001)。危险因素分析显示腺癌发生肺栓塞的风险高于非腺癌(比值比(OR)=3.07,P<0.0001),III-IV期患者发生肺栓塞的风险明显高于I-II期患者(OR=2.97,P<0.0001),D-二聚体水平高的患者发生肺栓塞的风险是正常患者的4.32倍(P<0.0001),白细胞(WBC)>11×109/L的患者发生肺栓塞的风险是WBC≤11×10^(9)/L患者的6.62倍(P<0.0001)。化疗史和中心静脉置管显著增加肺栓塞风险,OR值分别为3.02(P<0.0001)和2.30(P<0.0001)。然而,吸烟史、饮酒史、性别、糖尿病、COPD、高血压病等临床因素与肺栓塞发生无统计学相关性。结论肺栓塞的发生明显影响肺癌患者的预后,其相关的危险因素为病理类型、分期、化疗史、中心静脉导管置入史、D-二聚体升高、白细胞>11×10^(9)/L。Objective To investigate the risk factors of developing pulmonary embolism and its influence on the prognosis of lung cancer patients.Methods The following databases such as Wanfang Database,China National Knowledge Infrastructure(CNKI),Chinese Weipu Database,Medline Pubmed and EMBASE were searched to identify relevant articles which were published during January 2000 to March 2020.Statistical analysis was performed using RevMan 5.3 software.Results 9 controlled trials incorporating 1179 patients were included in this study.The results showed that the overall survival of lung cancer patients complicated with pulmonary embolism was significantly lower than that of lung cancer patients without pulmonary embolism(HR=2.82,95%CI[2.06,3.87],P<0.0001).The analysis on risk factors of developing pulmonary embolism showed that adenocarcinoma had a higher risk of pulmonary embolism than non-adenocarcinoma with Odds Ratio(OR)=3.07(P<0.0001).Patients in stage III-IV encountered significantly higher risk of pulmonary embolism than those in stage I-II(OR=3.07,P<0.0001).Furthermore,the risk of pulmonary embolism in patients with high level of D-dimer was 4.32 times higher than in normal patients(P<0.0001),and 6.62 times higher than those with WBC≤11×10^(9)/L(P<0.0001).Additionally,the history of chemotherapy and central venous catheterization significantly increased the risk of pulmonary embolism,with OR of 3.02(P<0.0001)and 2.30(P<0.0001),respectively.However,smoking,alcohol consumption,gender,diabetes,chronic obstructive pulmonary disease(COPD),cardiovascular disease,hypertension were not statistical correlated with the occurrence of pulmonary embolism in lung cancer patients.Conclusion The occurrence of pulmonary embolism significantly affects the prognosis of patients with lung cancer,and the related risk factors were pathological type,stage,chemotherapy,central venous catheterization,increased D-dimer level,and WBC>11×10^(9)/L.

关 键 词：肺癌 肺栓塞 中位生存期 预后 危险因素 

分 类 号：R734.2[医药卫生—肿瘤] R563.5[医药卫生—临床医学]