2020 年第 11 期 第 15 卷

合并与未合并恶性肿瘤肺栓塞患者的临床分析

Clinical analysis of malignant tumour and non-tumour patients with pulmonary embolism

作者：李闯刘弟世闻石少波杨波

英文作者：Li Chuang Liu Dishiwen Shi Shaobo Yang Bo

单位：武汉大学人民医院心血管内科武汉大学心血管病研究所心血管病湖北省重点实验室430060

英文单位：Department of Cardiovascular Medicine Renmin Hospital of Wuhan University Cardiovascular Research Institute of Wuhan University Hubei Key Laboratory of Cardiology Wuhan 430060 China

关键词：肺栓塞；恶性肿瘤；临床特点；Logistic回归；受试者工作特征曲线

英文关键词：Pulmonaryembolism;Malignanttumour;Clinicalcharacteristics;Logisticregression;

• 摘要：

• 目的 探讨合并与未合并恶性肿瘤肺栓塞患者的临床特点及其院内死亡的危险因素。方法 收集武汉大学人民医院2017年1月至2018年10月确诊的肺栓塞患者176例，按是否合并恶性肿瘤分为恶性肿瘤组（78例）和非肿瘤组（98例），分析2组的临床资料和院内死亡患者的危险因素及预测效能。结果 78例恶性肿瘤合并肺栓塞患者中肺癌患者最多，为35例（44.9%）。不明原因的呼吸困难或气促（96例）是肺栓塞的主要症状，恶性肿瘤组呼吸困难或气促、胸痛、咯血或痰中带血比例低于非肿瘤组［43.6%（34/78）比63.3%（62/98）、17.9%（14/78）比32.7%（32/98）、2.6%（2/78）比10.2%（10/98）］，差异均有统计学意义（均P<0.05）。恶性肿瘤组有30例（38.5%）肺栓塞患者无症状，与非肿瘤组7例（7.2%）存在明显差异（P<0.001）。2组间年龄、肺动脉高压比例、合并肿瘤外的肺栓塞易患因素比例、肺栓塞部位、pH值、血红蛋白、血小板计数差异均有统计学意义（均P<0.05）。动脉血氧分压降低、血红蛋白减少、心率≥100 次/min是肺栓塞患者院内死亡的危险因素，三者联合预测肺栓塞患者院内死亡的受试者工作特征曲线下面积为0.805（95%置信区间：0.672～0.938），敏感度为76.5%，特异度为81.8%。结论 合并与未合并恶性肿瘤的肺栓塞患者临床症状存在明显差异，合并恶性肿瘤的肺栓塞患者往往无明显肺栓塞症状，医师应高度警惕。联合动脉血氧分压、血红蛋白、心率三者的监测可以早期识别肺栓塞患者院内死亡风险。

• Objective To investigate the clinical features of pulmonary embolism(PE) in patients with malignant and non-malignant tumors and the risk factors of hospital death in patients with PE. Methods From January 2017 to October 2018, 176 patients with PE diagnosed in Renmin Hospital of Wuhan University were selected. According to whether they were combined with malignant tumors, they were divided into the malignant tumour group(78 cases) and the non-tumour group(98 cases). The clinical data, risk factors and predictive efficacy of in-hospital death were analyzed in both group. Results Among patients with malignant tumors and PE, lung cancer patients ［35 cases (44.9%)］ were the most. The main symptoms of PE were unexplained dyspnea or shortness of breath(96 cases). The proportions of dyspnea or shortness of breath, chest pain, hemoptysis or bloody sputum in the malignant tumor group were lower than those in the non-tumor group ［43.6%(34/78) vs 63.3%(62/98), 17.9%(14/78) vs 32.7%(32/98), 2.6%(2/78) vs 10.2%(10/98)］, the differences were statistically significant(all P<0.05). The proportion of asymptomatic patients with PE in the malignant tumor group was significantly higher than that in the non-tumor group ［30 cases(38.5%) vs 7 cases(7.2%)， P<0.001］. Differences in age, proportion of pulmonary hypertension, proportion of PE susceptibility factors outside the tumor, PE location, pH value, hemoglobin, and platelet count between the two groups were statistically significant(all P<0.05). Decreased arterial partial pressure of oxygen, decreased hemoglobin, and heart rate ≥100 beats/min were risk factors for in-hospital death in patients with PE. The area under the receiver operating characteristic curve of the three combined prediction of hospital death in patients with PE was 0.805 (95% confidence interval: 0.672 to 0.938), the sensitivity was 76.5%, and the specificity was 81.8%. Conclusions The clinical symptoms of PE patients with or without malignant tumors are significantly different, and patients in PE with malignant tumors usually have no obvious symptoms of PE. Combined monitoring of arterial oxygen partial pressure, hemoglobin, and heart rate can identify patients with PE early and reduce the risk of death in the hospital.