肺癌患者术后发生严重低蛋白血症的危险因素探讨

目的 探讨肺癌患者术后发生严重低蛋白血症(血清白蛋白＜25 g/L)的危险因素.方法 收集2010年1月至2012年11月新疆医科大学第一附属医院手术治疗200例肺癌患者的临床资料并进行回顾性分析.采用x2检验进行单因素分析和logistic回归方程进行多因素分析.计算ROC曲线下面积以进一步评估肺癌患者发生严重低蛋白血症的危险因素等级.结果 术后发生严重低蛋白血症患者64例(32.0％).单因素分析结果表明不同年龄、病变大小、手术方式、胸液引流量、发热时间、最高体温、有无术前低蛋白血症(血清白蛋白＜34 g/L)、有无淋巴结清扫对肺癌术后是否发生严重低蛋白血症有显著影响(P值均＜0.05);多因素分析结果表明胸液引流量、发热时间、最高体温、有无术前低蛋白血症、淋巴结清扫是肺癌术后严重低蛋白血症发生的独立危险因素(x2=114.679,P=0.000).不同风险等级差异有统计学意义(x2=36.280,P＜0.05).结论 肺癌患者术后发生严重低蛋白血症的高危因素为术后胸腔引流量＞1 000 ml、发热时间＞3 d、最高体温≥38.5℃、术前血清白蛋白水平＜34 g/L、有淋巴结清扫.

Risk factors contributing to postoperative severe hypoproteinemia in patients with lung cancer

Objective To detect risk factors contributing to severe hypoproteinemia (serum albumin ＜25 g/L) in postoperative patients with lung cancer.Methods The clinical data of 200 patients with lung cancer who received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to November 2012 were retrospectively analyzed.The single factor analysis was carried out with x2 test,and the logistic regression equation was used to analyze the multiple factors.Correlation factors of postoperative severe hypoproteinemia of lung cancer were analyzed by the receiver operator characteristic curve.Results Sixty-four patients (32.0％)were complicated with postoperative hypoproteinemia.Univariate statistical analysis showed that age,size of tumor,operative method,amount of thoracic cavity drainage,duration of fever,the highest body temperature,preoperative hypoproteinemia (serum albumin ＜ 34 g/L),and lymph node dissection were correlated with postoperative severe hypoproteinemia (all P ＜0.05).Multivariate logistic regression analysis showed that amount of thoracic cavity drainage,duration of fever,the highest body temperature,preoperative severe hypoproteinemia,lymph node dissection were the independent risk factors of postoperative severe hypoproteinemia (x2 =114.679,P =0.000).There was a significant difference in the incidence of postoperative severe hypoproteinemia among patients with different risk stratification (x2 =36.280,P ＜0.05).Conclusions The risk factors of postoperative severe hypoproteinemia in patients with lung cancer are postoperative amount of thoracic cavity drainage ＞1 000 ml,duration of fever ＞ three days,the highest temperature ≥38.5 ℃,preoperative serum albumin level ＜34 g/L,lymph node dissection.