Risk factors of lung cancer complicated with symptomatic venous thromboembolism

目的 分析肺癌合并症状性静脉血栓栓塞症(VTE)患者的临床特点,寻找肺癌患者发生VTE的危险因素.方法 回顾性分析2010年1月1日至2014年12月31日北京大学人民医院确诊的肺癌并且临床资料完整的患者,共纳入548例,其中男357例,女191例,平均年龄(64±11)岁,根据是否存在症状性VTE分为VTE组46例,对照组502例.整理临床资料及实验室检查参数,单因素分析比较两组患者特征的差别.计量资料的组间比较采用t检验或非参数检验,计数资料比较用X2检验.对可能有意义的因素行logistic回归分析.本研究中VTE组患者因VTE相关症状入院,D-二聚体和凝血酶原时间是在患者发生VTE之后获得,故在多因素分析中去除了D-二聚体及凝血酶原时间.应用SPSS 13.0统计软件进行统计处理和分析.结果 单因素分析结果显示,在性别、年龄、肿瘤病理分型、肿瘤分期、白细胞、血红蛋白、血小板、癌胚抗原、谷丙转氨酶、纤维蛋白原、活化部分凝血活酶时间及凝血酶原时间国际标准化比率等因素当中,肿瘤分期(X2 =14.177)、癌胚抗原(t=2.129)和血红蛋白(t=-2.424)是肺癌患者并发VTE的危险因素.logistic回归分析显示,肿瘤分期是肺癌合并VTE发生的独立危险因素(OR值为2.058,95％ CI:1.307～3.238,p=0.002),而癌胚抗原(r =0.395,P＜0.001)和血红蛋白(r=-0.144,P=0.001)与肺癌的分期有相关性.D-二聚体预测VTE形成的曲线下面积为0.825(95％ CI0.751 ～0.900,P＜0.001).结论 本研究中肺癌分期是肺癌患者发生VTE唯一的危险因素,肺癌晚期患者发生VTE的风险较高.但由于本研究为回顾性研究,不排除其他可能导致VTE的高危因素.Objective To seek risk factors of VTE in patients with lung cancer through analysis of clinical features of patients with lung cancer complicated with venous thromboembolism (VTE).Methods Retrospective investigation was performed on patients diagnosed with lung cancer and with complete clinical data who were hospitalized in Peking University People' s Hospital from January 1,2010 to December 31,2014.According to the presence of symptomatic VTE,patients were distributed into two groups,VTE group and control group.Patients' clinical data and laboratory parameters were collected.Single factor analysis was applied to compare the differences between the two groups.t test or nonparametric test was applied for intragroup comparison of measurement data,and chi-square test was applied for the comparison of counting information.Logistic regression analysis was applied to explore risk factors of venous thromboembolism.For VTE patients with this diagnosis when they were hospitalized,D-dimer and PT were obtained after theoccurrence of VTE,so D-dimer and PT were eliminated in the multiple factors analysis.SPSS 13.0 statistical software was applied for statistical management and analysis.Results 548 patients with lung cancer were include in the investigation,with male 357,female 191,average age of (63.8 ± 10.9) years old,46 patients in VTE group and 502 patinets in control group.According to the results of single factor analysis in gender,age,tumr pathologic type,tumor stage,WBC,Hb,PLT,CEA,ALT,FIB,D-dimer,PT,APTT,PT-INR,the tumor stage (x2 =14.177),CEA (t =2.129) and Hb (t =-2.424) were risk factors for lung cancer patients complicated with venous thromboembolism.Logistic regression analysis showed that tumor stage was the independent risk factor of lung cancer complicated with venous thromboembolism (OR2.058,95％CI 1.307-3.238,P=0.002),and CEA (r=0.395,P＜0.001) and Hb (r =-0.144,P =0.001) were associated with lung cancer stage.The area under the curve formed by D-dimer predicting VTE was 0.825 (95％ CI 0.751-0.900,P ＜ 0.001).Conclusion Tumor stage is the only risk factor for lung cancer patients complicated with venous thromboembolism in the study.However,because this study is a retrospective study,other potential high risk factors causing VTE cannot be excluded.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)6454-4583