肺癌患者肺部感染的相关临床危险因素分析

宋洋; 夏冰; 吴岳光

doi:10.16766/j.cnki.issn.1674-4152.001808

肺癌患者肺部感染的相关临床危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001808

杭州市肿瘤医院肿瘤外科，浙江杭州 310003

基金项目:

国家自然科学基金资助项目 81301927

详细信息

通讯作者:
宋洋，E-mail：bjsysy2020@163.com

中图分类号: R734.2 R563.1
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- 被引次数: 0
出版历程
- 收稿日期: 2020-06-27
- 网络出版日期: 2022-02-19

Analysis of related clinical risk factors of lung infection in patients with lung cancer

Oncology Surgery, Hangzhou Cancer Hospital, Hangzhou, Zhejiang 310003, China

摘要

摘要: 目的肺癌患者由于营养不良、放化疗等更容易发生感染，本文旨在对发生肺部感染的相关危险因素进行探究。方法回顾性研究2014年1月—2016年12月杭州市肿瘤医院收治的肺癌患者156例。肺部感染的定义为胸片显示存在新发的或正在进行的浸润性病变以及合并出现以下任何一项：新发化脓性痰、慢性痰液性质改变或发热。通过多变量Cox回归分析探究与肺部感染显著相关的危险因素。结果所有研究对象中60例(38.5%)出现肺部感染，直至随访结束，肺炎组患者的平均总生存率显著短于非肺炎组患者(48.5% vs. 74.2%，P < 0.05)；既往吸烟(32.8%)与正在吸烟(19.6%)患者的总生存率低于从不吸烟者(75.4%)，差异有统计学意义(P < 0.001)；多因素分析显示年龄(P=0.001)、临床Ⅳ期(P=0.045)、中性粒细胞减少症(P < 0.001)、吸烟(P=0.020)是肺癌患者发生肺部感染的独立危险因素。接受化疗的患者亚组分析中显示年龄(P=0.006)、中性粒细胞减少症(P < 0.001)和吸烟(P=0.030)、二线治疗(P=0.004)是肺炎发展的独立危险因素。结论对于肺癌患者，老年、吸烟和中性粒细胞减少症是影响其肺部感染的显著危险因素。
- 肺癌 /
- 肺部感染 /
- 肺炎 /
- 危险因素 /
- 多因素分析
Abstract: Objective To explore the relevant risk factors for lung infection. Methods We conducted a retrospective study of 156 lung cancer patients admitted to Hangzhou Cancer Hospital from January 2014 to December 2016. Pulmonary infection was defined as a chest radiograph showing the presence of new or ongoing infiltrating lesions combined with any of the following: new purulent sputum, changes chronic sputum, or fever. Multivariate cox regression analysis was used to explore the risk factors that were significantly related to lung infection. Results A total of 60 cases (38.5%) of all study subjects developed pulmonary infections. Until the end of follow-up, the average overall survival rate of patients in the pneumonia group was significantly shorter than that of patients in the non-pneumonia group (48.5% vs. 74.2%, P < 0.05). The overall survival rate of smoking patients was significantly lower than that of never-smokers (32.8% vs. 19.6% vs. 75.4%, P < 0.001). Multivariate analysis showed that age (P=0.001), clinical stage Ⅳ (P=0.045), neutropenia (P < 0.001), and smoking (P=0.020) were independent risk factors for lung infection in patients with lung cancer. A subgroup analysis of patients receiving chemotherapy showed that age (P=0.006), neutral granulocytopenia (P < 0.001), smoking (P=0.030), and second-line therapy (P=0.004) were independent risk factors for the development of pneumonia. Conclusion For lung cancer patients, old age, smoking, and neutropenia are significant risk factors affecting their lung infections.
- Lung cancer /
- Lung infection /
- Pneumonia /
- Risk factors /
- Multivariate analysis

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图 1 OS分析

注：A为肺炎与非肺炎比较；B为不同吸烟史患者比较。

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表 1 2组患者基线特征信息统计

组别	例数	年龄(x±s，岁)	性别(男/女，例)	BMI (x±s)	吸烟史[例(%)]				中性粒细胞减少
组别	例数	年龄(x±s，岁)	性别(男/女，例)	BMI (x±s)	从不吸烟	既往吸烟	当下吸烟	每年包数(x±s)	中性粒细胞减少
肺炎组	60	69.62±4.25	45/15	23.26±2.02	9(15.0)	26(43.3)	25(41.7)	39.42±20.36	26(43.3)
非肺炎组	96	67.36±3.66	52/44	23.45±3.17	32(33.3)	36(37.5)	28(29.2)	39.75±21.04	18(18.8)
统计量		0.852^a	5.958^b	-0.009^a	6.405^b	0.525^b	2.572^b	-0.289^a	11.019^b
P值		0.419	0.062	0.993	0.011	0.469	0.109	0.780	0.001
注：^a为t值，^b为χ²值。

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表 2 2组肺癌患者组织病理学及临床分期比较 [例(%)]

组别	例数	组织病理类型						临床分期
组别	例数	腺癌	鳞癌	小细胞肺癌	腺鳞癌	大细胞癌	其他	Ⅰ	Ⅱ	Ⅲ	Ⅳ
肺炎组	60	27(45.0)	14(23.3)	12(20.0)	1(1.7)	1(1.7)	5(8.3)	8(13.3)	5(8.3)	24(40.0)	23(38.3)
非肺炎组	96	62(64.6)	18(18.8)	8(8.3)	2(2.1)	2(2.1)	4(4.2)	32(33.3)	4(4.2)	17(17.7)	43(44.8)
χ²值		5.779	0.476	4.496	0.034	0.034	1.179	7.746	1.179	9.470	0.631
P值		0.016	0.490	0.034	0.854	0.854	0.278	0.005	0.278	0.002	0.427

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表 3 2组肺癌患者肺功能比较(x±s)

组别	例数	肺功能检测
组别	例数	FVC%预测值	FEV1%预测值	FEV1/FVC < 70% [例(%)]	FEV1/FVC
肺炎组	60	82.33±15.92	78.42±19.18	29(48.3)	0.91±0.27
非肺炎组	96	85.46±14.25	83.06±20.15	38(39.6)	0.92±0.24
统计量		-0.632^a	-0.529^a	1.154^b	-0.104^a
P值		0.545	0.446	0.283	0.857
注：^a为t值，^b为χ²值。FVC：用力肺活量；FEV1：第1秒用力呼气体积。

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表 4 2组肺癌患者临床治疗方式比较 [例(%)]

组别	例数	无治疗	手术	化疗	酪氨酸激酶抑制剂	联合放化疗	立体定向放疗	放疗	新辅助联合放化疗
肺炎组	60	4(6.7)	13(21.7)	24(40.0)	3(5.0)	9(15.0)	0(0.0)	7(11.7)	0(0.0)
非肺炎组	96	7(7.3)	37(38.5)	26(27.1)	16(16.7)	5(5.2)	2(2.1)	2(2.1)	1(1.0)
χ²值		0.030	4.828	2.829	4.699	4.334	1.266	6.238	0.629
P值		0.863	0.028	0.093	0.030	0.037	0.258	0.013	0.428

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表 5 整体及亚组肺炎发生Cox多变量分析

变量	B	SE	Wald χ²	P值	HR	95% CI
整体肺癌患者
年龄	0.584	0.191	1.097	0.001	1.055	1.022~1.079
临床分期
Ⅰ	-	-	-	-	-	-
Ⅱ	1.616	0.511	2.441	0.036	0.475	0.238~0.927
Ⅲ	1.808	0.619	2.837	0.685	1.231	0.508~2.945
Ⅳ	1.754	0.536	3.059	0.045	1.762	1.011~3.098
中性粒细胞减少症	0.471	0.232	3.961	< 0.001	2.625	1.547~4.305
吸烟	0.069	0.185	3.561	0.020	2.105	1.108~3.775
细胞毒性化疗亚组分析
年龄	-0.009	0.007	1.352	0.006	1.048	1.015~1.085
治疗方式				0.016
一线	-	-	-	-	-	-
二线	0.966	0.736	1.315	0.004	0.402	0.208~0.782
三线以上	1.506	0.874	1.738	0.772	0.905	0.474~1.725
中性粒细胞减少症	0.766	0.293	1.563	< 0.001	3.185	1.836~5.714
吸烟	0.584	0.179	3.269	0.030	2.115	1.082~4.236
注：“-”表示以变量赋值中最小值为参照。

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