原发性非小细胞肺癌患者PD-1/PD-L1抑制剂治疗后发生肿瘤治疗相关心功能不全的危险因素  

Risk factors for the occurrence of cancer treatment-related cardiac dysfunction in patients with primary non-small cell lung cancer after PD-1/PD-L1 inhibitors therapy

作　　者：王传统 徐露露 张瑞 杨军[2] WANG Chuantong;XU Lulu;ZHANG Rui;YANG Jun(Medical College,Qingdao University,Qingdao 266073,Shandong,China;Department of Cardiology,Yantai Yuhuangding Hospital,Yantai 264000,Shandong,China)

机构地区：[1]青岛大学医学部,山东省青岛市266073 [2]烟台毓璜顶医院心内科,山东省烟台市264000

出　　处：《广西医学》2023年第19期2310-2314,2342,共6页Guangxi Medical Journal

基　　金：安徽省卫生和计划生育委员会中医药科研课题(2016zy100)。

摘　　要：目的 探讨原发性非小细胞肺癌(NSCLC)患者程序性细胞死亡蛋白1(PD-1)/程序性细胞死亡蛋白配体1(PD-L1)抑制剂治疗后发生肿瘤治疗相关心功能不全(CTRCD)的危险因素。方法 回顾性分析192例接受PD-1/PD-L1抑制剂治疗的原发性NSCLC患者的临床资料,根据是否发生CTRCD,将患者分为CTRCD组(n=18)和非CTRCD组(n=174)。比较CTRCD组与非CTRCD患者的临床资料,采用多因素Logistic回归模型分析原发性NSCLC患者接受PD-1/PD-L1抑制剂治疗后发生CTRCD的危险因素,采用受试者工作特征(ROC)曲线评估危险因素单独及联合预测患者发生CTRCD的效能。结果 CTRCD组患者合并高血压的比例、血红蛋白水平、红细胞体积分布宽度标准差(RDW-SD)、血浆D-二聚体水平、血清胱抑素C水平高于非CTRCD组(P<0.05)。多因素Logistic回归分析结果显示,血清胱抑素C水平、血浆D-二聚体水平和RDW-SD是原发性NSCLC患者PD-1/PD-L1抑制剂治疗后发生CTRCD的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清胱抑素C水平、血浆D-二聚体水平、RDW-SD预测原发性NSCLC患者接受PD-1/PD-L1抑制剂治疗后发生CTRCD的曲线下面积分别为0.711、0.774、0.687,3者联合预测的曲线下面积为0.808。结论 血清胱抑素C水平、血浆D-二聚体水平和RDW-SD是原发性NSCLC患者接受PD-1/PD-L1抑制剂治疗后发生CTRCD的独立危险因素,3者联合检测对该类患者发生CTRCD有较好的预测价值。Objective To investigate the risk factors for patients with primary non-small cell lung cancer(NSCLC)suffering from cancer treatment-related cardiac dysfunction(CTRCD)after programmed death 1(PD-1)/programmed death ligand 1(PD-L1)inhibitors therapy.Methods The clinical data of 192 patients with primary NSCLC receiving PD-1/PD-L1 inhibitors therapy were retrospectively analyzed,and they were assigned to CTRCD group(n=18)or non-CTRCD group(n=174)according to the presence of CTRCD occurred.The clinical data were compared between the CTRCD group and the non-CTRCD group.The risk factors for patients with primary NSCLC suffering from CTRCD after receiving PD-1/PD-L1 inhibitors therapy were analyzed by using the multivariate Logistic regression model.The efficiency of risk factors for alone and jointly predicting patients suffering from CTRCD was evaluated by employing the receiver operating characteristic(ROC)curve.Results Patients of the CTRCD group obtained a higher proportion of concomitant hypertension,and higher hemoglobin level,red blood cell distribution width-standard deviation(RDW-SD),plasma D-dimer level,serum cystatin C level as compared with the non-CTRCD group(P<0.05).The results of multivariate Logistic regression analysis revealed that serum cystatin C level,plasma D-dimer level,and RDW-SD were the independent risk factors for patients with primary NSCLC suffering from CTRCD after PD-1/PD-L1 inhibitors therapy(P<0.05).The results of ROC analysis indicated that areas under the curve of serum cystatin C level,plasma D-dimer level,and RDW-SD in predicting patients with primary NSCLC suffering from CTRCD after receiving PD-1/PD-L1 inhibitors therapy were 0.711,0.774,0.687,respectively,and area under the curve of the combined prediction of the three was 0.808.Conclusion Serum cystatin C level,plasma D-dimer level,and RDW-SD are the independent risk factors for patients with primary NSCLC suffering from CTRCD after receiving PD-1/PD-L1 inhibitors therapy,and the combined detection of the three exerts relativel

关 键 词：原发性非小细胞肺癌 肿瘤治疗相关心功能不全 程序性细胞死亡蛋白1 程序性细胞死亡蛋白配体1 危险因素 预测效能 

分 类 号：R734.2[医药卫生—肿瘤]