恶性肿瘤合并急性肺栓塞患者的长期预后和相关因素分析  

Long-term prognosis and related risk factor in patients with malignant cancer and acute pulmonary embolism

作　　者：杨赓[1] 米玉红[1] 肖瑶[1] 梁颖[1] 龚静[1] 张韶岩[1] YANG Geng;MI Yuhong;XIAO Yao;LIANG Ying;GONG Jing;ZHANG Shaoyan(Department of Emergency Care Department,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所急诊监护室,100029

出　　处：《心肺血管病杂志》2023年第9期916-921,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析恶性肿瘤患者合并急性肺栓塞(acute pulmonary embolism,APE)的长期预后,并分析影响APE和死亡率的相关危险因素。方法:回顾性连续选择自2010年1月至2018年1月,在北京安贞医院诊治的276例恶性肿瘤合并APE患者为APE组,按照1:1比例选择年龄和肿瘤类型和分期匹配的、无APE的276例恶性肿瘤患者为对照组,比较两组一般资料,随访患者预后情况,随访截至时间为2020年1月1日,Kaplan-Meier生存分析和Log-rank检验比较两组的生存情况,并分析影响APE和死亡率的相关危险因素。结果:552例恶性肿瘤患者中,平均年龄(51.8±24.5)岁。绝大多数原发肿瘤为肺(114例)、子宫(62例)和卵巢(47例)。多数为高危患者(44例)和中危患者(205例)。低危APE患者无典型临床表现,而中高危患者出现呼吸困难、咳嗽、咳痰、咯血及晕厥等临床表现。与对照组比较,APE组的BMI较低,而合并糖尿病、心力衰竭、短暂性脑缺血发作/卒中、慢阻肺、静脉曲张、中心静脉置管较多,血压较低,心率较快,动脉氧分压更低,而D-Dimer和BNP等更高,手术治疗率也更高(均P<0.05)。中位随访42(31,58)个月,Kaplan-Meier生存分析显示两组的中位生存时间,差异有统计学意义(9.3 vs.12.1个月,P<0.05)。年龄≥60岁、糖尿病、静脉曲张、中心静脉置管和手术均是发生APE的危险因素(P<0.05),抗凝是发生APE的保护因素(OR=0.757,95%CI:0.416~0.954)。而中高或高危APE、年龄≥60岁、肿瘤IV期、心力衰竭和短暂性脑缺血发作/卒中是影响总生存率的危险因素。结论:恶性肿瘤合并APE患者长期预后差,死亡率高,中高或高危APE、老年、糖尿病、静脉曲张、中心静脉置管和手术均是发生APE的危险因素,应注意监测高危患者。Objective:To analyze the long-term prognosis of patients with malignant tumors combined with acute pulmonary embolism(APE),and to analyze related risk factors that affect APE and mortality.Methods:This was a retrospective cohort study.A total of 276 patients with malignant tumors and APE who were diagnosed and treated in Beijing Anzhen Hospital from January 2010 to January 2018 were enrolled and selected as the APE group.According to the ratio of 1:1,another 276 patients who were with similar age,tumor types and stage were selected as the control group.The general data of the two groups were recorded and compared,and the prognosis of the patients were followed up.The follow-up deadline was January 1,2020.Kaplan-Meier survival analysis and log-rank test compared the survival and,related risk factor for APE and mortality was analyzed.Results:Among the 552 patients with malignant tumors,the average age was(51.8±24.5)years.The vast majority of APE patients were located in lung(114 cases),uterus(62 cases)and soft nest cancer(47 cases).Most were high-risk(44 cases)and intermediate-risk patients(205 cases).Low-risk APE patients have no typical clinical manifestations,while high-risk patients have dyspnea,cough,sputum expectoration,hemoptysis,syncope and other clinical manifestations.Compared with the control group,the APE group had a lower BMI,but complicated diabetes,heart failure,TIA/stroke,COPD,varicose veins,more central venous catheters,lower blood pressure,faster heart rate,and arterial oxygen partial pressure lower,higher D-dimer and brain natriuretic peptide,etc.,and higher surgical treatment rate(all P<0.05).The average follow-up was 42(31,58)months.Kaplan-Meier survival analysis showed that the median survival time between the two groups was significantly different(9.3 vs.12.1 months,P<0.05).Age≥60 years old,diabetes varicose veins,center Intravenous catheterization and surgery are risk factors for APE,and anticoagulation is a protective factor for APE.And high-risk APE,age≥60 years,tumor stage IV,heart f

关 键 词：恶性肿瘤 急性肺栓塞 预后 危险因素 

分 类 号：R54[医药卫生—心血管疾病]