【摘要】背景与目的 已有的研究结果表明恶性肿瘤常合并静脉血栓形成和肺栓塞，并以肺癌最常见。但是肺癌合并肺栓塞的发生机制和危险因素尚未完全明了。本研究的目的是总结我院54例肺癌合并肺栓塞的临床资料，并探讨其危险因素及预后。方法 对1999年4月-2010年1月江苏省肿瘤医院和江苏省老年研究所收治的肺癌合并肺栓塞患者进行回顾性病例-对照研究。单因素分析后，对可能有意义的因素再行条件logistic回归分析，寻找肺栓塞相关危险因素，同时应用Log-rank检验分析伴有和不伴有肺栓塞肺癌患者的生存差异。结果 本研究纳入54例肺癌合并肺栓塞患者和162例不伴有肺栓塞肺癌作对照。单因素分析时选择P<0.20的变量进入回归模型进一步分析。回归模型结果发现接受化疗治疗的患者发生肺栓塞风险的OR值为2.64，III期-IV期肺癌合并肺栓塞的OR值为2.25，腺癌合并肺栓塞的OR值为2.12，血红蛋白>140 g/L的肺癌患者合并肺栓塞的OR值为2.10，均具有统计学差异（P<0.05）。合并肺栓塞的肺癌患者生存时间明显低于不合并肺栓塞的肺癌患者（P=0.02）。 结论 化疗、晚期肿瘤、肺腺癌和高血红蛋白是肺癌合并肺栓塞的重要危险因素；合并肺栓塞的肺癌患者的生存时间明显低于无肺栓塞的肺癌患者。

【Abstract】Background and objective Malignant tumors often combined with venous thrombosis and pulmonary embolism, especially in lung cancer. It has been proven that, the mechanisms and risk factors for lung cancer patients contracting pulmonary embolism are unclear. The aim of this study is to summarize the clinical data on 54 patients with lung cancer and concomitant pulmonary embolism, and to analyze the risk factors and prognosis of lung cancer with pulmonary thromboembolism (PTE). Methods From April 1999 to January 2010, the clinical presentation of lung cancer patients with PTE from the Jiangsu Cancer Hospital and the Jiangsu Gerontic Institute were evaluated in the present retrospective study. Univariate analysis was conducted to determine the possible associated variables. Conditional logistic regression analysis was applied to explore risk factors of pulmonary embolism. Patient survival was also compared with matched controls via a Log-rank test. Results A total of 54 lung cancer patients with PTE, matched with 162 lung cancer patients as controls, were included. In the univariate analysis, a P<0.20 was considered as possible risk factor, which was included into the logistic regression model. The logistic regression model showed that the OR combined with pulmonary embolism was 2.64 in patients receiving chemotherapy, 2.25 in patients with stage III-IV disease, 2.39 in patients combined with chronic obstructive pulmonary disease (COPD), 2.12 in patients with adenocarcinoma, 2.10 in patients with serum hemoglobin>140 g/L, and 1.76 in patients with central venous catheters. A significant difference was observed among the groups that received chemotherapy, adenocarcinoma, stage III-IV disease and high henoglobin (P<0.05). The survival time in patients with pulmonary embolism was remarkably lower than that in patients without pulmonary embolism (P=0.02). Conclusion Chemotherapy, late stage disease and high serum hemoglobin are important risk factors for lung cancer patients with concomitant pulmonary embolism. The survival time of these patients is significantly lower than that in patients without pulmonary embolism.