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23例肺癌并发肺栓塞的临床分析

Clinical Features in 23 Lung Cancer Patients Complicated with Pulmonary Thromboembolism

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【作者】 李娜王燕

【Author】 Na LI;Yan WANG;Department of Respiration Medicine, Tianjin Medical University General Hospital;Department of Medical Oncology, Tianjin Medical University General Hospital;

【机构】 天津医科大学总医院呼吸科天津医科大学总医院肿瘤内科

【摘要】 背景与目的已有研究结果表明肺栓塞是恶性肿瘤的常见并发症,并以肺癌多见,本研究探讨肺癌并发肺栓塞患者的临床特点、危险因素及对生存期的影响。方法回顾性分析2009年6月-2013年7月在天津医科大学总医院肿瘤内科就诊明确为肺癌并确诊为合并肺栓塞的23例患者的临床资料,对照组为随机选取同期在总医院肿瘤内科确诊为肺癌患者46例,采用Kaplan-Meier分析总生存时间。结果共确诊肺癌1,128例,其中23例明确诊断肺栓塞,肺癌合并肺栓塞患者腺癌16例(69.6%),不明原因呼吸困难16例(69.6%),较肺癌组高(P<0.01),肺癌合并肺栓塞组的血红蛋白、白蛋白、血氧分压较肺癌组低(P<0.05),白细胞、D-Dimer较肺癌组高(P<0.05),两组血小板、谷丙转氨酶、谷草转氨酶无统计学差异。肺癌合并肺栓塞同时合并下肢深静脉血栓患者10例(43.48%),急性肺栓塞高危患者6例(26.09%)。单因素分析显示,血红蛋白<100 g/L、白细胞>11×109/L、D-Dimer>500 ng/mL、血氧分压<80 mmHg、白蛋白<30 g/L是肺癌发生肺栓塞的危险因素(OR值分别为5.50、11.03、4.83、4.68、9.63)。16例(69.6%)肺栓塞分布于肺癌确诊前后5个月内,肺栓塞发生于确诊肺癌的时间中位数为3.05个月。截止到2013年7月29日,肺癌合并肺栓塞组患者的中位生存时间为7.77个月,明显低于肺癌组患者的19.27个月(P=0.02),肺癌合并肺栓塞患者化疗组生存时间高于非化疗组。结论肺癌合并肺栓塞患者的常见病理类型为腺癌,其临床表现常见不明原因呼吸困难、咳嗽,肺癌确诊后前5个月为肺栓塞高发时期,肺癌患者发生肺栓塞会降低其生存时间。化疗对于肺癌合并肺栓塞患者的生存有益。

【Abstract】 Background and objective Malignant tumors are often complicated with pulmonary thromboembolism(PTE), particularly in lung cancer(LC). This study investigated the clinical characteristics, risk factors, and survival time of patients with PTE and LC. Methods We retrospectively reviewed the clinical data of patients with LC in Medical Oncology of Tianjin Medical University General Hospital between June 2009 and July 2013. A total of 23 patients suffered from both PTE and LC. A total of 46 cases were used as control subjects. The survival of these patients was compared with that of the control subjects by Kaplan-Meier analysis. Results A total of 1128 cases were diagnosed with LC, in which 23 were clearly diagnosed with PTE, and 16(69.6%) patients who suffered from both LC and PTE developed adenocarcinoma. These patients also exhibited a higher incidence of unexplained dyspnea than those who were diagnosed with LC only(P<0.01). The patients with both PTE and LC displayed lower counts of hemoglobin(Hb), albumin(ALB), and blood oxygen pressure(PO2) than those with LC only(P<0.05). The patients with both PTE and LC also exhibited higher counts of leukocyte(WBC) and D-dimer than those with LC only(P<0.05). No statistical difference was found between the two groups in terms of platelet counts, glutamic pyruvic transaminase level, and glutamic oxaloacetic transaminase level(P>0.05). Ten cases(43.48%) with deep venous thrombosis were observed in the PTE and LC group, and six patients(26.09%) were at a high risk of acute pulmonary embolism. Hb<100 g/L, WBC>11×109/L, D-Dimer>500 ng/ml, PO2<80 mmHg, ALB<30 g/L were the risk factors of LC with PTE(odds ratio values were listed as follows: 5.50, 11.03, 4.83, 4.68, 9.63, respectively). On July 29, 2013, the median survival time of patients with PTE and LC was 7.77 months. This result was significantly lower than that(19.27 months) of patients with LC only(P=0.02). The survival time of patients suffering from both LC and PTE and undergoing chemotherapy was higher than that of patients who did not undergo such treatment. Conclusion The common pathological type observedin patients with both LC and PTE was adenocarcinoma. The common clinical manifestations were unexplained dyspnea and cough. The first five months after LC diagnosis corresponded to a high period of PTE. Patients with LC and PTE exhibited less survival time. As such, chemotherapy is beneficial for the survival of patients with LC and PTE.

【关键词】 肺肿瘤; 肺栓塞; 化疗; 生存时间;

【Key words】 Lung neoplasms; Pulmonary thromboembolism; Chemotherapy; Survival time;

【分类号】R563.5;R734.2;R45;

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