肺癌合并侵袭性肺曲霉病预后的影响因素
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摘要
目的探讨肺癌合并侵袭性肺曲霉病预后的影响因素。方法选取2016年2月20日至2018年1月20日郑州大学附属郑州中心医院收治的162例肺癌合并侵袭性肺曲霉病患者。随访3个月,分析肺癌合并侵袭性肺曲霉病预后的影响因素。结果随访3个月,失访6例,死亡90例,存活66例,失访率和全因死亡率分别为3.7%(6/162)、57.7%(90/156)。性别、吸烟史、糖尿病、高血压与肺癌合并侵袭性肺曲霉病的预后无关(P>0.05)。年龄、器官衰竭、低蛋白血症、肺癌临床分期、糖皮质激素使用史、肺部细菌感染、抗侵袭性肺曲霉病治疗时长、诊断前是否开始抗侵袭性肺曲霉病治疗与肺癌合并侵袭性肺曲霉病的预后有关(P<0.05)。器官衰竭、肺癌临床分期Ⅲ～Ⅳ期、低蛋白血症、合并肺部细菌感染是肺癌合并侵袭性肺曲霉病患者预后的独立危险因素(P<0.05),抗侵袭性肺曲霉病治疗>3 d、诊断前开始抗侵袭性肺曲霉病治疗是肺癌合并侵袭性肺曲霉病患者预后的独立保护因素(P<0.05)。结论器官衰竭、肺癌临床分期Ⅲ～Ⅳ期、低蛋白血症、肺部细菌感染的肺癌合并侵袭性肺曲霉病患者的短期预后差,应重视早期、持续抗侵袭性肺曲霉病治疗的价值。
Objective To explore the factors affecting prognosis of lung cancer complicated with invasive pulmonary aspergillosis.Methods A total of 162 patients with lung cancer complicated with invasive pulmonary aspergillosis admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from February 20, 2016 to January 20, 2018 were selected. The patients were followed up for 3 months. The factors affecting prognosis of lung cancer complicated with invasive pulmonary aspergillosis were analyzed.Results Following up for 3 months, 6 cases were missed, and 90 cases died, and 66 cases survived. The missed visit rate and all-cause mortality were 3.7%(6/162) and 57.7%(90/156) respectively. The sex, smoking history, diabetes, hypertension were not related to the prognosis of lung cancer complicated with invasive pulmonary aspergillosis(P>0.05). The age, organ failure, hypoproteinemia, the clinical stage of lung cancer, the used history of glucocorticoid, pulmonary bacterial infection, duration of anti-invasive pulmonary aspergillosis treatment, and whether anti-invasive pulmonary aspergillosis treatment was started before diagnosis were related to the prognosis of lung cancer complicated with invasive pulmonary aspergillosis(P<0.05). Multivariate analysis showed that organ failure, the clinical stage Ⅲ to Ⅳ of lung cancer, hypoproteinemia and pulmonary bacterial infection were independent risk factors for prognosis of patients with lung cancer complicated with invasive pulmonary aspergillosis(P<0.05), and anti-invasive pulmonary aspergillosis treatment for more than 3 days and anti-invasive pulmonary aspergillosis treatment before diagnosis were independent protection factors for prognosis of patients with lung cancer complicated with invasive pulmonary aspergillosis(P<0.05).Conclusion The short-term prognosis of lung cancer complicated with invasive pulmonary aspergillosis with organ failure, lung cancer with clinical stage Ⅲ to Ⅳ, hypoproteinemia and complicated with pulmonary bacterial infection was poor. Attention should be paid to the value of early and continuous anti-invasive pulmonary aspergillosis treatment.
Objective To explore the factors affecting prognosis of lung cancer complicated with invasive pulmonary aspergillosis.Methods A total of 162 patients with lung cancer complicated with invasive pulmonary aspergillosis admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from February 20, 2016 to January 20, 2018 were selected. The patients were followed up for 3 months. The factors affecting prognosis of lung cancer complicated with invasive pulmonary aspergillosis were analyzed.Results Following up for 3 months, 6 cases were missed, and 90 cases died, and 66 cases survived. The missed visit rate and all-cause mortality were 3.7%(6/162) and 57.7%(90/156) respectively. The sex, smoking history, diabetes, hypertension were not related to the prognosis of lung cancer complicated with invasive pulmonary aspergillosis(P>0.05). The age, organ failure, hypoproteinemia, the clinical stage of lung cancer, the used history of glucocorticoid, pulmonary bacterial infection, duration of anti-invasive pulmonary aspergillosis treatment, and whether anti-invasive pulmonary aspergillosis treatment was started before diagnosis were related to the prognosis of lung cancer complicated with invasive pulmonary aspergillosis(P<0.05). Multivariate analysis showed that organ failure, the clinical stage Ⅲ to Ⅳ of lung cancer, hypoproteinemia and pulmonary bacterial infection were independent risk factors for prognosis of patients with lung cancer complicated with invasive pulmonary aspergillosis(P<0.05), and anti-invasive pulmonary aspergillosis treatment for more than 3 days and anti-invasive pulmonary aspergillosis treatment before diagnosis were independent protection factors for prognosis of patients with lung cancer complicated with invasive pulmonary aspergillosis(P<0.05).Conclusion The short-term prognosis of lung cancer complicated with invasive pulmonary aspergillosis with organ failure, lung cancer with clinical stage Ⅲ to Ⅳ, hypoproteinemia and complicated with pulmonary bacterial infection was poor. Attention should be paid to the value of early and continuous anti-invasive pulmonary aspergillosis treatment.
引文
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[3] MINESAKI S,KOYAMA N,ISHIDA H,et al.Successful pneumonectomy for invasive pulmonary aspergillosis and advanced non-small cell-lung cancer[J].BMJ Case Rep,2013.Doi:10.1136/bcr-2012-007925.
[4] MITRA D,SHAW A,TJEPKEMA M,et al.Social determinants of lung cancer incidence in Canada:A 13-year prospective study[J].Health Rep,2015,26(6):12-20.
[5] QIN J,FANG Y,DONG Y,et al.Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis:retrospective analysis of 2 150 liver transplantation cases[J].Br J Radiol,2012,85(1016):e429-e435.
[6] BOYD M,OJHA S,GOYOS J,et al.Invasive pulmonary aspergillosis and lung adenocarcinoma:Case report[J].Thorac Cancer,2013,4(2):212-214.
[7] LIN S J,SCHRANZ J,TEUTSCH S M.Aspergillosis case-fatality rate:systematic review of the literature[J].Clin Infect Dis,2001,32(3):358-366.
[8] 韩瑶,刘丹,梁宗安,等.肺癌合并侵袭性肺曲霉病患者生存率及死亡危险因素分析[J].西部医学,2016,28(1):45-48.
[9] YAN X,LI M,JIANG M,et al.Clinical characteristics of 45 patients with invasive pulmonary aspergillosis:retrospective analysis of 1 711 lung cancer cases[J].Cancer,2009,115(21):5018-5025.
[10] 杨艳荣,张志强.老年肺癌患者院内感染及其相关危险因素[J].中国老年学杂志,2014,34(7):1959-1960.
[2] SUN K S,TSAI C F,CHEN S C,et al.Galactomannan Testing and the Incidence of Invasive Pulmonary Aspergillosis:A 10-Year Nationwide Population-Based Study in Taiwan[J].PLoS One,2016,11(2):e149964.
[3] MINESAKI S,KOYAMA N,ISHIDA H,et al.Successful pneumonectomy for invasive pulmonary aspergillosis and advanced non-small cell-lung cancer[J].BMJ Case Rep,2013.Doi:10.1136/bcr-2012-007925.
[4] MITRA D,SHAW A,TJEPKEMA M,et al.Social determinants of lung cancer incidence in Canada:A 13-year prospective study[J].Health Rep,2015,26(6):12-20.
[5] QIN J,FANG Y,DONG Y,et al.Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis:retrospective analysis of 2 150 liver transplantation cases[J].Br J Radiol,2012,85(1016):e429-e435.
[6] BOYD M,OJHA S,GOYOS J,et al.Invasive pulmonary aspergillosis and lung adenocarcinoma:Case report[J].Thorac Cancer,2013,4(2):212-214.
[7] LIN S J,SCHRANZ J,TEUTSCH S M.Aspergillosis case-fatality rate:systematic review of the literature[J].Clin Infect Dis,2001,32(3):358-366.
[8] 韩瑶,刘丹,梁宗安,等.肺癌合并侵袭性肺曲霉病患者生存率及死亡危险因素分析[J].西部医学,2016,28(1):45-48.
[9] YAN X,LI M,JIANG M,et al.Clinical characteristics of 45 patients with invasive pulmonary aspergillosis:retrospective analysis of 1 711 lung cancer cases[J].Cancer,2009,115(21):5018-5025.
[10] 杨艳荣,张志强.老年肺癌患者院内感染及其相关危险因素[J].中国老年学杂志,2014,34(7):1959-1960.