肺癌合并静脉血栓栓塞症的临床特点及易患因素分析

目的探讨肺癌合并静脉血栓栓塞症(VTE)的临床特点及易患因素。方法收集我院收治的33例肺癌合并VTE患者(VTE组)的临床资料,选择同期入院但未发生VTE的66例患者(非VTE组)病历资料作为对照,分析两组患者的一般情况、实验室检查、肺癌病理类型、分化程度、TNM分期、基因检测、治疗情况等临床信息。结果 VTE组中ZPS评分≥2分的患者显著多于非VTE组(24 vs 8例,P=0.000),血清总蛋白和白蛋白较非VTE组降低(分别为58.23±7.04 vs 61.43±6.03,P=0.021;30.72±5.90 vs 34.84±5.11,P=0.001),D-二聚体升高比例明显大于非VTE组(93.94%vs 60.61%,P=0.001)。两组患者肺癌病理类型均以腺癌为主,低分化多见,Ⅳ期占多数,VTE组腺癌所占比例高于非VTE组(75.76%vs 46.97%,P=0.034),接受EGFR-TKI治疗的患者多于非VTE组(39.39%vs 9.09%,P=0.000)。VTE组在肺癌确诊前、确诊时及确诊后3、6和12个月VTE累积发生率分别为6.06%、33.33%、48.48%、57.58%、69.70%,化疗前及化疗后3、6和12个月VTE累积发生率分别为31.82%、81.82%、86.36%、90.91%。结论 ZPS评分≥2分、血清总蛋白和白蛋白降低、D-二聚体升高以及病理类型为腺癌、接受EGFR-TKI治疗的肺癌患者,发生VTE的风险较高,且多发生在肺癌确诊后和化疗后的3~6个月内。

Clinical features and risk factors of lung cancer patients complicated with venous thromboembolism

Objective To investigate the clinical features and risk factors of lung cancer patients complicat -ed with venous thromboembolism ( VTE) .Methods The clinical date of 33 cases of lung cancer complicated with VTE were compared with another 66 cases of lung cancer patients without VTE during the same period , including the general conditions, laboratory tests, pathological type, tumor differentiation, clinical stage, gene detection and treat-ment .Results Patients with ZPS≥2 and an increase in D-dimer level in the VTE group were significantly more than patients without VTE , and the levels of serum total protein and albumin were lower in the VTE group than in patients without VTE.In this two groups, the main pathological type was adenocarcinoma , and most of them were stage Ⅳand poorly differentiated .The proportion of adenocarcinoma and patients who received EGFR-TKI treatment in the VTE group were higher than that in patients without VTE .The incidence of VTE was 6.06%, 33.33%, 48.48%, 57.58%and 69.70%before and 3,6 and 12 months after confirmed diagnosis , respectively.The cumulative inci-dence of VTE was 31.82%, 81.82%, 86.36% and 90.91% before and 3, 6 and 12 months after chemotherapy , respectively.Conclusion The risk factors of VTE in patients with lung cancer include ZPS≥2, serum total protein and albumin reduced , D-dimer increased and pathological types of adenocarcinoma , and EGFR-TKI treatment , and most VTE occurred within 3 to 6 months after confirmed diagnosis of lung cancer and the treatment of chemotherapy .