肺癌相关肺动脉高压患者临床特点及相关因素分析

目的 通过病例对照研究了解肺癌相关肺动脉高压患者临床特点，并对其相关因素进行分析。方法 随机选取肺癌伴发肺动脉高压患者128例作为病例组，选取128例性别相同、年龄相差3岁以内的肺癌不伴发肺动脉高压患者进行1∶ 1病例对照研究，采用SPSS19.0统计学软件进行单因素和多元Logistic回归分析。结果 两组在临床症状上差异有统计学意义；肺癌伴发肺动脉高压易于发生于腺癌患者（P=0.019），肿瘤转移患者（68.75% vs 45.31%），肺内肿瘤转移患者（39.06% vs 3.91%）；肿瘤淋巴结转移患者（P=0.000）；容易表现出出血倾向（27.34% vs 1.56%）；D-二聚体和纤维蛋白原定量升高；血小板升高（34.38% vs 15.67%）；肺动脉主干内径增宽（24.22±2.59mm vs 20.75±2.09mm）；肺部磨玻璃样改变；对抗癌治疗的效果差。多元Logistic回归分析显示纤维蛋白原定量升高（OR=2.524，95% CI：1.171~5.441，P=0.000）及血小板计数升高（OR=3.21，95% CI：1.509~6.832，P=0.003）是危险因素，而治疗后呼吸困难等临床表现好转（OR=0.038，95% CI：0.014~0.107，P=0.000）是保护因素。结论 肺癌伴发肺动脉高压好发于腺癌、肿瘤细胞转移和淋巴结肿瘤细胞转移患者；易发生出血倾向、D-二聚体升高、纤维蛋白原计量升高、血小板计数升高、右心衰竭、肺部磨玻璃样间质改变。纤维蛋白原定量升高、血小板计数升高是肺癌伴发肺动脉高压的独立危险因素，治疗后呼吸困难好转是保护因素。

Clinical Features and Hazards of the Pulmonary Arterial Hypertension Induced by Lung Cancer

Objective To study pulmonary arterial hypertension induced by lung cancer clinical features and to analyze relative factors. Methods A hospital-based 1:1 matched case-control study was adopted.128 cases of pulmonary tumor with pulmonary hypertension that diagnosed at the first and the third affiliated hospital of Harbin Medical University were enrolled. SPSS 19.0 was used to do data analysis. Matched Chi-square test and conditioned logistic regression model were used for multivariate analysis to estimate odds ratios. Results Case group than the control group were higher in the incidence of adenocarcinoma, tumor metastasis rate (68.75% vs 45.31%), intra-pulmonary metastasis (39.06% vs 3.91%), the rate of lymph node metastasis. The lung cancer patients with pulmonary hypertension than just the slung cancer patients have more changes respectively in complained symptoms, bleeding tendency (27.34% vs 1.56%), D-dimer, fibrinogen quantitative, platelet (34.38% vs 15.67%), right ventricular diameter (19.39±3.28mm vs 18.21±2.05mm), pulmonary artery trunk diameter (24.22±2.59mm vs 20.75±2.09mm), lung CT performance for grinding glass sample cases. There is no obvious difference in acceptance of anti-tumor treatment before pulmonary hypertension between case group and control group (54.69% vs 50.75%, P=0.523). Compared with the control group, conventional symptomatic treatment in patients has poor reactivity in cases group(36.72% vs 95.52%). The multivariate Logistic regression analysis showed that quantitative elevated fibrinogen and high platelet count is a risk factor for lung cancer with pulmonary hypertension, the general reactivity of symptomatic treatment is good for the protection of the lung cancer with pulmonary hypertension. The elevated fibrinogen quantitative make a 2.524- fold increased risk of pulmonary hypertension in patients with lung cancer (95% CI:1.171-6.441, P=0.993). Platelet count increased to a 3.21 -fold risk of pulmonary hypertension in patients with lung cancer (95% CI:1.509-6.832, P=1.509). The improvement of dyspnea after the treatment is protective factors (95% CI:0.014-0.107, P=0.000). Conclusion The lung cancer patients with pulmonary hypertension than just lung cancer patients not only have more complained symptoms, right heart failure clinical manifestation, bleeding tendency, ground glass sample pulmonary interstitial performance but also D-dimer rise, fibrinogen and platelet count increased. Case group than the control group were higher in the incidence of adenocarcinoma, tumor metastasis rate, intra-pulmonary metastasis rate, the rate of lymph node metastasis. Antitumor therapy (surgery, radiotherapy, chemotherapy and immune targeted therapy) is not the leading cause of lung cancer with pulmonary hypertension.Fibrinogen quantitative and platelet count elevated is the independent risk factors of the disease, dyspnea improved after treatment is to protect factors.