肺癌合并静脉血栓栓塞症患者的诊疗特点

马旭; 韩森; 聂鋆; 戴玲; 胡维亨; 陈筱玲; 张洁; 马向娟; 田广明; 吴頔; 龙皆然; 韩金娣; 王洋; 张自然; 张艳华; 王丹; 方健

doi:10.3971/j.issn.1000-8578.2020.19.1243

肺癌合并静脉血栓栓塞症患者的诊疗特点

Diagnosis and Treatment Characteristics of Lung Cancer Patients with Venous Thromboembolism

摘要

摘要:
目的探讨静脉血栓栓塞症（VTE）对肺癌患者原发疾病诊疗方案的影响。
方法回顾性分析北京大学肿瘤医院收治的肺癌患者中，发生VTE患者的临床资料。计算肺癌患者VTE的发生率，分析VTE对原发疾病肺癌的影响。
结果 1766例肺癌患者中有115例（6.5%）发生VTE，其中男性78例（67.8%）。深静脉血栓82例（71.3%）、肺栓塞21例（18.3%）、肺栓塞合并深静脉血栓12例（10.4%）。症状性VTE74例（64.3%）。102例（88.7%）患者进行抗血栓治疗。在抗血栓治疗的患者中，97例（95.1%）患者使用药物治疗，其中65例（67.0%）患者使用了足量或标准剂量。52例（45.2%）患者VTE治疗后显效或者有效，32例（27.8%）经治疗后无效或者恶化，31例（27.0%）未复查或者情况不详。11例（9.6%）患者在抗血栓治疗中发生出血等不良反应。30例（26.1%）患者因为VTE导致抗肿瘤治疗方案改变。
结论 VTE是肺癌患者的常见并发症。肺癌合并VTE患者的抗血栓治疗情况复杂，治疗效果不理想，出血等不良反应风险较高。VTE严重影响原定抗肿瘤治疗方案的实施。

Abstract:
Objective To explore the impact of venous thromboembolism (VTE) on the diagnosis and treatment of lung cancer patients.
Methods We retrospectively analyzed the clinical data of lung cancer patients with VTE treated in Peking University Cancer Hospital. The incidence of VTE was calculated and the relation between VTE and lung cancer was analyzed.
Results Among 1766 patients with lung cancer, VTE occurred in 115(6.5%) patients. Among 115 VTE cases, there were 78(67.8%) males patients; 82(71.3%) cases were deep venous thrombosis, 21(18.3%) cases were pulmonary embolism, 12(10.4%) cases were deep venous thrombosis with pulmonary embolism; 74(64.3%) cases were symptomatic VTE; 102(88.7%) patients received antithrombotic therapy. Among the patients who received antithrombotic therapy, 97(95.1%) cases chose drug therapy. In drug treatment, 65(67.0%) cases used adequate/standard dose. Among 115 VTE cases, 52(45.2%) patients had improvement or disappearance of thrombus, 32(27.8%) patients had no improvement, and 31(27.0%) patients with unknown results; 11(9.6%) patients had adverse reactions such as bleeding during antithrombotic therapy; 30(26.1%) patients changed antineoplastic treatment plan due to VTE.
Conclusion VTE is a common complication of lung cancer patients. Antithrombotic therapy for lung cancer patients with VTE is complex, the treatment effect is not ideal and the risk of adverse reactions such as bleeding is high. VTE has a great impact on the implementation of anti-cancer treatment.

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