FEV_1和DLCO对非小细胞肺癌患者胸腔镜肺叶切除术后肺部并发症的预测价值  

Predictive value of FEV1 and DLCO on pulmonary complications after thoracoscopic lobectomy in NSCLC patients

作　　者：李晓亮 樊立茂 郭朝卫 王新刚 LI Xiaoliang;FAN Limao;GUO Chaowei;WANG Xingang(Department of Thoracic Surgery,Second Central Hospital of Baoding City,Baoding Hebei 072750,China Corres)

机构地区：[1]保定市第二中心医院胸外科,河北保定072750

出　　处：《中国急救复苏与灾害医学杂志》2024年第8期1050-1054,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：保定市科学研究与发展计划项目(编号:16ZF012)。

摘　　要：目的 评估第1秒用力呼气容积(FEV_(1))、肺一氧化碳弥散量(DLCO)对非小细胞肺癌(NSCLC)患者经胸腔镜肺叶切除术后肺部并发症(PPC)及短期预后的预测价值。方法 前瞻性对2019年2月—2023年1月在保定市第二中心医院行电视胸腔镜手术肺叶切除术的150例NSCLC患者进行分析,根据术后30 d内的PPC发生情况,将患者分为PPC组(n=26)及无PPC组(n=124),并记录患者的院内死亡情况。结果 PPC组患者FEV_(1)%术后预测值(ppoFEV_(1)%)、DLCO%术后预测值(ppoDLCO%)和DLCO更低,而住院时间和院内病死率,吸烟史比例更高,年龄更大(P<0.05)。通过受试者(ROC)曲线分析显示,ppoFEV_(1)%和ppoDLCO%预测肺叶切除术患者发生PPC的曲线下面积(AUC)分别为0.850(95%CI:0.771~0.930)、0.858(95%CI:0.779~0.936),最佳截断值分别为59.26%、53.25%。Lasso回归和逐步回归分析显示,年龄(β=0.074,OR=1.077),ppoFEV_(1)%(β=-0.036,OR=0.964)和ppoDLCO%(β=-0.103,OR=0.902)是具有统计学意义的预测因素(P<0.05)。通过Pearson相关性分析,PPC组患者的ppoFEV_(1)%、ppoDLCO%与住院时间呈负相关(r=-0.473,P=0.015;r=-0.434,P=0.027)。经ROC曲线分析,ppoFEV_(1)%、ppoDLCO%对肺叶切除术患者院内死亡的预测AUC分别为0.850(95%CI:0.771~0.930)、0.926(95%CI:0.871~0.982)。结论 ppoFEV_(1)%<59.26%、ppoDLCO%<53.25%的行电视胸腔镜手术肺叶切除术的NSCLC患者具有更高的PPC发生风险,检测患者的ppoFEV_(1)%、ppoDLCO%有助于临床医生对NSCLC患者进行风险分层、预后预测。Objective To evaluate the predictive value of forced expiratory volume in 1 second(FEV_(1))and diffusing capacity of the lung for carbon monoxide(DLCO)on pulmonary complications(PPC)and short-term prognosis after thoracoscopic lobectomy in non-small cell lung cancer(NSCLC)patients.Methods 150 NSCLC patients who underwent video-assisted thoracic lobotomy in our hospital from February 2019 to January 2023 were prospectively analyzed.According to the occurrence of PPC within 30 days after surgery,the patients were divided into a PPC group(n=26)and a group without PPC(n=124).Hospital deaths were recorded.Results Post predictive operation FEV_(1)%(ppoFEV_(1)%),post predictive operation DLCO%(ppoDLCO%)and DLCO were lower in PPC group,while hospital stay and in-hospital mortality were significantly higher(P<0.05).The area under the curve(AUC)of PPC in lobectomy patients predicted by receiver(ROC)curve analysis of ppoFEV_(1)%and ppoDLCO%were 0.850(95%confidence interval[CI]:0.771-0.930)and 0.858(95%CI:0.779-0.936),and the best truncation values were 59.26%and 53.25%,respectively.Lasso regression and stepwise regression analysis showed that age(β=0.074,OR=1.077),ppoFEV_(1)%(β=-0.036,OR=0.964)and ppoDLCO%(β=-0.103,OR=0.902)were statistically significant predictive factors.By Pearson correlation analysis,ppoFEV_(1)%and ppoDLCO%of patients in PPC group were negatively correlated with length of hospital stay(r=-0.473,P=0.015;r=-0.434,P=0.027).ROC curve analysis showed that the predictive AUC of ppoFEV_(1)%and ppoDLCO%for in-hospital death in lobectomy patients was 0.850(95%CI:0.771-0.930)and 0.926(95%CI:0.871-0.982),respectively.Conclusion NSCLC patients with ppoFEV_(1)%<59.26%and ppoDLCO%<53.25%undergoing video-assisted thoracic lobotomy have a higher risk of PPC.The detection of ppoFEV_(1)%and ppoDLCO%of patients is helpful for clinicians to stratify the risk and predict the prognosis of NSCLC patients.

关 键 词：第1秒用力呼气容积术后预测值 肺一氧化碳弥散量(DLCO)术后预测值 肺叶切除术 术后肺部并发症 院内死亡 

分 类 号：R734.2[医药卫生—肿瘤]