原发性肺癌合并肺栓塞的临床特征分析

摘要

目的 探讨原发性肺癌合并肺栓塞的临床特点.方法 选取2011年1月至2014年12月期间我院收治的35例原发性肺癌合并肺栓塞患者为研究对象,为观察组,选取同期我院收治的80例未合并肺栓塞的原发性肺癌患者为对照组.记录全部患者的一般资料、肺栓塞的发生时间、临床症状体征、实验室指标、影像学检查结果、治疗经过及疾病转归.采用单因素比较和多因素logistic分析筛选出原发性肺癌患者合并肺栓塞的危险因素.结果 观察组患者中,呼吸困难(65.7%)、咳嗽(62.9%)、发热(51.4%)这三个症状最常见,"三联征"同时出现者仅占8.6%.观察组中呼吸困难、发热、烦躁不安、"三联征"的发生率显著高于对照组,差异有统计学意义(P<0.05).观察组中确诊肺癌前发生肺栓塞者者8例(22.9%),确诊肺癌时发现者5例(14.3%),确诊肺癌后发生者22例(62.9%).多因素logistic回归分析结果表明腺癌、血白细胞(WBC)≥11×109/L、D-二聚体(DD)>500μg/L是原发性肺癌患者合并肺栓塞的独立危险因素(P<0.05).观察组的中位生存时间分别为6.5个月,显著低于对照组的16.3个月(P<0.05).结论 呼吸困难、咳嗽、发热是原发性肺癌合并肺栓塞患者的常见临床表现,肺癌确诊后3个月内为肺栓塞的高发期.腺癌、高WBC血症、高DD血症是原发性肺癌患者合并肺栓塞的独立危险因素.肺癌患者合并肺栓塞后生存时间明显缩短.%Objective To observe the clinical characteristic of primary lung cancer complicated with pulmo-nary embolism. Methods 35 patients with primary lung cancer complicated with pulmonary embolism from January 2011 to December 2014 were enrolled in the study as the observation group. Then 80 primary lung cancer patients without pulmonary embolism during the same period were selected as the control group. The general data, the occur-rence time of pulmonary embolism, clinical symptoms and signs, laboratory indexes, imaging findings, treatment and prognosis of all patients were recorded. Risk factors of pulmonary embolism in patients with primary lung cancer were screened by single factor analysis and multiple logistic regression analysis. Results Dyspnea ( 65. 7%) , cough (62. 9%), fever (51. 4%) were are the most common symptoms, and the "triad syndrome" accounted for only 8. 6% in the observation group. The incidence of dyspnea, fever, irritability, "triad syndrome" in the observation group were significantly higher than that of the control group (P<0. 05). In the observation group, the diagnosis of pulmonary embolism was made before the diagnosis of lung cancer in 8 cases ( 22. 9%) , simultaneously with lung cancer in 5 cases (14. 3%), after the diagnosis of lung cancer in 22 cases (62. 9%). Multivariate logistic regres-sion analysis results showed that adenocarcinoma, white blood cell ( WBC) ≥11 × 109/L and D - dimer ( DD) >500ug / L were the independent risk factors of primary lung cancer patients complicated with pulmonary embolism (P<0. 05). The median survival time of the observation group was 6. 5 months, which was significantly lower than 16. 3 months in the control group (P<0. 05). Conclusion Dyspnea, cough, and fever are the common symptoms of primary lung cancer complicated with pulmonary embolism. The first 3 months after lung cancer diagnosis are the peak time for pulmonary embolism. Adenocarcinoma, higher WBC and higher DD are independent risk factors for pri-mary lung cancer complicated with pulmonary embolism. The survival time of primary lung cancer patients is signifi-cantly shorter after complicating with pulmonary embolism.