肺癌合并肺血栓栓塞症和深静脉血栓形成的比较研究

目的比较肺癌合并肺血栓栓塞症(PTE)和深静脉血栓形成(DVT)的临床特点及预后。方法对2003年1月至2013年4月北京医院肺癌合并PTE和DVT的患者进行回顾性临床分析,记录年龄、性别、临床表现、病理类型、TNM分期、PS评分、化疗方案及预后等临床信息。结果 PTE组35例,年龄(67.31±9.38)岁,DVT组45例,年龄(64.62±12.48)岁。PTE组肺部基础疾病的发生率高于DVT组(9 vs 4例,P=0.043);而DVT组留置深静脉导管的患者显著多于DVT组(11 vs 1例,P=0.007)。PTE组HCT和Hb较DVT组增高(分别为36.9±4.01 vs 33.44±5.57,P=0.003;125.4±14.43 vs 113.48±21.28,P=0.006)。PTE组中有14例PTE患者为无意中发现。在两组病人中,以NSCLC为主,病理类型多为腺癌,TNM分期Ⅲ~Ⅳ期居多。肺癌合并PTE组3月、6月、9月和12个月累积发生率分别为71.4%、77.1%、82.9%和85.7%;DVT组3月、6月、9月和12个月累积发生率分别为75.6%、77.8%、82.2%和84.4%。生存分析显示,PET组和DVT组,中位生存时间无显著差异(5.0±2.1月vs 15.6±6.59月,P=0.12)。结论肺癌合并PTE和DVT患者具有相同的危险因素,但PTE组较多合并肺部疾病,而DVT组较多留置深静脉导管。两组患者中腺癌是最常见的病理类型,TNM分期多为Ⅲ~Ⅳ期。PTE或DVT多发于肺癌诊断3~6月内,并导致患者预后不佳。

Comparative study between lung cancer with pulmonary thromboembolism and deep vein thrombosis

Objective To compare the clinical picture and outcomes of lung cancer patients with pulmonary thromboembolism （PTE） and deep vein thrombosis （DVT）.Methods The clinical data of 35 lung cancer patients complicated with PTE and 45 lung cancer patients complicated with DVT were retrospectively analyzed.Their age,gender,clinical picture,pathological type,clinical stage,performance status,therapeutic regimen and prognosis were recorded.Results The average age of the PTE group was 67.31 ±9.38 years old and 64.62 ± 12.48 years old in the DVT group.The incidence of pulmonary disease was higher in the PTE group than in the DVT group.Central venous catheters were more used in the DVT group than in the PTE group.The levels of HCT and Hb were higher in the PTE group than in the DVT group.There were 14 PTE patients who were identified incidentally.In this two groups,most of them were non-small cell lung cancer （NSCLC） and their main pathological type was adencarcinoma.The incidence of PTE was 71.4％,77.1％,82.9％ and 85.7％ within 3,6,9 and 12 months respectively,and 40.7％,62.9％,70.4％ and 74.1％ in the DVT group.There was no significant difference in median survival time between the two groups.Conclusions Lung cancer patients who are complicated with PTE and DVT have similar risk factors,but there are more pulmonary disease in the PTE group,while more central venous catheters are used in the DVT group.VTE usually occurs in advanced disease and the most common pathology types are adenocarcimoma.Most PTE and DVT events occur during 3 to 6 months after lung cancer diagnosed,which makes the patient＇ s prognosis worse.